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Radiology Rapids > Brain Quickie > Flashcards

Brain Quickie Flashcards

1
Q

What does the labyrinthine branch of AICA supply?

A

Vestibulo-cochlear and facial nerves

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2
Q

Clinical clue to differentiate AICA from PICA infarct?

A

Hearing loss

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3
Q

Horner syndrome includes…

A
  • ptosis (drooping eyelid),
  • miosis (constricted pupils)
  • anhidrosis (ipsilateral decreased sweating) from sympathetic dysfunction.
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4
Q

Clinical presentation of SCA infarction includes…

A

dysarthria, ipsilateral ataxia, and Horner syndrome

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5
Q

Brain imaging features of Carbon Monoxide poisoning

A

bilateral, symmetric globi pallidi cytotoxic edema

also seen toxic etiology (illicit drug use)

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6
Q

Corpus callosum (CC) agenesis classic imaging findings

A
  • colpocephaly—lateral ventricular “tear drop” appearance (with a parallel orientation)
  • radiating pattern of the central gyri (sagittal view)
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7
Q

Focal nodules along the subependymal lining of the lateral ventricles, differentials?

A

tuberous sclerosis, heterotopic gray matter (HGM), and metastasis.

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8
Q

Lissencephaly—type I classic features and what must be ruled out for diagnoses

A

hourglass configuration with smooth cortical surface, shallow sylvian fissures with lateral displacement of the middle cerebral vessels. Subcortical gray matter and thick band heterotopia.

*correlate with gestational age to rule out normal immature brain

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9
Q

A well defined, non-enhancing, hypodense (CSF density) unilocular cystic lesion with no surrounding edema.
Differentials

A

perivascular space, porencephalic cyst,
neuroglial cyst,
cerebral hydatid cyst
if enhances > consider tumor/infection

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10
Q

Perivascular spaces (PVS) are also known as

A

Virchow-Robin spaces

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11
Q

Congenital CMV CT features

A 
periventricular calcifications, 
cortical malformations (agyria, focal cortical dysplasia, schizencephaly)
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12
Q

Schizencephaly

A

rare cortical malformation that manifests as a grey matter lined cleft extending from the ependyma to the pia mater, separated with CSF

Open vs closed lip
Bilateral vs unilateral

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13
Q

Ring Enhancing Lesions

A

D: demyelinating disease (incomplete rim enhancement)
R: radiation necrosis

M: metastasis
A: abscess, (bacterial or fungal)
G: glioblastoma
I: infarct (subacute phase), inflammatory - neurocysticercosis (NCC), tuberculoma.
C: contusion, resolving hematoma
A: AIDS, i.e. Toxoplasmosis, Cryptococcus.
L: lymphoma (common in immunocompromised).

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14
Q

Common site for hematogenous seeding in brain

A

anterior circulation at the gray-white junction

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15
Q

Herpes encephalitis commonly involved sites

A
  • medial temporal lobes
  • insular cortex
  • inferior frontal lobes

may be bilateral but asymmetric

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16
Q

Clinical signs for uncal herniation

A

Ipsilateral mass effect of CN 3:

  • ipsilateral pupil dilation, unresponsive to light
  • ipsilateral eye deviation “down and out”

-compression of the reticular activating system of midbrain > altered conscious state

-motor deficits
usually contralateral hemiparesis
in ~25% ipsilateral hemiparesis due to Kernohan phenomenon

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17
Q

Uncal herniation CT clues

A

Effacement of suprasellar and prepontine cisterns

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18
Q

Common CNS metastases

A
  • Breast
  • Lung
  • Melanoma
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19
Q

Classic CT finding for cavernous malformation

A

calcified “popcorn” lesion on non-contrast CT with NO surrounding vasogenic edema unless haemorrhage is present

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20
Q

Hypertensive haemorrhage common sites

A
  • basal ganglia
  • subcortical white matter
  • thalamus
  • pons
  • cerebellum
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21
Q

Blood supply basal ganglia

A

ACA branches of A1 segment (medial lenticulostriate artery)- anterior inferior parts of basal nuclei and anterior limb of internal capsule
MCA branches of MI (lateral lenticulostriate artery)- superior parts of caudate, most of lentiform and posterior limb of internal capsule

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22
Q

3 basic components of AVM

A
  1. enlarged arterial feeders
  2. compact nidus
  3. dilated draining vessels
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23
Q

Direct CT signs for CVT

A
  • hyperdense thromboses vein (“cord sign”)
  • lack of luminal enhancement in sagittal sinus (“empty delta sign”) on CTV

*indirect: intense contrast enhancement of falx and tentorium

can lead to venous infarct (pattern not consistent with arterial territory)/hemorrhage

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24
Q

Causes for lobar haemorrhages

A
  • cerebral amyloid angiopathy (elderly)
  • AVM (young)
  • tumors
  • bleeding disorders/antigoagulation
  • CVT
  • cerebral aneurysm

-hypertension (primary/secondary)

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25
Q

PCA supplies

A 
Occipital lobes
Temporal lobes
thalamus
hypothalamus
posterior limb of internal capsule
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26
Q

infarction of the medial occipital lobes causes

A

Homonymous hemianopia (visual defect of either the right or left halves of the visual field)

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27
Q

Bilateral watershed zone infarct etiology

A

Usually secondary to hypotension

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28
Q

What procedure can be lethal in cerebral empyema?

