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Applied Radiographic Pathology 2 > Brain Pathologies > Flashcards

Brain Pathologies Flashcards

1
Q

A brain tumour has a potential to completely change someone’s character and they can suddenly become violent /aggressive to those around. How can this situation be managed when the patient is having an imaging examination?

A
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2
Q

Someone with parkinson’s disease will develop shaky, jerky movements. Will this require an adaptation of technique for a given radiography examination?

A
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3
Q

What are the most effective imaging modalities used to visualise the brain?

A

MRI and CT

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4
Q

What are T1 and T2 weighted Images?

A

T1w

Fluid = Dark
Bone = Dark
Fat = Bright
Air = Dark
Muscle = Grey
White matter = light grey
Grey matter = Dark grey

T2w

Fluid = Bright
Bone = Dark
Fat = Bright
Air = Dark
Muscle = Darker Grey
White matter = Darker grey
Grey matter = Dark grey

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5
Q

Why is CT with IV lodinated Contrast used when imaging the brain?I

A

It is used to enhance the Image with Information onthe vascularity and characteristics of organs and pathologic lesions

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6
Q

What is the role of the iodine in a CT IV iodinated contrast in the brain?

A

The iodine density blocks the passage of the x-ray photons causing the contrast to appear denser (white) on the CT images

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7
Q

Why are pre and post contrast (+/-C) imaging used normally in the brain?

A

For the diagnosis stage, as some very small lesions might be masked by the way dense contrast

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8
Q

How are small lesions detected?

A

By the use of contrast agents to make the small lesions more conspicuous

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9
Q

How are lesion characterisation determined in be brain?

A

Some lesions will enhance uniformly, some not at all and many just a little. This helps to derive the imaging characteristics of a given lesion

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10
Q

What is the extent of lesions being Imaged?

A

It is often difficult to image boundaries of lesions due to distortion from surrounding oedema/ necrosis- Contrast helps depict the the size, shape and position of lesions

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11
Q

How is MRI IV contrastdifferent from CT?

A

MRl is based on magnetisation, not ionising radiation, so IV contrast have magnetic properties to differentiate from that of the surrounding tissue

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12
Q

What is used as a ‘positive’ Iv contrast agent for MRI?

A

Gadolinium - Shows up bright on T1w sequences

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13
Q

What pathologies are enhanced by the use of IV Gadolinium contrast in MRI?

A

Sometimes used in MS to enhance demyelination plaques as it helps to distinguish between active/chronic quiescent
For assessing early Ischemia, parenchymal brain infections and meningeal lesions

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14
Q

What are some risk associated with taking contrast?

A

It is generally well tolerated by patient
Low chance of allergic reactions
Small risk of nephrongenic systemic fibrosis (NSF) in patients in chronic kidney failure /dialysis

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15
Q

What is the Aetiology of Brain tumours?

A

Unknown
Exposure to radiation
Genetic factors, cerebral palsy

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16
Q

What is the risk factors of Brain tumours?

A

Increase in age, though uncommon in children

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17
Q

What is the pevelance of brain tumour?

A

Slight Predominance of primary tumours in males

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18
Q

What is the first and second most common type of cancer?

A

1 - Leukaemia
2 - Brain tumor

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19
Q

In Brain tumour distribution what does Gliomas account for?

A

Gliomas account for 40% of all tumours and 78% of malignant tumours

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20
Q

What are meningiomas?

A

It a mass that originates from the meninges
Meningiomas enhance uniformly
They can appear in Isolation or there may be multiple lesions

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21
Q

What are the common location (types) of meningiomas In a coronal slice of the brain?

A

Parasagittal
Falcine
Intraventricular
Convexity (left on the image)

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22
Q

What are the common location (types) of meningiomas In a sagittal slice of the brain? 🧠

A

(2) Parasagittal (at the top of the brain sighty to the right of Image )
(8) Olfactory Groove (on the right side at the bottom the curved corner)
(4) Supraseller
(5) Clivus (Slightly above the 6)
(6) Foramen magnum (on the ‘trunk’)
(9) Cerebellar (bottom left on the image)

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23
Q

What is a Glioma?

A

Type of tumour that occurs in the brain and spinal cord
The develop from the glial cells that support the nerve cells in the brain
There are 4 main types

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24
Q

How are Gliomas staged?

