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SUMRAD > BRAIN- CT > Flashcards

BRAIN- CT Flashcards

1
Q

Pt needs an XRAy of skull from head trauma. What are reasons for skull XR?

A 
**RARE to order
AP, lateral view
Foreign body
Child abuse
Mets, Multiple Myeloma
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2
Q

In order to view maxillary sinuses which Xray technique is required?

A

Towne

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3
Q

If you suspect a CVA, what type of CT is needed first?

A

CT w/o contrast

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4
Q

What are indications for CT?

A 
Head trauma (clinically significant)
Headache (atypical, worst ever)
Delirium (unexplained)
HA + fever (meningitis, abscess, enceph)
Seizure (1st ever)
Vertigo w/ central sx
Coag + trauma (old ppl on Coumadin!)
Cancer Hx + new HA, ALOC, focal neuro
Vomiting in absence of abdominal sx
Child abuse

BLOOD CAN BE VERY B*AD
check, blood, cisterns, brain, ventricles, bone

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5
Q

What is normal regarding these structure on CT w/o contrast?

  • Basal ganglia calcifications
  • Pineal gland
  • choroid plexus
  • Pituitary
A

Normal HYPERattenuation (white)

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6
Q

What is abnormally white and black on CT With contrast?

A
  • Abnormal white things:
  • Blood
  • Tumor/ mass/ infxn
  • Abnormal dark things
  • Air, edema, ischemia
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7
Q 
In order to determine the following what image is advantagous?
Vascular lesions
Arteriovenous malformation, aneurysm
Tumors (ring-enhanced lesion)
Brain abscess (ring-enhanced lesion)
A

CT Contrast

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8
Q

What is considered abnormal on CT w/ contrast?

A

White things:

  • Abnormal meningeal uptake –peripheral enhancement of edema
  • Fresh bleeding
  • “ring enhancement” of tumors, infxn
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9
Q 
IF the following is suspected what is ideal imaging:
CVA -Early 
Meningioma
Neuro deficits- MS  
Axonal injury
Cerebellar lesions
A 
MRI
No radiation
T1- fluid black, T2 fluid white
Gladolium contrast avail
NO ACUTE CVA d/t instablity
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10
Q

When looking at the AP for XR, what can you see posteriorly?

A

Occipital and Lambdoid sutures
AP- cassette at back beam face pt, seeing Posterior
PA- cassette at front beam face back, seeing Anterior

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11
Q 
If you see the following on a CT, then what level is this?
Eye
Sphenoid sinus
Temporal bone
Mastoid air cells
Pons
4th ventricle-post and inf
Cerebellum
A

Inferior

Close to base of skull

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12
Q

Trauma in this area can cause epidural bleed due to what?

A

Pterion- merge of sutures
Thinnest part of sckull
MCA runs here

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13
Q

How should the systematic approaches be for CT?

A 
Name
Symmetry
Densisty
Lucenty
Blood- new or old
Ischemia
Infarct
Edema
Tumors, mets
Hydrocephlus
Bony windows
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14
Q

ON the brain CT, what is normal grey and darker grey?

A

White matter- dark grey contain myelin
INT

Gray- Grey matter- cell bodies, EXT

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15
Q

What can be seen at the midbrain slice?

A 
Frontal lobe
**Sylvian fissure- PAIR lateral
Temporal lobe
Suprasellar cistern- middle, pituitary
Midbrain
4th ventricle- post
Cerebellum
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16
Q

This can be seen at within the MOST important view, SMILEY FACE.

A

Superior sagittal sinus (in falx)- forehead
Lateral ventricles (frontal and occipital horns)-EYES
3rd ventricle- NOSE
4th ventricle- Mouth
cerebellum- chin
Mid superior up

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17
Q

These are seen at what level.
Lateral ventricles- longer, darker

Caudate nucleus -abutting frontal part of lateral ventricle, light grey

Internal capsule – anterior & posterior limbs (the white matter bw insula & basal ganglia)- thickened canal. cheek crease

Putamen (part of lentiform nucleus)- lateral to capsule

3rd ventricle- NOSE

Quadrigeminal cistern - CHIN-, replace 4th ventrical(posterior to colliculi)
Cerebellar vermis

Thalamus- medial to capsule, CHEEKS

Corpus callosum- EYEbrow togther

A

EVIL face

Basal Ganglia level

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18
Q

What are the darker grooves and the tissue btwne the grooves?

A

GYRI- tissue wormy like

SULCI- tunnel spaces

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19
Q

Describe the pattern of menigies in CT and MRI?

A

Superficial to Deep
Dura Mater- on the skull , 2
Arachonoid- weblike btwn dura and pia. Sub
PIA mater- on the brain tissue

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20
Q

What are the phases of blood attenuation on CT?

A

Acute bleed- hypER- white

Subacute -isodesne- same color

Chronic hypO- Darker grey

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21
Q

Describe each soft tissue structure normal seen on CT.

A

CSF → hypoattenuated

Bone, calcifications →hypERattenuated

Vascular structures →HYPER- BLACK if no blood or blocked
AA- MCA, ACA, PCA, VBA

22
Q

What should be examined b4 any DX of skull on CT?

A

Bony window

Suture(sutures have cortical bone on joint surfaces)

23
Q

Mrs. Happy has shoulder pain, what image is appropriate?

