Brant & Helms Ques. Flashcards
Hyperdense tumours suggests increased cellular density due to small cells. Which tumours are associated with this?
1: Lymphoma
2: Medulloblastoma
3: Pineoblastoma
4: neuroblastoma,
Mets from:
5: Melanoma
6: Lung Ca
7: Colon
8: Breast
What are the commonest primaries to metastasis to the spine?
Breast
Prostate
Lung
Renal
What is the management of tuberous sclerosis?
- Neurology r/v for medical mx of epilepsy (if indicated)
- Neurosurgical r/v if indicated
- Further imaging to assess for cardiac rhabdomyomas, renal angiomyolipomas and pulmonary cystic lung disease
- Screening of family members
What are the features of Klippel-Feil syndrome?
It is a vertebral segmentation anomaly characterised by:
- Fusion of multiple cervical vertebral bodies / block vertebra
- Sprengel’s shoulder
- Scoliosis
- Omovertebral bone: bone connecting vertebra to the scapula
- Cervical ribs
- Deafness due to ear anomalies
There maybe:
- Platybasia
- Syringomyelia
- Encephalocoele
What is the difference between myelopathy and radiculopathy?
Myelopathy results from compromise of the S
SPINAL CORD itself i.e. mechanical compression,
intrinsic lesions, or inflammatory process.
Classic symptoms include bladder and bowel
incontinence, spasticity, weakness, and ataxia.
Radiculopathy generally results from impingement of the SPINAL NERVES, either within the spinal canal, lateral recess, or neural foramen, or along the extraforaminal course of the nerve
DDx for Intramedullary spinal lesions?
1: Ependymoma
2: Astrocytoma
3: Haemangioblastoma
4: Lipoma
5: Epidermoid
6: Dermoid
7: Intramedullary AVM
8: Mets (rare)
NB The commonest disease that causes abnormal Intramedullary signal is MS
DDx for INTRADURAL Extramedullary lesion?
So arising from the dura think?
1: Meningioma
2: Schwannoma
3: Neurofibroma
4: Haemangiopericytoma
5: Drop / leptomeningeal mets
6: Lipoma / Epidermoid
7: Rare: Extramedullary AVM (veins)
What should always be done if an abnormal T2W Intramedullary lesion is detected?
When a mysterious bright intramedullary lesion is seen on a T2WI the next step should be MR
of the brain (to search / exclude further lesions which may represent concomitant MS plaques)
How does SLE differ from MS in the spinal cord?
1: The spinal cord will show diffuse areas of increased signal intensity with cord swelling on T2WIs.
2: SLE “lesions” have less well-defined margins than the discrete plaques of MS and
3: It may involve four to five vertebral body segments.
4: Lupus of the cord may show dramatic improvement on MR after corticosteroids
With regards to the vertebral body collapse, how does the number of vertebral bodies involved help distinguish, infection, neoplasm and osteoporosis.
Infection: Single vertebral involvement is rare. Usually at least two vertebrae around an affected disk (pyogenic) or intact disk with subligamentous spread (tuberculosis or fungus)
Neoplasm: Single or multiple non-contiguous
Osteoporosis: Typically several vertebra show loss of height, to varying degrees
With regards to vertebral body collapse, how can infection, neoplasm and osteoporosis be differed with regards to which portion of the vertebra is affected ?
Infection:
Destruction greatest at endplates.
Posterior elements relatively spared.
Abnormal marrow signal centered around disk in osteomyelitis/discitis complex
Neoplasm:
Irregular vertebral body involvement.
Pedicles typically affected cf infection
Entire vertebra often infiltrated
Osteoporosis:
Anterior “wedge” deformity of the vertebral body.
Posterior elements spared.
Portions of vertebral body retain normal marrow, even with acute compression fracture.
With regards to vertebral body collapse, how can infection, neoplasm and osteoporosis be differed with regards to Marrow signal ?
Infection:
Decreased on T1
Increased on T2
Normal diffusion
Neoplasm:
Decreased on T1
Increased on T2
Restricted diffusion caused by “marrow packing”
Osteoporosis:
T1 and T2 normal (unless acute fracture)
Diffusion may be increased at the fracture plane
With regards to vertebral body collapse, how can infection, neoplasm and osteoporosis be differed with regards to Disk integrity ?
Infection:
Pyogenic: disk involved and enhances
Nonpyogenic: disk spared
Neoplasm:
Disks typically spared (prostate cancer an exception)
Osteoporosis:
Disks spared
With regards to vertebral body collapse, how can infection, neoplasm and osteoporosis be differed with regards to Epidural component (if present)?
Infection: Granulation tissue (best seen postgadolinium) extends several levels above and below the affected vertebrae
Neoplasm:
Focal mass usually only at level of affected vertebra(e)
Lymphoma an exception, with more extensive epidural mass.
Osteoporosis:
Rare, unless acute fracture with hematoma or retropulsion of fragments
What are the 2 commonest INTRAMEDULLARY neoplasms ?
1: Ependymoma
2: Astrocytoma
It can be difficult to distinguish them