A

They are staged from 1 to 4 according to the speed of tumour growth

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24
Q

How are Gliomas staged?

A

They are staged from 1 to 4 according to the speed of tumour growth

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25
Q

What are the different types of Gliomas?

A

Astrocytoma
Ependynomas
Oligodendroglioma
Mixed tumours

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26
Q

What is the most common of the stage 4 tumours?

A

Glioblastoma Multiforme (GBM)

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27
Q

What is the most diagnosed tumour?

A

Gliomas

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28
Q

What is the epidemiology of brain tumour?

A

As a whole account for <2% of all diagnosed cancer in England and Wales

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29
Q

What is the prevalence of a Glioma?

A

Tend to occur later in life, most commonly between age 70-75 but not unheard of in children
The prognosis is generally better the younger the patient

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30
Q

What is the incidence of Glioma?

A

More common in men than women with a ratio of 4:3

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31
Q

What is the median survial for Grade 3 tumours such as anaplastic astrocytoma?

A

2-3 Years

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32
Q

What is the median survial for Grade 4 tumours such as Glioblastoma Multiforme (GBM)?

A

1 year and the people diagnosed with GBM tend to be older than those diagnosed with stage 3 tumours

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33
Q

How to answer and identify a Glioblastoma on MRI Axial - example answer

A

Axial, T2w (no marks on Pathology Question)
Large right-sided glioblastoma
Hyperintense with surrounding Oedema
Midline shift to the left

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34
Q

How to answer and identify a Glioblastoma on MRI coronal- example answer

A

Coronal T1-W + C (no marks if for pathology)
Large irregular mass on R side of brain
Mass is hypointense with central heterogenous signal
Peripheral irregular contrast enhancement typical of glioblastoma

35
Q

What are brain metastases?

A

It is a secondary brain cancer that has spread from a tumour in another part of the body
It can be Solitary or multiple lesions

36
Q

What organs can many tumour or cancer types spread to?

A

Brain
The most common being lung , breast, testicular, kidney, bladder, certain sarcomas and melanoma

37
Q

What are the Clinical signs & symptoms of a brain tumour?

A

Seizures- a twitch, or involving the whole body
Gradual neurological deficits - difficulty thinking, slow comprehension , weakness
Vision problems - blurred vision /floaters
Headache - Persistent; worse in morning or when bending /coughing (due to pressure in brain)
Dizziness and nausea/vomiting
Drowsiness
Depending on location in brian may have changess in Personality, forgetfulness, numbness, loss of coordination, difficulty walking, difficulty speaking

38
Q

What are some treatment options for brain tumours?

A

Depends on location and histology - Surgical removal If possible, radiation therapy, chemotherapy, Combinations of all 3, drug therapy

39
Q

What is the aetiology of acromegaly?

A

Pituitary gland secretes excess growth hormore, usally due to benign tumour (pituitary adenoma), resulting in pituitary gigantism (proportional increase in size in skeletally immature Patient

40
Q

What are the radiological appearances of Acromegaly?

A

Thickening of the bony cortex of the skull vault
Enlarged sinuses and Pituitary fossa
Enlarged, protruding mandible

41
Q

What is acromegaly?

A

Generalised enlargement of the skull result of in pronounced brow
Jaw protrusion (sometimes with gaping teeth)
Enlargement of the hands, feet, nose, lips and ears with skin thickening, tongue
Soft tissues swelling of the vocal cords resulting in a characteristic deep voice and slowed speech Abnormally tall heights (if it occurs before puberty)

42
Q

What is the treatment of acromegaly?

A

Excision/ radiotherapy / chemotherapy

43
Q

What are the different types of infection in the brain?

A

Meningitis - inflammation of the pia and arachnoid mater that can reach the meninges
Encephalitis - A viral inflammation of the brain and meninges
Brain abscess- usally results from chronic infection in the sinuses or middle ear
Not seen on conventional imaging - MRI or CT required

44
Q

What is infection clinical presentation when infection is not too severe?

A

Mild fever
Mild headache
Lethargy
Loss of appetite
Stiff neck/ back ( occasionally)
Clumsiness
Unsteady gait
Confusion
Drowsiness
Irritabillity
Light Sensitivity
Vomiting

45
Q

What is infection clinical presentation when infection takes hold?

