Brain and spine imaging

Question 1

Confluent white matter lesions in a child

Answer 1

ADEM
MS
Dysmyelination: Alexander, Canaavan, MCLD, XLACD
Treatment related leukodystrophy
MELAS

Question 2

Ring enhancing lesion

Answer 2

Metastasis
Abscess
GBM
Infarct
Contusion
Demyelination
Radiation necrosis

Question 3

Pineal Mass

Answer 3

Pineoblastoma: young, enhance, restrict, drop mets, peripheral calc
Pineocytoma/pineal cyst: peripheral calc, pineocytoma enhances
Germinoma/teratoma/YST/choriocarcinoma: young, central calc, gan restrict and enhance, fat if teratoma, drop met

adjacenet meningioma or tectal plate glioma

Question 4

Sellar/suprasellar mass in child

Answer 4

RCC - don’t enhance, can have nodule, often t1 bright, claw of enhancing pituitary, 25% calc - no calc helps differentiate
Craniopharyngioma - adamantinomatous cystic/solid with calc in 90%, t1 bright “crank oil”, papillary solid no calc
Granulomatous hypophysitis
Germ cell tumour
Hypothalamic hamartoma (enhances=glioma)
Optic nerve glioma

Question 5

PF mass in child

Answer 5

Medulloblastoma: most common, hyperdense, restrict, roof, 20% calc, drop mets/zuckerguss
Ependymoma: toothpaste, calcify, floor, 50% calc.
JPA: cyst and nodule, 20% calc, 2nd commonest
ATRT
Brainstem glioma

Question 6

PF mass in adult

Answer 6

Metastasis
Haemangioblastoma
Lhermitte-Duclos/AVM/cavernous malformation
Infarct/bleed

Question 7

Confluent white matter lesions in adult

Answer 7

Demyelination
Toxic/metabolic leukoencephalopathy: chemotherapy/radiotherapy
Vasculopathy
Neoplasm: gliomatosis cerebri pattern, lymphoma
Atypical infection: HIV leukoencephalopathy/Progressive multifocal leukoencephalopathy
CADASIL: 30-50, spares subcortical U, anterior temporal lobes and external capsule initially involved, thickened vessel BM
MELAS: childhood/early adult, predilection for parieto-occipital

Question 8

PF malformation

Answer 8

DW malformation: torcula/lambdoid inversion
DW variant/vermian hypoplasia: abnormal fastigial point, no torcula/lambdoid inversion
Blakes pouch cyst: increased cerebellovermian angle, normal fastigial point
Mega cisterna magna
Arachnoid cyst
Joubert syndrome

Question 9

CPA mass

Answer 9

VS
Meningioma
Epidermoid
Arachnoid cyst
Aneurysm

Question 10

Cerebellar tonsillar herniation

Answer 10

raised intracranial pressure: mass, oedema, IIH
intracranial hypotension
chiari 1/2/3 malformation

Question 11

CSF lined cortical cleft

Answer 11

schizencephaly is GM lined: open lip (T2) closed lip (T1) associated with septo-optic dysplasia
Porencephalic cyst:lined by gliotic WM
Encephalomalacia:lined with gliotic WM but doesnt communicate with ventricle

Question 12

Enhancing intramedullary spinal lesion

Answer 12

haemangioblastoma
astrocystoma
ependymoma
demyelination
metastasis

Question 13

Intradural extramedullary mass

Answer 13

nerve sheath tumour
meningioma-dont have to have a dural tail
epidermoid
metastasis

Question 14

Diffuse infiltrating temporal lobe mass/oedema

Answer 14

HSV encephalitis: patchy enhancement, restriction, haemorrhage, spares BG
Limbic encephalitis:brain/lung, subacute onset, non-haemorrhagic
Low grade glioma/gliomatosis cerebri
Status epilepticus
Infarct- venous with vein of labbe

Question 15

Cortically based cystic temporal lobe mass in a patient with seizures

Answer 15

Ganglioglioma: cortical cyst with nodule, 50% enhance and calcify, scallops calvarium
Pleiomorphic xanthoastrocytoma: cortical cyst with nodule, enhancing dural tail
Dysembryonic neuroepithelial tumour: associated with cortical dysplasia. Calcification and enhancement are uncommon.

Question 16

Intraparenchymal haemorrhage

Answer 16

Contusion
Primary intracerebral haemorrhage - hypertensive vs. amyloid angiopathy
Haemorrhagic lesion: metastasis(MRCT)/GBM or vascular

Question 17

Corpus callosal lesion

Answer 17

Toxic demyelination: Machiafavi bignami/antiepileptics/Chemotherapy
Oedema post seizure
GBM
Lymphoma
Radiation necrosis
Demyelination
Diffuse axonal injury (GW->CC->Brainstem)

Question 18

Subependymal nodules

Answer 18

SEN or SEGA in TS
Grey matter heterotopia
Torch infection (CMV>toxo)
Metastases

Question 19

Massive supratentorial CSF collection in a newborn

Answer 19

Massive hydrocephalus
Hydraencephaly
Alobar holoprosencephaly
Agenesis of the corpus callosum with midline interhemispheric cyst
Bilateral open lip schizencephaly

Question 20

Intraventricular mass

Answer 20

Choroid plexus papilloma
Central neurocytoma
Metastasis
Meningioma
Ependymoma
SEGA

Question 21

Cerebellar atrophy

Answer 21

Alchohol abuse
Antiepileptic therapy
Paraneoplastic syndrome
Multisystem atrophy

Question 22

Spinal cord signal abnormality

Answer 22

intramedullary neoplasm: ependymoma (adults, heterogeneous, circumscribed)/ haemangioblastoma/metastasis/astrocytoma (children, diffuse, homogeneous)
demyelination
transverse myelitis
cord infarct (grey matter)
Spinal AVM
B12 deficiency/HIV myelopathy
contusion

Question 23

solitary region of cortical and subcortical signal abnormality in an adult

Answer 23

Infarct
Glioma
Cerebritis
Contusion
Seizure oedema

Question 24

Epidural spinal mass

Answer 24

Disc extrusion
Epidural haematoma - GRE
Epidural abscess
Metastasis
Lipomatosis -steroids/obesity
Synovial cyst

Question 25

Basal ganglia cystic lesions

Answer 25

VR spaces
Lacunar infarcts
Gelatinous pseudocysts/cryptococcomas in cryptococcus
Neurocysticercosis
TB
Mucopolysaccharoidoses