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Rad video > Head & neck > Flashcards

Head & neck Flashcards

1
Q

Bad signs of acute subdural haematoma

4

A

Heterogeneity
Convexity
Inc Mass effect
SAH

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2
Q

Features of isodense SDH

Further imaging

A

Unexplained mass effect
Effaced sulci
“thick’ cortex”
WM buckling

Do contrast
MR diagnostic

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3
Q

Traumatic brain haematoma - ring enhancing lesion
Diagnostic aids/clues
4

A

Bilateral
Orbitofrontal
Haemosiderin ring
Other injuries

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4
Q

Diffuse axonal injury
Grading - 3
Deeper lesions worse prognosis

A

1 : lobar WM. Lesions bloom

2: involves corpus callosum typically splenium
3: Dorsolateral midbrain

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5
Q

Worrying features of skull fractures

7

A 
Overlies a dural sinus
Overlies MMA
Overlies eloquent cortex
Depressed > table width
Open/compound
Traverses ICA canal
Temporal bone # ( opacification of mastoid air cells)
Skull base # ( blood in sphenoid sinus)
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6
Q

Carotico-cavernous fistula CT findings

5

A 
Proptosis
Enlarged extra ocular muscles
Convex ipsilateral CS
Enlarged superior opthalmic vein
Retrobulbar fat stranding
Check Brain - venous infarcts
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7
Q

Early NCCT signs of stroke
3

Penumbra on PWI : at risk area

DWI : infarct core

A

Loss of GW differentiation : insular ribbon sign, BG effacement (less delineation)

Dense artery sign (30%) - asymm, correlates c Sx

Hypodensity

Subacute : gyriform CE

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8
Q

Distal Carotid artery dissection features

A

mid to distal ICA below cavernous segment
Bulb spared
NO false lumen
Subintimal haematoma ( do MRI T1 FS - methaemaglobin in wall)
DSA may be normal!

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9
Q

Proximal carotid artery dissection features

A 
Progression of aortic dissection
CCA
ICA extension uncommon
False lumen
May be asymptomatic
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10
Q

ICA dissection imaging signs

A 
location unusual for atherosclerosis ( bulb spared)
string sign
aneurysmal dilatation
occlusion
intimal flap may be seen
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11
Q

Amyloid angiopathy
features
B-amyloid peptide deposition

A

Lobar haemorrhage in elderly (15% >60y, 50%>70y)

Subcortical microhaemorrhages, spares BG cf HTN

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12
Q

Non traumatic ICH

causes

A 
Underlying lesion: tumour, AVM, cavernoma, aneurysm
Amyloid angiopathy
Dural sinus thrombosis
Hypertension
Coagulopathy
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13
Q

Hypertensive haemorrhage

locations & pattern

A

Putamen/EC - 60%
Thalamus - 15-25%
Pons/CBL - 10%
Lobar 5-15%

Acute focal haematoma
Subacute/ch microbleeds

CTA dot sign - active bleed

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14
Q

Cavernous malformation

features

A

Discrete collections of endothelial lined sinusoids

Vascular hamartoma

ICH risk - 0.15-1% annually

Sporadic- 75%, familial 10-30% ( fam cavernomatosis)

Angiographically occult

Associated DVA

COMPLETE haemosiderin rim

Variable SI locules

Popcorn appearance

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15
Q

Capillary telangiectasia in brain

A 
Brainstem
Ass with radiation
No T2 abnormality
Brush like Ca+
GRE blooming
Do not touch
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16
Q

Spetzler-Martin Grading AVM
Size
Eloquence
Venous drainage

A

<3cm - 1
3-6cm -2
>6cm - 3

Eloquence 1 - 0

Venous drainage superficial/deep

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17
Q

RF for intracranial aneurysms

9

A 
Smoking
Cocaine
Age > 50y
Female > Male
FMD
Anatomic variants eg trigem artery
Type IV Ehlers Danlos
NF 1
ADPCKD
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18
Q

Trigeminal artery vs Persistent fetal PCA

A

Trigeminal originates from CAVERNOUS ICA to BA

persist fetal from supraclinoid ICA (above sella)

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19
Q

PseudoSAH
causes
4

A

Cellular material ( infection, carcinomatosis, granulomatous etc, clean ventricles)
Iodinated contrast (myelogram, leak due to RF etc)
CSF Hypotension
Anoxia

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20
Q

Pseudopseudo SAH

A

Global anoxia/hypoxia due to dense venous stasis (white cerebellum, indistinct BG, no hydrocephalus)

