Brain

Question 1

what do you call the gyri in the cerebellum

Answer 1

folia

Question 2

what imaging modality is best for seeing pathology

Answer 2

T2

Question 3

what is impacted in a posterior circulation stroke

Answer 3

occipital lobes

vision problems, vertigo

Question 4

what determines the neurological defect a patient presents with in stroke

Answer 4

anatomical site of injury to brain parenchyma

Question 5

what do you need to confirm the absence of to start thrombolysis/thromboectomy

Answer 5

haemorrhage (do unenhanced CT to look for blood) 
stroke mimic (tumour, seizure etc)

Question 6

what is the PCA territory

Answer 6

occipital lobes

Question 7

what is MCA territory

Answer 7

outside of brain

Question 8

what is ACA territory

Answer 8

inside of brain up to frontal lobes

Question 9

earliest visible CT sign for ismchaemic stroke

Answer 9

hyperdense segment of a vessel

Question 10

wishing first few hours what does ismchaemic stroke look like on CT

Answer 10

loss of grey-white matter differentiation
hypo attenuation of deep nuclei (happens in insular cortex first?)

cortical hypo density with associated parenchymal swelling with resultant gyral enhancement

Question 11

what does advanced stroke look like on CT

Answer 11

hypo attenuation and swelling become more marked resulting in significant mass effect

Question 12

what does advanced ismchaemic stroke look like on CT

Answer 12

hypo attenuation and swelling become more marked resulting in significant mass effect

Question 13

what does an old ischaemic stroke look like on CT

Answer 13

more gloss occurs eventually appearing as region of low density with volume loss

Question 14

what does acute blood appear as on unenhanced CT

Answer 14

white

Question 15

causes of intracranial haemorrhage

Answer 15

trauma

underlying lesion

Question 16

what is intra axial haemorrhage

Answer 16

within the brain substance

Question 17

example of axial haemorrhage

Answer 17

lobar haemorrhage
midline shift

acute haematoma in basal ganglia (type of haemorrhage stroke)

Question 18

what is extra-axial haemorrhage

Answer 18

out with the brain substance

eg. in the meninges

Question 19

what is extradural haemorrhage

Answer 19

between the skull and the outer layer of dura

usually associated with trauma

bleeding usually arterial most common from torn middle meningeal

classically overlies the temporal parietal region

mass effect causing midline shift

Question 20

what is a subdural haemorrhage

Answer 20

blood between dura and arachnoid matter

normally in elderly patients due to tearing of bridging veins as brain shrinks away from dura with age

also seen in shaken baby syndrome

needs CT

semilunar shape

crosses structures

mass effect

subdural will NOT cross the midline

if you can’t see sulci going all the way out to the edge its a sign of subdural haematoma (chronic)

moon shaped

Question 21

what does an acute on chronic subdural haematoma look like

Answer 21

chronic clotted blood goes to back, new acute blood goes to front

Question 22

what is subarachnoid haemorrhage

Answer 22

blood within the subarachnoid space

hyper dense material found filling the subarachnoid space

commonly around the circle of willis

can be traumatic or located to other vascular formations

WHITE STAR SIGN

see it in:

• suprasellar cistern
• others

do CT cerebral angiography to look for underlying berry aneurysm

Question 23

what causes death in subarachnoid haemorrhage

Answer 23

hydrocephalus, vasospasm and infarction

Question 24

early signs of hydrocephalus

Answer 24

enlarged temporal horns

Question 25

most common causes of brain mets

Answer 25

``` lung breast melanoma small cell colorectal ```

Question 26

first line test for brain mass

Answer 26

CT can be hypo or hyper dense solitary or multiple useful to determine oedema/mass effect if crossed BBB then will be enhanced?? less likely to if not??

Question 27

hallmarks of metastatic disease

Answer 27

lots of oedema lots of mass effect avidly enhance

Question 28

hallmarks of primary brain tumours

Answer 28

solitary supra or infra tentorial degree of oedema mass effect and enhancement depends on grade

Question 29

most common brain tumour

Answer 29

glioma

Question 30

what is coning

Answer 30

basilar tonsils pushed out the bottom of the brain

Question 31

what is the spinal cord contained in

Answer 31

thecal sac

Question 32

what nerve root comes out the bottom of L3 for example:

Answer 32

L3 L4 comes out on top?

Question 33

causes of spinal cord compression

Answer 33

``` disc vertebrae epidural space dura intradural space ```

Question 34

treatment for cord compression

Answer 34

urgent MRI spine

Question 35

how does cord compression present

Answer 35

back pain with red flags - history of malignancy - major trauma - thoraci/radicular pain - constant progressive non-mechanical pain - systemically unwell - widespread neurological signs and symptoms loss of power in lower limbs saddle anaesthesia, loss of sensation

Question 36

treatment for cord compression

Answer 36

urgent MRI spine | treat cause?