We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Images in Neurology |

Iatrogenic Brain and Cervical Cord Magnetic Resonance Imaging Susceptibility Artifacts From Metallic Microemboli

David Roshal, DO; Meredith Snapp, MD; David P. Friedman, MD; Andro Zangaladze, MD, PhD
Arch Neurol. 2011;68(1):132-133. doi:10.1001/archneurol.2010.336.
Text Size: A A A
Published online


A 55-year-old woman who had undergone cardiac catheterization in 2004 and Da Vinci robotic surgery for mitral valve repair in 2005 presented with headaches and a brain magnetic resonance image showing multiple microhemorrhages. Magnetic resonance imaging of the brain and cervical spine from 2009 (Figure 1 and Figure 2) showed innumerable susceptibility artifacts not seen in 2003. Head computed tomographic results were normal (Figure 1). We presumed that our patient had metallic microemboli following either the cardiac catheterization or robotic surgery.13 Our patient also had cervical cord involvement, which has not been previously reported to our knowledge. Neurologists should be aware of these iatrogenic susceptibility artifacts to avoid misdiagnosing them as microhemorrhages and potentially stopping necessary anticoagulation treatment.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.

Brain magnetic resonance imaging (MRI) and computed tomographic scan. A, Axial T2-weighted MRI shows small, rounded hypointensities (arrows). B, Axial B = 0 diffusion-weighted MRI shows several rounded hypointensities (arrows) that are more prominent compared with the hypointensities in A. C-F, Axial susceptibility-weighted MRI shows innumerable foci of blooming susceptibility artifacts (red arrows) with adjacent crescentic hyperintensity (blue arrows), suggesting foci of susceptibility artifacts; this sequence is much more sensitive to susceptibility artifacts than T2-weighted, B = 0 diffusion-weighted, or even gradient-echo MRI. G, An axial computed tomographic scan of the head shows no evidence of calcifications or air. R indicates right; L, left.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Axial gradient-echo magnetic resonance imaging of the cervical spine at the C4-C5 level shows a hypointense susceptibility artifact (arrow) in the cervical cord without a corresponding signal abnormality on a sagittal T2-weighted sequence (not shown).

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

1 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have a Torn Meniscus or Ligament of the Knee?

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis