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Neuroradiology > Core > Flashcards

Core Flashcards

1
Q

Cerebral edema affecting only white matter, usually

A

Vasogenic edema (Because there is more interstitial space)

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2
Q

Most common causes of vasogenic edema (3)

A

Neoplasm, infarct or infection

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3
Q

Cause of cytotoxic edema

A

Cell death, usually from infarction (N.B. water ions trapped inside swollen cells feature reduced diffusivity)

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4
Q

Cause of interstitial edema

A

Imbalances in CSF flow, most commonly due to obstructive hydrocephalus.

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5
Q

Look of interstitial edema on imaging

A

Periventricular fluid, often called “transependymal flow of CSF” (misnomer)

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6
Q

Physical exam findings of downward transtentorial herniation (4)

A
  1. Compression ipsilateral CN III –> pupillary dilation and “down and out”
  2. Compression ipsilateral PCA –>medial temporal/ occipital infarct
  3. Shearing of perforating vessels –> Duret hemorrhages
  4. Compression of contralateral cerebral peduncle against Kernohan’s notcdh –> ipsilateral hemiparesis to herniated side.
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7
Q

Are most brain lesions hypo or hyperintense on T1?

On T2?

A

Hypointense due to pathologic prolongation of the longitudinal recovery.

On T2, hyperintense

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8
Q

Causes of T1 hyperintensity? (6)

A
  1. Most commonly: gadolinium, fat and proteinaceous substance
  2. Some paramagnetic stages of blood (intra and extracellular methemoglobin)
  3. Melanin
  4. Mineralization (copper, iron, manganese)
  5. Slowly-flowing blood
  6. Calcium (rarely, when not dispersed in bone)
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9
Q

Causes of T2 hypointensity? (6)

A
  1. Most paramagnetic stages of blood (except hyperacute blood of methemoglobin)
  2. Calcification
  3. Fibrous lesion
  4. High cellular tumors with high nucleus:cytoplasm ratio producing low lesional water content
  5. Vascular flow void.
  6. Mucin (the is not well hydrated).
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10
Q

Usefulness of proton density imaging?

A

For visualization of demyelinating plaques in the posterior fossa.

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11
Q

On DWI, is reduced diffusivity hyper or hypointense?

On ADC?

A

DWI: Hyperintense
ADC: hypointense

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12
Q

What is T2 shine through

A

Lesions that are inherently hyperintense on T2-weighted images may also be hyperintense on DWI even without restricted diffusion. Must correlate with dark spot on ADC.

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13
Q

DDx for reduced diffusion (6)

A
  1. Acute stroke
  2. Bacterial abscess
  3. Cellular tumors, (lymphoma, medulloblastoma)
  4. Epidermoid cyst
  5. Herpes encephalitis.
  6. Creutzfeldt-Jakob disease.
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14
Q

Blooming artifact.

A

Hemosiderin and calcium produce inhomogeneities in the magnetic field, which leads to blooming artifact.

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15
Q

DDx of multiple dark spots on gradient recall echo (5)

A
  1. Hypertensive microbleeds (primarily in the basal ganglia, thalami, cerebellum and pons)
  2. Cerebral amyloid angiopathy (subcortical white matter, most commonly parietal and occipital lobes)
  3. Familial cerebral cavernous malformations
  4. Axonal shear injury
  5. Multiple hemorrhagic metastases
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16
Q

What happens to N-acetylaspartate (NAA) in most abnormalities?

A

It decreases

17
Q

One of the few disorders with elevated NAA

A

Canavan disease.

18
Q

MR spec finding seen in high-grade tumors and indicates anaerobic metabolism.

A

lactate “doublet”

19
Q

Normal spectrum line

A

Hunter’s Line

20
Q

Areas of the brain without blood brain barrier (4)

A
  1. Choroid plexus
  2. Pituitary and pineal glands
  3. Tuber cinereum in the inferior hypothalamus
  4. Area postrema in the inferior aspect of the 4th ventricle.
21
Q

DDx of periventricular enhancement (4)

A
  1. Primary CNS lymphoma
  2. infectious ependymitis
  3. primary glial tumor
  4. multiple sclerosis
22
Q

DDx of gyriform enhancement (4)

A
  1. Herpes encephalitis
  2. Meningitis
  3. Subacute infarct (6 days to 6 weeks)
  4. Posterior reversible encephalopathy syndrome.
23
Q

Mnemonic for ring enhancing brain lesions

A 
MAGIC DR:
Metastasis
Abscess
Glioma
Infarct
Contusion
Demyelinating disease
Radiation
24
Q

Why does the normal dura not enhance on MRI

A

MRI enhancement requires both water protons and gadolinium. Normal dura has few water protons.

25
Q

DDx of pachymeningeal enhancement (5)

A
  1. Intracranial hypotension
  2. Postoperative
  3. Post lumbar puncture.
  4. Meningeal neoplasm
  5. Granulomatous disease
26
Q

Most common metastatic disease to the dura (2)

A

Breast cancer, prostate cancer.

Neuroradiology (3 decks)

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