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CLASP Radiology > Brain Imaging > Flashcards

Brain Imaging Flashcards

1
Q

what is the first line for brain imaging

A

CT (with/ without contrast)

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2
Q

what are pros and cons for MRI brain

A 
better soft tissue resolution
grey and white matter differentiation more obvious than CT
longer duration 
CI in some 
with/without contrast
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3
Q

do you xray head

A

never usually

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4
Q

what are the cistern in the brain

A

suprasellar and quadrigeminal

CSF spaces

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5
Q

what will a T1 MRI look like

A

fluid will be black -good for anatomy and structure

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6
Q

what will a T2 MRI look like

A

fluid will be white - good for seeing pathology

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7
Q

what does interruption of blood flow in an intracranial artery lead do

A

deprivation of oxygen and glucose

this initiates a cascade which if not stopped causes cell death via liquid factor necrosis

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8
Q

what are the causes of ischaemic stroke

A

embolism- cardiac (AF, ventricular aneurysm, endocarditis), paradoxical (patent foramen ovale), atherosclerotic, fat, embolism, air
thrombosis (clot)- perforator (lacunar infarct), acute plaque rupture with overlying thrombosis
arterial dissection

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9
Q

what area is affected by a stroke causing face, leg, arm weakness

A

parietal lobes- MCA territory

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10
Q

what area is affected by a stroke causing executive dysfuntion

A

frontal lobe (ACA, MCA)

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11
Q

what area is affected by a stroke causing vision problems

A

posterior circulation - occipital lobe

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12
Q

how long a window for thrombolysis

A

4.5-6 hours

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13
Q

why do you image the brain in acute stroke

A

exclude intracranial haemorrhage
confirm ischaemia
exclude stroke mimics (e.g tumour)
permit rapid treatment (thrombolysis/ mechanical thrombectomy)

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14
Q

how do you image acute stroke

A

non contrast CT

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15
Q

what is the early signs of an ischaemic stroke on CT

A

hyperdense segment of a vessel (wedge shape)

direct visualisation of the intravascular thrombus/ embolus (the clot in the vessel)

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16
Q

what part of brain looses structure fastest when infarcted

A

insula

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17
Q

what is seen on CT a few hours after an ischaemic stroke

A

loss of grey/ white matter differentiation, hypoattenuation (become less dense) of deep nuclei
cortical hypodensity with associated parenchymal swelling with resultant gyral effacement (loss of structure)

with time the hypoattenutation and swelling become more marked resulting in a significant mass effect- midline shift

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18
Q

what is gliosis, when does it happen and what does it look like on CT

A

due to liquid factor necrosis
happens following ischaemia (stroke)
appears as a region of low density with volume loss

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19
Q

what can white things on a CT brain be

A

calcium
blood
melanoma mets

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20
Q

damage to which vessels causes a subdural haemorrhage

A

bridging veins (blood between dural and arachonoid)

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21
Q

what colour in blood on unenhanced CT scan

A

white

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22
Q

what is intra/extra axial

A

intra axial- within brain substance

extra axial- outwith brain parenchyma but inside the skull

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23
Q

what are the subdivision of extra axial haemorrhages

A

extra dural (between skull and outer layer of dura mater)
subdural (between dura and arachnoid- with CSF)
subarachonoid (will follow sulci and gyri)

24
Q

what is the typical appearance of a hypertensive bleed

A

acute haematoma in the basal ganglia (thalamus)

25
Q

what are extra dural haemorrhages associated with

A

trauma, often have associated skull fracture

26
Q

what vessels is usually damaged in an extra dural haemorrhage

A

usually arterial- commonly the middle meningeal artery

27
Q

what shape is an extradural haemorrhage

A

biconvex
can cause mass effect with midline shift, herniation and sulcal effacement
limited by cranial sutures

28
Q

what usually causes a subdural haemorrhage

A

can happen at any age- usually due to head trauma
infants- NAI
young adults- RTA
elderly- falls

29
Q

what does a subdural haemorrhage look like

A

semilunar shape
crosses sutures
doesnt cross midline
can cause mass effect

30
Q

what causes an acute on chronic subdural haematoma

A

people who are anticoagulated- repeated falls

31
Q

how does a subdural evolve on CT from subacute to chornic

A

subacute brain will be isodense

chronic will be hypodense

32
Q

what does an acute on chronic subdural haemorrhage look like

A

will see fluid level of acute blood adjacent to more chronic collection

33
Q

is subarachnoid haemorrhage intra or extra axial

A

extra axial (blood within the subarachnoid space not within the parechyma)

34
Q

what does a subarachnoid haemorrhage look like

A 
hyperdense material commonly around the circle of willis 
can also go into cistern, fissures, sulci 
stellate sign (star)
35
Q

what are subarachnoid haemorrhages associated with

A

85% berry aneurysm

can be traumatic/ related to other vascular malformations

36
Q

what is done when a subarachoid haemorrhage is found in the asbence of trauma

A

CT cerebral angiography is performed

37
Q

what do most people die of who have a subarachonid haemorrhage

A

hydrocephalus -> vasospasm -> infarction

38
Q

what cancers commonly metastasise to the brain

A

lung, breast, melanoma, renal cell, colorectal

39
Q

what are the majority of brain tumours in adults

A

mets

primary brain tumours more common in children

40
Q

what is usually the first test for an intracranial mass

A

CT

41
Q

what does hypo and hyper dense CT mean

A

hypo dense= black

hyper dense= whitw

42
Q

what can contrast be used for in intracranial masses

A

can make lesions more conspicuous - depends on integrity of blood brain barrier

43
Q

what do brain mets usually look like

A

usually mutliple
supra or infra tentorial
lots of oedema and mass effect
avidly enhance

44
Q

what do primary brain tumours usually look like on CT

A

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

45
Q

describe tonsilar herniation (coning)

A

descent of the cerebral tonsils below the foramen magnum

brainstem is compressed against the clivus - altering the vital life sustaining function of the pons and medulla

46
Q

what is the spinal cord in

A

within spinal canal of vertebral column, within thecal sac

47
Q

where is the conus medullaris

A

L1

48
Q

what is the treatment for spinal cord compression

A

is a surgical emergency

prompt decompression to prevent neurological damage

49
Q

what can cause spinal cord compression

A 
intervertebral disc: disc protrusion, disc extrusion, discitis, osteomyelitis 
vertebral: trauma, tumour 
epidural space: adscess, haematoma 
dura: spinal meningioma 
intradural space: nerve sheath tumour
50
Q

what are the red flags for back pain

A

Hx of malignancy
major trauma
thoracic/ radicular pain
constant, progressive, non mechanical pain
systemically unwell
widespread neurological signs and symptoms
urinary retention, saddle anaesthesia

51
Q

what Ix for spinal cord compression

A

MRI spine

52
Q

what does a retropulsed vertebrae mean

A

has been pushed backwards

53
Q

what is used for thrombolysis in stroke

A

alteplase

54
Q

when would you not thrombolyse

A

if patient heavily anticoagulated e.g. on warfarin

careful in Hx of previous infarct (likely to bleed)

55
Q

what is seen on CT a long time after a stroke

A

scarring- gliosis, volume loss, ex vacuolar dilation

CLASP Radiology (6 decks)

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