A

LOC (Loss of consciousness) - unresponsive, coma
Muscle weakness/paralysis
Severe headache
Seizures
Sudden change in metal functions

46
Q

What is encephalitis?

A

Uncommon but it’s very serious condition where brain tissue suddenly becomes enflamed

47
Q

What is the Prevalence of encephalitis?

A

Can affect anyone but the very young and very old are most at risk

48
Q

What are the cause of encephalitis?

A

Viral encephalitis - herpes simplex virus and the chickenpox virus
Immunodeficiency
Bacterial or fungal infections - much more rare occurrence

49
Q

What is cerebrovascular disease?

A

Any process that is caused by an abnormality to the blood vessels or supply to the brain
This includes the process of abnormal vessel wall or ruputure, bleeding, occlusion of a vessel and decreased Cerebral blood flow

50
Q

What diseases are included in Cerebrovascular disease?

A

Arteriosclerosis
Arteritis
Aneurysms
Hypertensive haemorrhage
Arteriovenous malformations

51
Q

What is a type of cerebrovascular disease?

A

Stroke

52
Q

What are the different types of strokes and % of accountability of Strokes?

A

Ischemic stroke (Area of deprived of blood) - 80% of strokes
Haemorrhagic stroke (area of bleeding) - 20% of strokes

53
Q

What is ischemic stroke?

A

It is an area deprived of blood due to plaque or a blood clot which blocks blood flow to a part of the brain
Also can be caused by clogged arteries, or ‘atheroscleroisis’, where fat, cholesterol, and other substances collect on the wall of the arteries, forming a sticky substance called plaque

54
Q

What is the clinical Presentation of a stroke?

A

Sudden onset
May result in hemiplegia (Paralysis on one side) or coma
May be a trivial neurological disorder

55
Q

What are some Symptoms of Stroke?

A

Hemiparesis -weakness on oneside
Dysarthria - difficulty speaking
Impaired Judgment and memory
Emotional Lability
Loss of neuromuscular control - e. g can’t control bowel movements
Apraxia

56
Q

What are the risk factors of stroke?

A

Smoking
obesity
High salt intake
Sedentary lifestyle
Increased strees levels
Increased BP
Cardiac valve disease
Dysrhythmias
Diabetes mellitus
High Cholestrol
Sex
Age
Race
Heredity

57
Q

What is a Transient ischemic attack (TIA) (mini strokes)?

A

Results when a cerebral artery is temporaily blocked, decreasing blood flow to the brain
Temporarily reduced function

58
Q

What are some Clinical considerations for stroke patients?

A

Communication - Patient may have impaired speech, unable to confirm ID
Weakness - Patient may need help dressin/undressing, mobility problems
Moving and handling issues
Adapting radiographic technique

59
Q

How is stroke treated?

A

It is essential to exclude intracranial bleeding prior to treatment
Anticoagulant therapy
Rehabilitation - occupational and physiotherapy often required

60
Q

What are the two different types of haemorrhagic Stroke?

A

Intracerebral hemorrhage
Subarachnoid hemorrhage

61
Q

What is intracerebral hemorrhage?

A

Rupture of Cerebral blood vessel (usally artery)
Bleeding into /around brain
Frequently associated with hypertension, aneurysm

62
Q

What is intracerebral hematoma?

A

Is an accumulation of blood inside the brain, caused by the rupture of a blood vessel

63
Q

what is the clinical presentation of ICH (intracerebraI haemorrhage)?

A

Usually during daytime activity with progressive (minutes to hours) development of :-
- Alteration in level of consciousness (approximately 50%)
- Nausea and vomiting (approximately 40-50%)
- Headache (approximately 40%)
- Seizures (approximately 6-7%)
- Focal neurological deficits

64
Q

What is subarachnoid haemorrhage (SAH)?

A

Usually due to ruptured saccular aneurysm
Blood escapes into subarachnoid space, especially the basal cisterns and CSF (Cerebral spinal fluid) pathways

65
Q

What are the posible causes of SAH?

A

AVM
Hypertension
Head trauma (most common)

SAt accounts for 3% of strokes and 5% of stroke deaths

66
Q

Whatare the clinical Presentation of SAH?