A

MRI, but relative risk d/t Gadlonium contrast

24
Q

Mrs. KFC has CR 1.8, w/ BUN <20:1. What is not allowed?

A

MRI w/ contrast
Unstable pt
Hepatorrenal dfx

25
Q

After symmetry, and attenuatin is examined what is next to examine on CT brain?

A

Brain atrophy- wider sulci, space btwn skull

Midline shift- mm

Cerebral edema

Cerebral mass

Pneumocephalus- air, black dots

26
Q

Since the skull is box, but a bleed occurs what happens to structures intracranially?

A

MIDLINE shift- structures like lateral seen clearly but pushed over
Examine- Falx (sicklelike) cerebri

EFFACement- squishes structures, CANNOT be seen clearly

27
Q

Encephalomalacia looks like what on CT?

A 
Darker area, that isn't normally dark
softening of brain tissue
1. infarct
2. infx
3. trauma
28
Q

What is a type of hydrocephalus, dilated ventricles, when the **ENITRE ventricle and 4th ventricle is enlarged?

A

Communicating HYDROcephalus

Extravasuclar cause, dec reabsorption of CSF

29
Q

If your grandparent has acute, gait disturbance, dementia, incontinence. Then what should be ordered?

A 
**Normal Pressure Hydrocephalus-
COMMUNICATING HYDRO
CT brain
gyri/sulci are normal
4th Ventricle enlarged
30
Q

If the all the ventricles are enlarged except the 4th ,what is suspected?

A

NON Communicating HYDROcephalus

Obstruction of outflow of CSF, tumor, mass

31
Q

After, IV and treatment post head trauma, what are key findings to R/o on CT?

A 
Subdural hematoma
Epidural hematoma
Intracerebral Hemorrhage
Cerebral contusion
Skull FX
REASONS to order NON Contrast 1st
Neuro finding
Glasco <8
LOC
Wounds
Vomiting w/ no Abdominal and post trauma-epidural MC
32
Q

On the head trauma case, there is a crescent/concave shape hyperattenueted and diminished ventricle?

A 
SUBDURAL
Less bad d/t VENOUS orgin, slow bleed
BTWN dura and arachnoid
Does not cross midline
May cross sutures
Acute
subacute
chronic
33
Q

On the head trauma case, there is a biconvex/oval shape hyperattenueted and and a midline shift?

A 
EPIDURAL- dura and skull
ACUTE
confined due to not crossing sutures
W/ skull FX
Loss of gyri culci
Midline shift
effacement
Pneumocephalus
34
Q

What is the story with epidural?

A

Pt trauma, LOC, THEN wakes up ok, but risk of herniatio

35
Q

What is reason to not have contrast on acute head trauma?

A

SUBARACHONOID HEMORRHAGE

  1. cisterns and sucli- white
  2. Effacement

Thunderclap worse HA
Eti- **#1 Trauma, aneurysm, AVM, tumor

hyperattenation on NON con CT
IF contrast all white, CAN miss BLEED

36
Q

What will reveal axonaly injury?

A

MRI

37
Q

If a suspected CVA is indicated, what is FIRST?

A

NON CONTRAST CT
<6H ischemia does show
IF stable, MRI is ideal

38
Q

What occurs weeks after CVA on CT?

A

HYPO attenuated fluid

INFarts seen in region

39
Q

What should be ordered for worst headache of life, women, obese, young w/ VA changes, n/v?

A

CT

BIH/pseudotumor

40
Q

What type of CT abnormalities are common in htn, DM, atherosclerosis?

A

Lacunar infarcts- darkened spots, often found incidentally in basal ganglia, pons

MRI- T2 infarcts will be white
MRI- T1 infarct will be BLACK

41
Q

What cause ICP and is seen on NON CONT CT?

A

Mass, blood edema, hydrocephalus

SX- HA, vomiting, papilledema, LOC

42
Q

What are indicators of cerebral edema?

A

Effaced gyri sulci
Undistinguished grey and white matter
Ventricles compressed
Global or local

43
Q

What are causes of cerebral edema?

A

Infx
Trauma
Toxic
Psuedotumor

44
Q

What is HypOattenuated RING around infxn, malignancy, acute hemorrhage and ONLY Affects **white matter location?

A

Vasogenic Cerebral Edema

+/- Midline shift

45
Q

What is hypOattenuated REGION where ischemia occurred. May see watershed/trickl effect point of infarct. Which region is often seen?

A

CYTOTOXIC cerebral Edema

affect ***BOTH white and grey matter.

46
Q

PT C/C mild weakness in arms? What is on DDX

A

CVA
Signs on NON con CT
1. Hyperdense vessel sign at MCA

  1. Loss of “insular ribbon” (the white matter between insular cortex & nuclei)
  2. Lentiform & caudate nucleus NOT distinguishable -loss of white matter btwn the two
  3. Effacement of sulci
47
Q

Tumors such as glioma, astrocytoma are common where?

A

intra-axial w/in parenchymal

48
Q

Menigioma, acousti neuroma are seen where?

A

extra-axial invasion

49
Q

What is round multiple and enhanced with contrast?

A

Metastases

50
Q

What tapeworm common in uncooked pork, what will have vasogenic edema surrounding it? Curable

A

Neurocysticercosis

multiple cyst ring-like lesions in brain

SUMRAD (13 decks)

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