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Head & Neck > H&N - Cranial Nerves & Brachial Plexus > Flashcards

H&N - Cranial Nerves & Brachial Plexus Flashcards

1
Q

Best sequence for looking at optic nerves?

A

3D black blood sequence is best for looking at optic nerves

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2
Q

In head and neck cancers what nerve connection should you be aware of?

A

Maxillary nerve or trigeminal and the 7th cranial nerve in regions of pteryopalatine fossa and vidian canal

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3
Q

Philips vs siemens system to view cranial nerves in high detail

A

For extranial nerves used 3d sequence MDSE.

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4
Q

Skull base imaging

Sequences

A
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5
Q

What are imaging signs of dural invasion?

A

Imaging signs suggestive of dural invasion:

– >5mm thick linear or nodular dural enhancement
– Focal dural disruption
– Cortico-pial enhancement
– Vasogenic edema
– Parenchymal enhancement

Dural enhancement doesnt neccessarily indicate invasion

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6
Q

Orbital invasion by sinonasal tumours

Consequences for surgery

A
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7
Q

Anterior skull base tumours

What are they?

A
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8
Q

Olfactory neuroblastoma

A
  • Dumbell
  • DWI
  • Originates from olfactory mucosa
  • Cysts can be common
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9
Q

How to separate skull base?

A

Parasaggital is separated by lateral aspect of foramen ovale

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10
Q

Midline saggital central skill base lesions

Summary

A
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11
Q

Intraosseous pituitary macroadenoma

A

Invade inferiorly into bone

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12
Q

Parasaggital skull base tumours

Summary

A
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13
Q

Petroclival chondrosarcoma

A

In region of pertroclival synchondrosis

Very bright T2
Present with 6th nerve palsy due to relation with dorellos canal

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14
Q

DO NOT TOUCH
lesion in skull base

A
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15
Q

What is helpful in differentiating cavernous sinus meningioma vs pituitary adenoma?

A

Meningioma follows signal of grey matter.

Use MR Spectroscopy - meningioma will have a peak (look up)

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16
Q

Perineural spread along V2 - example

A
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17
Q

Lateral central skull base pathology

Summary

A
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18
Q

Spheno-orbital bone masses

A

Consider:

  • Sphenoorbital meningoma (ca n have soft tissue components extending into orbit)
  • Osteosarcoma
  • Mets
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19
Q

Posterior skull base tumours

Summary

20
Q

Schwannoma vs paraganglioma vs meningioma of Jugular foramen

A

Remodelling and expansion - schwannoma

21
Q

Sensory and motor cranial nerve

Summary

A

Mixed: 5th, 7th, 9th, 10th

22
Q

Olfactory Bulb

Anatomy and size

A

Can vary with age and sex.

Olfactory bulb can regenerate.

Look for asymmetry - sign of atrophy

Small olfactory cilia can be torn off the bone in trauma - see first image

23
Q

Olfactory anatomy in temporal lobe

24
Q

Best way to visualise optic tract?

A

Align volume FLAIR with chiasm saggitally

25
Q

Best sequence to look at brainstem nuclei on MRI

A

Best is

m-FFE images (early, middle and late TE echoes in 1 image).

Will give these:
-myelinated is black
-unmyelinated = grey

26
Q

Best sequences for looking at cavernous sinus on coronal CN?

A

TSE T1 High resolution 2.3 mm thick + C

27
Q

To visualise 4th nerve

A

Look at dorsal midbrain on CISS T2

28
Q

6th nerve anatomy

A

Use 2.3m slices

Give gad to enhance basilar plexus posterior to clivus - will see 6th entering dorellos

29
Q

INO summary

30
Q

Trigeminal nerve

V2 anatomy

A

Pathology at any level along nerve can cause v1/v2/v3 distribution symtoms

Therefore should image all course of nerve to level of C3

31
Q

Where do 5th V2 and 7th nerve contact?

A

Sphenopalatine gangliona in PPF

32
Q

Trigeminal V3

Anatomy

A

Ovale, mandibular nerve and lingual nerve

Can see on

3D CRANII

33
Q

Best sequence to look for pathological enhancement of 7th nerve?

A

Black blood with GAD

Black blood will null vessels so any enhancemnt is abnormal.

On a standard T1 post GAD - the only reliable abnormal enhancement is at Labryinth segment and fundus of IAC

34
Q

Best sequence to visualise 9-12th CN?

35
Q

Function of Vagus and Accessory

36
Q

Course of hypoglossal nerve in H&N

37
Q

What is only CN to pass inferior to hyoid?

38
Q

Schwannoma vs Neurofibroma

Imaging features

39
Q

What to think of in bilateral CN enhancement?

What to think in leptomeninges and nerve enhancement?

40
Q

Sequences for intrcranial extra-axial nerves

  • Within cisterns
  • Skull base foramina
41
Q

3rd nerve palsy

Pupil sparing vs not spared

What are causes?

42
Q

Extracranial nerves

How to image? sequences

43
Q

Best way to image optic neuritis

A

Black blood post contrast is best
- all arteries and veins suppressed

3D FLAIR FATSAT is more sensitive than T1 + Gad

44
Q

Imaging for paraganglioma

A

Non contrast MR angiography is best. Look for dots.

Inject contrast to look for extent of paraganglioma.

45
Q

Vocal cord palsy

What are imaging apperances?

Head & Neck (11 decks)

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