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DDx > DDx-Neuro > Flashcards

DDx-Neuro Flashcards

1
Q

DDx?

A

DDx communicating hydrocephalus:

True obstruction (called extraventricular obstructive): defn: CSF can exit ventricles but the arachnoid villi are plugged:

  • Blood: SAH
  • Pus: meningitis: TB or bacterial.
  • Cancer: carcinomatosis meningitis

No obstruction:

  • Brain atrophy: ex vacuo.
  • Normal-pressure hydro.
  • Choroid plexus papilloma: tumour that secretes CSF.
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2
Q

Dx?

A

Dx, non-communicating hydrocephalus: defn: CSF cannot exit all the ventricles so upstream ventricles are big.

Foramen of Monro:

  • Colloid cyst.

Aqueduct:

  • Aqueductal stenosis
  • Tectal glioma

4th ventricle:

  • Posterior fossa tumour
  • Cerebellar edema/bleed
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3
Q

DDx

A

DDx multifocal brain masses:

  1. Mets: 50% solitary.
  2. Syndromes: NF-2.
  3. Multifocal primary brain tumours:
  • Examples:
    • Lymphoma
    • Multicentric GBM
    • Gliomatosis cerebri
    • Medulloblastoma
    • Ependymoma
    • Oligodendroglioma
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4
Q

General DDx of an intracranial tumour + mimics?

A
  • Brain tumour: met or primary
  • Lymphoma: restricts
  • Abscess: restricts
  • Infarct: restricts
  • Big MS plaque: incomplete ring enhancement
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5
Q

DDx bleeding intracranial met?

A
  • Thyroid
  • Melanoma
  • Renal
  • Carcinoid
  • Choriocarcinoma
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6
Q

DDx, this?

A

DDx, cortical-based brain tumours: PDOG

  • PXA (pleiomorphic xanthroastrocytoma): cyst w/nodule, ALWAYS supratentorial.
  • DNET (dysembryoplastic neuroepithelial tumour): bubbly, no enhancement (see below).
  • Oligodendroglioma: calcs common, expands cortex.
  • Ganglioglioma: can look like anything; EPILEPSY.
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7
Q

DDx intraventricular mass?

A

Misc:

  • Mets
  • Meningioma
  • Colloid cyst: can cause sudden death via acute onset hydro, so inform ED immediately.

Ventricular wall/septum pellucidum:

  • Medulloblastoma: peds, 4th vent ROOF; way more common than ependymoma; like to drop met–zuckerguss of leptomeningeal carcinomatosis.
  • Ependymoma: 6yo or 30yo, 4th vent FLOOR & squeeze out of the 4th like toothpaste.
  • SEGA: Hx TS, peds (kid w/seizures, developmental delay & renal AMLs).
  • Central neurocytoma: young adult; swiss cheese/cystic.
  • Subependymoma: adult.

Choroid plexus:

  • Choroid plexus papilloma: peds-trigone, adult-4th vent.
  • Choroid plexus carcinoma: peds only; Hx Li-Fraumeni.
  • Xanthogranuloma: adults only, restrict.
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8
Q

DDx, in order of prevalence

A

DDx CPA mass:

Vestibular schwannoma (75%):

  • Hetero enhancement; widens the porus acousticus = trumpet-shaped IAC; no calcs.

Meningioma (10%):

  • Homog enhancement; no IAC widening; calcs more often; take up octreotide & Tc-MDP.

Epidermoid (5%):

  • Acquired, so Hx trauma (LP spine); follows CSF but restricts.

Dermoid cyst (1%):

  • T1 bright; Hx NF-2; most commonly in the suprasellar cistern; can explode & will see fat droplets floating in the ventricles.

Others:

  • IAC lipoma
  • Arachnoid cyst: will follow CSF; will not restrict.
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9
Q

DDx infratentorial brain mass?

A

DDx infratentorial brain mass: most are peds except hemangioblastoma.