A

Lumbar puncture

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29
Q

Cephalohematoma

A

Subperiosteal hematoma bound by sutures

if crosses midline, consider caput seccundum or subgaleal hematoma

30
Q

Supracellar mass differentials:

A
  • Craniopharyngioma
  • pituitary macroadenoma ( micro adenomas are typically hormonally active , unlike macro)
  • Rathke cleft cyst (female predominance)
  • thrombosed aneurysm (CTA or MRA)
  • dermoid/epidermoid cyst
31
Q

Common site for arachnoid cyst

A

Middle fossa

32
Q

Differentials for prominent extra-axial spaces in infants

A
  • enlarged subarachnoid space
  • hematoma (ensure to ask for trauma)
  • communicating hydrocephalus
  • brain atrophy
33
Q

Does SAH require further work up?

A

Yes, vascular imaging in order to exclude aneurysm or AVM

34
Q

Intracranial giant aneurysms

A
  • larger than 25mm
  • exhibit peripheral calcifications
  • Heterogenous contrast enhancement
  • connects to arterial origin
35
Q

Colloid cyst

A
  • benign
  • spherical focal high attenuated structure
  • 99% within the foramen of Monro/anterior third ventricle
  • always check for hydrocephalus/ventricle asymmetry
36
Q

Choroid plexus tumors

A

occur most commonly in younger children and are the most common brain tumor under 1 year of age.

37
Q

differential diagnosis for a mass at the cerebellopontine angle includes

A

meningioma,
epidermoid cyst,
schwannoma.

Vestibular schwannomas (VS) are the most common cerebellopontine angle (CPA) mass.

38
Q

CNS Hemangioblastoma: common location and CT features

A
  • Crebellum (40-70%), then spinal cord and medulla

- Cystic lesion with mural nodular enhancement

39
Q

what is PRES?

A

Posterior reversible Encephalopathy Syndrome:
a transient neurotoxic state may be secondary to HTN, pre/eclampsia, immune suppression, shock/sepsis

bilateral and symmetric distribution
vasogenic edema pattern
common in parietal and occipital lobes

40
Q

Holoprosencephaly

A

a rare congenital brain malformation resulting from incomplete separation of the two hemispheres.
alobar
semilobar
lobar

absent septum pellucidum and mono ventricle seen within whole spectrum

41
Q

Pseudosubarachnoid hemorrhage

A

Describes an apparent increased attenuation within the basal cisterns simulating true subarachnoid hemorrhage. It is usually due to cerebral edema.

42
Q

Toxoplasmosis commonly involved site

Treatment

A

Basal ganglia

pyrimethamine (requires folinic acidity for toxicity) and sulfadiazine for about 6weeks

43
Q

Wilson disease

A

autosomal recessive disease with impairment of copper transport leading to copper deposition in organs and cellular damage

44
Q

Primary CNS lymphoma enhancement pattern

A

intense enhancement in immunocompetent individuals

ring enhancement in immunocompromised individuals

45
Q

Differentials for a well circumscribed tumor in the temporal lobe

A
  • ganglioglioma (*common neoplastic cause for temporal epilepsy)
  • pilocytic astrocytoma
  • oligodendrioglioma (50-65% in frontal lobe)
  • pleomorphic xanthoastrocytoma
46
Q

Heterogenous hemispheric mass with malignant features in a child

A

Gliobalstoma multiforme (predilection for the cerebral hemispheres)
primitive neuroectodermal tumor (PNET)&raquo_space; CSF seeding common, so image spine
atypical teratoid rhabdoid tumor
choroid plexus carcinoma with significant parenchymal invasion

47
Q

Metastases prone to hemorrhage

A 
"Mr CT"
melanoma
Renal Cell
Choriocarcinoma
Thyroid
48
Q

Differential bilateral thalamic hypodensity

A

artery of Percheron infarct
DVT
Wernickes encephalopathy (form of thiamine -B1 deficiency) -
basilar tip infarction

49
Q

Structures supplied by distal basilar artery

A

midbrain, thalami, PCA distribution

*effects: visual, oculomotor deficits, somnolence or behavioural changes

50
Q

Heterogenous enhancement of extra axial lesions ddx

A

meningioma
metastases
hemangiopericytoma

51
Q

Intracranial aneurysms

A

commonly saccular, occur at bifurcations

52
Q

Normal pressure hydrocephalus classic triad

A

gait disturbance
dementia
urinary incontinence

53
Q

What do the 5 point star of the supra cellar cistern represent

A

fissures between:

