Brain

Question 1

benefits of CT

Answer 1

fast
well tolerated
can use contrast
interventions such as angiography, venography

Question 2

benefits of MRI

Answer 2

better soft tissue resolution
can use contrast
specialist imvx

Question 3

drawbacks of MRI

Answer 3

longer duration
contra-indicated for some
can be poorly tolerated

Question 4

are brain X-rays used

Answer 4

not really

Question 5

what causes an ischaemic stroke?

Answer 5

a sudden cessation of adequate amounts of blood reaching parts of the brain.

Question 6

what is the typical presentation of an ischaemic stroke?

Answer 6

rapid onset neurological deficit, which is determined by the area of the brain that is involved

Question 7

pathophysiology of stroke

Answer 7

Interruption of blood flow through an intracranial artery leads to deprivation of oxygen and glucose -> if circulation is not re-established -> liquefactive necrosis

Question 8

T2 weighted image

Answer 8

fluid will be bright

better for pathology

Question 9

T1 weighted image

Answer 9

fluid will be black

better for anatomy

Question 10

why image in stroke?

Answer 10

exclude intracranial haemorrhage
confirm ischaemia
exclude other pathologies that may mimic stroke eg tumour
permit rapid treatment

Question 11

gold standard scan in stroke

Answer 11

non contrast CT scan

Question 12

3 categories of cause of stroke

Answer 12

embolis
thrombosis
arterial dissection

Question 13

earliest CT signs of stroke

Answer 13

hyperdense segment of a vessel

direct visualisation of the intravascular thrombus/embolus

Question 14

within a few hours of stroke CT

Answer 14

loss of grey-white matter differentiation
hypoattenuation of deep nuclei: cortical hypodensity with associated parenchymal swelling with resultant gyral effacement

Question 15

after significant time of stroke on CT

Answer 15

significant mass effect

gliosis

Question 16

intracranial haemorrhage causes

Answer 16

traumatic
atraumatic
due to an underlying lesion

Question 17

what colour is acute blood on an unenhanced scan

Answer 17

white

Question 18

types of intracranial haemorrhage

Answer 18

intra axial

extra axial

Question 19

intra axial intra cranial haemorrhage

Answer 19

within the brain substance

Question 20

extra axial intracranial haemorrhage

Answer 20

outwith the brain parenchyma but in side the skull

Question 21

what are extra axial intracranial haemorrhage divided into

Answer 21

extra dural
subdural
subarachnoid

Question 22

what is an extradural haemorrhage

Answer 22

Collection of blood between the inner surface of the skull and outer layer of the dura, .

Question 23

extradural haemorrhages are not usually assoc with trauma

Answer 23

false, usually assoc with trauma esp skull fracture

Question 24

most common vessel bleeding in extra dural haemorrhage

Answer 24

middle meningeal artery

Question 25

what shape are extra dural haemorrhages

Answer 25

biconvex

Question 26

complication of extradural haemorrhage

Answer 26

mass effect with herniation

Question 27

what is subdural haemorrhage?

Answer 27

Collection of blood accumulating in the subdural space, the potential space between the dura and arachnoid mater

Question 28

main cause of subdural haemorrhage

Answer 28

head trauma

Question 29

causes of subdural haemorrhage by age group

Answer 29

infants- NAI young adults - RTA elderly - falls

Question 30

shape of subdural haemorrhage

Answer 30

Semilunar shape | Crosses the sutures

Question 31

describe subarachnoid haemorrhage

Answer 31

Extra-axial intracranial haemorrhage | Blood within the subarachnoid space

Question 32

appearance of subarachnoid haemorrhage

Answer 32

Hyperdense material is seen filling the subarachnoid space.

Question 33

most common location of subarachnoid haemorrhage

Answer 33

circle of willis (berry aneurysm)

Question 34

causes of subarachnoid haemorrhage

Answer 34

traumatic | vascular malformations

Question 35

subarachnoid haemorrhage on scan

Answer 35

Large volume of HIGH ATTENUATION acute blood in the 1. Suprasellar cistern 2. Sylvian fissures 3. Sulci

Question 36

if SAH occurs in the absence of trauma, what is performed to look for berry aneurysm

Answer 36

CT cerebral angiography

Question 37

complications of SAH

Answer 37

HYDOCEPHALUS VASOSPASM INFARCTION

Question 38

where does metastasis to the brain most commonly come from

Answer 38

``` lung breast melanoma renal cell colorectal ```

Question 39

appearance of intracranial mass on CT

Answer 39

hypo- or hyper dense often rounded solitary or multiple

Question 40

use of CT for masses

Answer 40

useful to determine oedema/mass effect

Question 41

metastasis to the brain appearance

Answer 41

usually multiple masses oedema mass effect avidly enhance

Question 42

primary brain tumours appearance

Answer 42

usually solitary mass | degree of effect depends on grade of tumour

Question 43

describe mass effect and brain herniation

Answer 43

Shift of cerebral tissue from its normal location, into an adjacent space as a result of mass effect

Question 44

describe tonsilar herniation

Answer 44

Descent of the cerebellar tonsils below the foramen magnum

Question 45

what is tonsilar herniation called clinically

Answer 45

coning

Question 46

result of tonsilar herniation

Answer 46

Brainstem is compressed against the clivus altering the vital life-sustaining functions of the pons and medulla (eg respiratory and cardiac centres) Fatal if not corrected

Question 47

describe hydrocephalus

Answer 47

The flow of CSF becomes impaired either due to anatomical obstruction of normal reservoirs/channels or because it can no longer be resorbed The upstream CSF spaces become dilated and CSF leaks out across the barriers

Question 48

treatment of spinal cord compression

Answer 48

prompt surgical decompression

Question 49

causes of spinal cord compression

Answer 49

``` disc issues vertebral trauma or tumour epidural abscess or haematoma spinal meningioma nerve sheet tumour in the intradural space ```

Question 50

presentation of spinal cord compression

Answer 50

back pain with red flags

Question 51

red flags back pain

Answer 51

``` history of malignancy Major trauma Thoracic/radicular pain constant, progressive, non- mechanical pain systemically unwell widespread neurological signs and symptoms Loss of power in lower limbs loss of sensation, saddle anaesthesia urinary retention ```

Question 52

invx spinal cord compression

Answer 52

MRI spine as you can't see the spinal cord or conus medullaris in CT or X-ray