  • Atypical teratoma/rhabdoid tumour: type of medulloblastoma, but in a much younger kid (2yrs); has calcs, whereas medullo does not (see below).
  • JPA: cyst + nodule in a kid.
  • Hemangioblasoma: cyst + nodule in an adult.
  • Medulloblastoma/ependymoma: 4th vent.
  • Diffuse pontine glioma: no Bx needed, appearance is classic, T2 bright.
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10
Q

DDx supratentorial brain mass?

A

DDx supratentorial brain mass: mets, lymphoma, abscess +…

  • Mets: the most common supratentorial mass.
  • Astrocytoma: the most common primary brain tumour in adults.
    • Higher grades enhance; lower don’t except for pilocytic astrocytoma.
    • GBM: crosses the midline & can restrict.
    • Gliomatosis cerebri: involves at least 3 lobes & often bilateral; T2 hyper w/little mass effect; doesn’t typically enhance as is low grade.
  • Oligodendroglioma: cortical-based.
  • Lymphoma: seen in AIDS pts & post-xplant.
    • Periventricular, thick, irregular enhancement (rim-phoma) w/restricted diffusion.
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11
Q

DDx skull base tumours?

A

DDx skull base tumours:

  • Chordoma:
    • Midline + T2 bright (see below).
    • Will extend across a disc space if in the spine (commonly C2).
  • Chondrosarc:
    • Lateral to midline.
    • T2 bright but w/rings & arcs on CT.
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12
Q

DDx sella/parasellar mass?

A

DDx sella/parasellar mass:

  1. Pituitary adenoma: most common.
    • When functional, secrete prolactin.
    • T1 dark, T2 bright & enhance less than normal pituitary.
  2. Pituitary apoplexy:
    • Unlike adenoma, T1 bright.
    • From pregnancy or macroadenoma.
  3. Rathke’s cleft cyst:
    • B/w anterior/posterior pituitary.
    • Very bright on T2; no enhancement.
  4. Epidermoid: restricts.
  5. Craniopharyngioma:
    • Strongly enhance.
    • 2 types, papillary (adults) & adamantinomatous (kids); the kids’ version calcifies.
  6. Hypothalamic hamartoma:
    • No enhancement.
    • Precocious puberty + gelastic seizures.
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13
Q

DDx pineal region lesion:

A

DDx pineal region lesion:

  1. Germinoma: most common; almost always in boys in the pineal (in girls will be suprasellar); enhances & enGulfs calcs (see below).
  2. Pineoblastoma: highly invasive; assoc w/retinoblastoma (trilateral); enhance + blast calcs apart.
  3. Pineocytoma: well-circumscribed & non-invasive.
  4. Pineal cyst: thin rim enhancement; looks like a cyst; calls in 25%.
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14
Q

DDx ?

A

DDx brain lesions that restrict diffusion: BEACCH

Bacterial abscess

Epidermoid

Acute ischemia/stroke

Cellular tumour: lymphoma, GBM, medulloblastoma

CJD

HSV

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15
Q

DDx T1 bright brain lesions

A

DDx T1 bright brain lesions:

  1. Fat: lipoma, dermoid.
  2. Melanin: melanoma met.
  3. Blood: bleeding met, tumour.
  4. Cholesterol: colloid cyst.
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16
Q

DDx ring-enhancing lesions in the brain

A

DDx ring-enhancing lesions in the brain: MAGICAL DR:

Mets

Abscess

GBM

Infarct, infection (neurocysticercosis)

Contusion

AIDS: toxo

Lymphoma

Demyelination: incomplete ring

Radiation necrosis

17
Q

DDx ?

A

DDx pachymeningeal enhancement: enhancement does not extend into the sulci (so dural only, not arachnoid or pia):

  1. Intracranial hypotension
  2. Sarcoid
  3. TB
  4. Fungal infections
  5. Dural attachment of a meningioma
  6. Mets: breast, prostate

DDx (4 decks)

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