A

Thunderclap headache
Photophobia and meningism (headache, back and neck ache etc)
In almost half the Patients - collapse and loss of consciousness

67
Q

How to answer about subarachnoid haemorrhage?

A

Hyperattenuating material is seen filling the subarachnoid space
Most commonly this is apparent around the basal cistern (envelopes the circle of willis), on account of Majority of saccular (berry) aneurysms occuring in this region (~65%), or in the sylvian fissure (~30%)
Axial CT shows acute blood (hyperdense)

68
Q

What is the next course of action for SAH Patients?

A

CTA (computed tomography angiogram) or catherter angiogram recommend
An endovascular coiling would be carried out

69
Q

What is epilepsy?

A

Epilepsy is defined as a tendency to have recurrent seizures (Sometimes called fits)

70
Q

What is the cause of a seizure?

A

A seizure is caused by a sudden burst of excess electrical activity in the brain, causing a temporary disruption is the normal message passing between brain cells.

This disruption results in the brain’s messages becoming halted or mixed up

71
Q

What is the Prevalence of epilepsy?

A

1 in every 131 People in the UK have epilepsy - this equates to at least 456.000 People
It can affect anyone
Some People may have asingle seizure episode in their life

72
Q

How many types of Seizures are there?

A

40

73
Q

What is the Aetiology of epilepsy?

A

There are many reasons so there are being characterised into 3 categorieS:
Symptomatic Epilepsy - known cause
Idiopathic Epilepsy - unknown cause
Cryptogenic Epilepsy - known but unproven cause

74
Q

What are Symptomatic epilepsy?

A

Known cause -

Head injury
Infections of the brain (e.g. meningitis)
Stroke
scarring of the brain
Famicily history or genetic disposition

75
Q

What are some epilepsy seizure triggers?

A
  • Stress
  • Lack of sleep
  • Alcohol, particularly binge drinking and during a hangover
  • Illegal drugs such as cocaine, amphetamines, ecstasy, and any opiate-based drugs (heroin, methadone or codeine)
  • Health conditions that cause a high temperature (fever)
  • Flashing lights (uncommon, affects only 5%, known as Photosensitive epilepsy)
  • Before, during or after period (hormones released by the body during that time can affect chemicals in the brain, making seizures more likely)
76
Q

How is epilepsy diagnosed?

A

Electroencephalogram (EEG)
Computerised tomography (CT)
Magnetic resonance Imaging (MRI)
Functional Imaging (PET , spect, fMRI) is useful in locating the eliptogenic Zone and Mapping functional areas of the brain)

77
Q

When would a CT be used instead of an MRI?

A

When MRI is not available or is contraindicated and for children or young people in whom a general anaesthetic or sedation would be required for MRI but not CT

78
Q

What Image modality is used to Image epilepsy in an acute situation?

A

CT may be used to determine whether a Seizure has been caused by an acute neurological lesion or illness

79
Q

What are some Symptoms of seizure?

A

Stiffening and twitching of muscles
Incontinence or loss of body functions
Loss of consciousness
Abnormal sensations (e g. tingling on one side of the body or awareness of a strange taste or smell)

80
Q

What should be done is someone is having a Seizure?

A

Try to remove any objects on which the person could hurt themselves
Try to put the patient into the recovery position
Stay with the person until they regain consciousness, then try to calm them
NEVER put anything in the person’s mouth during an attack
If it last more than 5mins, medical help should be sought immediately - If not no need for medical attention

81
Q

What is a type of Degenerative disease?

A

Multiple sclerosis
Huntington’s Disease
Parkinson’s Disease
Senile Dementia

82
Q

What are some symptoms of Multiple sclerosis?

A

Temporary loss of vision
Double vision
Unsteadiness in walking / diziness

Inversion recovery (FLAIR)

83
Q

What are the symptoms of huntington’s disease?

A

Spasmodic movement
Speech difficulties
Psychological disorders

84
Q

What are symptoms of parkinson’s disease?

A

Slowness of movement
Muscular rigidity
Tremor
Speech difficulties

85
Q

What are the Symptoms of senile dementia?

A

General lowering of Intelligence
Cessation of higher functions
Cessation of the ability to reason
Poor eyesight & hearing

Applied Radiographic Pathology 2 (7 decks)

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