By Dr. Piyush Ojha, DM Resident, GMC Kota under the guidance of Prof. Dr. Vijay Sardana (HOD, Neurology)

1. SPOTTERS IN NEUROLOGY
DR. PIYUSH OJHA
DM RESIDENT
DEPARTMENT OF NEUROLOGY
GOVT MEDICAL COLLEGE, KOTA

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3. EYE OF TIGER APPEARANCE

4. EYE OF TIGER APPEARANCE
• Seen on T2 W/ FLAIR images
• Seen in Hallervorden-Spatz disease/ NBIA / PANK –II associated
neurodegeneration.
• Hyperintense area in Globus Pallidus surrounded by hypointense area
• Low signal – due to excessive iron accumulation
• Central high signal – due to gliosis and neuronal loss

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6. HOT-CROSS-BUN SIGN

7. HOT-CROSS-BUN SIGN
• Seen in Axial T2 W images
• Seen in Multiple System Atrophy (MSA-C)
• Crucifrom hyperintensities in Pons
• Due to selective loss of myelinated transverse pontocerebellar fibers
and neurons in the pontine raphe with preservation of the pontine
tegmentum and corticospinal tracts.
• May also be seen in :-

8. PUTAMINAL SLIT SIGN
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9. PUTAMINAL SLIT SIGN
• Seen in T2 W axial images
• Seen in MSA-P at lateral margin of putamen
• T2 hyperintensity in Putamen due to gliosis,demyelination and
increased intracellular fluid (due to severe atrophy of putamen and
enlargement of space between putamen and external capsule)
• Sensitivity ~ 97%
• Sometimes may be seen in Wilson disease also (young patients)

10. SWALLOW TAIL SIGN4

11. SWALLOW TAIL SIGN
• The Swallow tail sign describes the normal axial imaging appearance
of nigrosome-1 within the substantia nigra on high resolution T2*/SWI weighted
MRI.
• Absence of the sign (absent swallow tail sign) is reported to have a diagnostic
accuracy of greater than 90% for Parkinson disease.

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13. FACE OF GIANT PANDA

14. FACE OF GIANT PANDA
• T2 W images
• Seen in Wilson’s disease.
• High signal intensity in the Midbrain tegmentum sparing the red nucleus (forms
eyes)
• Preservation of signal intensity of the lateral portion of the pars reticulata of the
substantia nigra makes up the ears.
• Low signal intensity of the superior colliculus makes up the chin/mouth
• Similar changes when seen in Pons – Face of Miniature Panda / panda Cub Sign
• Together called as – Double Panda Sign.

15. ELEPHANT SIGN
• Elephant sign represents atrophy of medial aspect of the temporal lobes and
hippocampi
• Seen in Alzheimer disease.
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16. DURAL/MOUSE TAIL SIGN
• Seen in 60-70% of Meningioma (also in Primary CNS Lymphoma, Sarcoidosis,
Schwanoma)
• Represents thickening and enhancement of duramater.
• Tail should enhance more than tumor and taper away from tumor.
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18. HUMMING BIRD SIGN / PENGUIN SIGN
• Midsagittal MRI – atrophy of midbrain tegmentum with relatively preserved pons.
• Seen in Progressive Supranuclear palsy (PSP)
MIDBRAIN
TEGMENTUM=BILL
ROSTRAL
MIDBRAIN=HEAD
PONS = BODY
CEREBELLUM = WING

19. MICKEY MOUSE/MORNING GLORY SIGN
• Represents abnormal concavity of the lateral margin of midbrain tegmentum.
• Classically seen in PSP
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20. TIGROID SKIN/LEOPARD SKIN APPEARANCE
• Linear hypointensities radiating from ventricular margins within periventricular
white matter on T2 W images
• Seen in Metachromatic Leukodystrophy, Pelizaeus Merzbacher disease
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23. MEDUSA HEAD SIGN/ SPOKE-WHEEL SIGN
• Seen best on Contrast T1 W images.
• Seen in developmental venous anomalies (venous angioma)
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24. HOCKEY STICK SIGN
• DWI and FLAIR images – symmetrical pulvinar hyperintensities
• Characteristic of variant CJD
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25. MOLAR TOOTH SIGN
• Seen in Joubert Syndrome
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Deep Interpeduncular Fossa
Thick elongated Superior
cerebellar Peduncles
Cerebellar Vermis hypoplasia

26. THANK YOU