  • between the two frontal lobes (1)
  • between frontal and temporal lobe (2)
  • between temporal lobe and brainstem (2)
54
Q

Common Subarachnoid Hemorrhage patterns

A

diffuse: likely from ACA or carotid aneurysm
unilateral in region of Sylvian fissure: MCA bifurcation
Prepontine or cerebello-pontine region: basilar tip or PCA

55
Q

Subdural Hematomas usual causes

A

often NOT associated with trauma
patients with increased CSF space (from atrophy or dehydration) are at risk from rotational acceleration/deceleration&raquo_space; as veins are fixed at the skull but can rotate with the cortex

56
Q

Secondary clues and differentials to skull fractures

A

clues:
jagged and sharp lines
step off along skull surface
adjacent subgaleal hematomas and subcutaneous air

differentials to exclude- suture lines (main/accessory/variants), vascular impressions

57
Q

In the setting of trauma, small hyperdense foci noted within parenchyma, differential

A

blood from a SAH may accumulate within sulci making distinguishing SAH from parenchymal bleed difficult
*parenchymal bleed may have surrounding edema

58
Q

What is the risk with blood within the Ventricles?

A

CSF obstruction with impaired CSF reabsorption(at arachnoid granulations) likely leading to non-communicating hydrocephalus

59
Q

Density (HU) of acute hemorrhage vs brain parenchyma

A

Acute bleed: 50-80HU (hyper acute, ie within an hour, may be isointense)
Brain: 30-40HU

60
Q

Non-pathological calcifications commonly seen in

A
  • choroid plexus
  • pineal gland
  • falx and tentorium
  • basal ganglia
61
Q

when reporting intraparenchymal hemorrhage, what must you include?

A
  • size of hemorrhage
  • location
  • wether it extends to the ventricles
  • if there is hydrocephalus
  • if there is mass effect (sulcal, loss of basal cisterns, hernation >midline shift, uncal, foramen magnum)
62
Q

Diffuse Axonal Injury

A

Results from shearing forces of axons
MRI more sensitve (black spots on SWI)

when present on CT: scattered small round foci of hemorrhage along grey-white matter junction, corpus callous and in basal ganglia.

63
Q

Common location to watch out for Epidural hematoma

A

Along the squamous portion of temporal bone&raquo_space; Pterion (H-shaped formation of sutures)

Middle meningeal artery commonly injured causing epidural bleed

64
Q

What does basal cisterns effacement suggest?

A

important finding !!!

Transtentorial/uncal herniation

65
Q

How do you differentiate arachnoid granulations from venous thrombus?

A

arachnid G- appear as round defect
thrombus -linear filling defect

ALSO&raquo_space; thrombus is usually hyper dense on non-contrast CT whereas arachnoid Gs are CSF density

66
Q

what nerves may be compressed with PCA and SCA aneurysm?

A

Oculomotor and Trochlear Nerves (midbrain)

67
Q

Artery of Percheron infarct feautures:

A

Super rare as this is anatomic variant!

  • bilateral paramedian thalamic and midbrain infarction (most common)
  • isolated bilateral paramedian thalamic infarction
  • bilateral paramedian thalamic and anterior thalamic infarction
  • bilateral paramedian thalamic, anterior thalamic and midbrain infarction (least common)
68
Q

What is Superficial siderosis?

A

Cause: chronic SAH, and source of bleeding is found in less than 50% of patients

A RARE disorder characterized by deposition of hemosiderin in leptomeninges covering cerebrum, cerebellum, brain stem, cranial nerves and spinal cord

Clinical Triad: sesorineural hearing loss, cerebellar ataxia, and pyramidal signs along with hemorrhagic or xanthochromic CSF

CT/MRI

69
Q

Identify the pathology and it’s features

A

Optic nerve sheath meningioma

These benign tumors arise in middle-aged patients (slight female predominance) from the dural sheath around the optic nerve.
Has an association with neurofibromatosis type 2

Clinical: proptosis, progressive visual loss, color vision defects and afferent pupillary defect (sluggish reaction to light)

CT features:

  • usually isoattenuating
  • calcifications seen in 20-50% cases
  • tram tracking: enhancing tumour surrounding the non-enhancing optic nerve (axial/sagittal)
  • doughnut: cuff of enhancing tumour around a central non-enhancing dot (optic nerve)
70
Q

Most common intramedullary (spine) tumors

A
  • ependymoma (most common in adults).&raquo_space;usually well circumscribed
  • astrocytoma (most common in
    children) .&raquo_space; infiltrative pathology
  • hemangioblastoma
  • paraganglioma
  • metastasis
71
Q

Common hemorrhagic mets to the brain

A
  • Renal
  • thyroid
  • melanoma
  • choriocarcinoma

Radiology Rapids (10 decks)

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