CSF hypotension : ?crowded normal blood vessels, SD collections and large dural sinuses

No hydrocephalus

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21
Q

Idiopathic intracranial hypertension
( BIH, pseudotumour cerebri)
Features
RF

A 
Women
3rd decade
Obese/weight gain
May be drug induced(steroids)
Papilloedema
Headaches, visual obs, diplopia, pulsatile tinnitus
Look for secondary causes 
Empty sella
Flat post globe
Vert tortuous , distended ON sheath
Slit like ventricles - rare
Focal compression mid transverse sinuses (pseudostenosis)
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22
Q

Infarcts in young patients

4 main cause categories

A

Cardiovascular: CHD, valve disease, LA myxoma

Prothrombotic: SCD

Inherited: vascular - neurocut, CADASIL ; metabolic : MELAS, homocystinuria

Acquired : dissection, NAI, moya-moya, systemic angiitis, migraines, OCP, street drugs

23
Q

Paediatric BG calcification

4 main

A

Fahr’s

Hypo/hyper parathyroidism

MELAS - stroke like cortical lesions that cross vascular territories, parieto-occipital, inc lactate on MRS ( in normal brain regions)

HIV

24
Q

MELAS

mitochondrial myopathy/angiopathy
encephalopathy
lactic acidosis
stroke-like episodes

A

2nd decade
parieto-occipital
inc lactate in normal brain
progressive with periodic exacerbations

25
Q

Pontine hyperintensity
causes
4 main

A

Ischaemia

Infection

Neoplasm - glioma

WM pathology: demyelination, myelinolysis, PML

26
Q

Central pontine myelinolysis
( osmotic myelinolysis)

alcoholics, malnutrition, Tx, burn

spastic quadraparesis
pseudobulbar palsy
often rapidly progressive

A

non-inflammatory, non vascular
acute destruction of myelin

Symmetrical T2/FL hyper
Diff +
No post CE
batwing contour 
Spares corticospinal and peripheral tracts

Can have symmetrical extrapontine lesions : BG, thalami, midbrain

27
Q

Posterior reversible encephalopathy syndrome

clinical
CT
MRI - locations (5)

A

acute encephalopathy
WM hyperintensity
vasogenic oedema (no DWI unless non reversible component))
No CE

posterior fossa
parietal
occipital
posterior frontal
temporal

many associations!

10% have haemorrhage/infarcts

28
Q

Mural nodule with cyst

intracranial

A

Juvenile pilocytic astrocytoma (CE wall)
Pleomorphic xanthoastrocytoma
Ganglioglioma
Haemangioblastoma ( non CE wall, PF)

29
Q 
Pleomorphic xanthoastrocytoma
Demo
location
RF
prognosis
A 
rare
astrocytoma subtype
children and young adults
superficial cortical location
Temporal most common
Cyst with mural nodule
minimal oedema
good prognosis
30
Q

Oligodendrogliomas

A 
low grade and anaplastic
younger patients
better prognosis cf astro
frontal lobe most common
Cortical expansion
cortical involvement
Ca 2+ > 80%
Can appear aggressive
Variable CE
31
Q

Intracranial tumours with Ca

5

A 
Oligodendroglioma
Ependymoma
Craniopharyngioma
Choroid plexus tumour
Meningioma
32
Q

Intracranial chondrosarcoma

4 features

A

v. rare
Extra axial
very well defined
Do not have calcium

33
Q

Intraparenchymal lesions with dural involvement

2

A

Metastases
Lymphoma
V. rare for glioblastoma

34
Q

Subependymoma vs central neurocytoma

A

attached to septum pellucidum
Only neurocytoma enhances
Neurocytoma v. vascular!

35
Q

Tumours with CSF Dissemination

5

A 
PNET
Medulloblastoma
Pineoblastoma
Ependymoma
Choroid plexus Ca.
36
Q

Mass lesions with diffusion restriction

4

A

Epidermoid

Abscess

Mucinous adenoca mets

Cellular tumours: lymphoma, PNET, meningioma

37
Q

Tumour mimicking brain lesions

4

A

Radiation necrosis ( esp bilateral, non vascular)

Tumefactive demyelinating lesion

Pyogenic abscess

Toxoplasma encephalitis

38
Q

CADASIL Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopathy

Demo
RF

A

hereditary Small vessel disease
causes stroke in young-middle adults
earlier age of stroke onset
inc frequency of migraine aura/hemiplegic migraine
variable pattern of ischaemic WM lesions on MR

involvement of temporal poles characteristic

39
Q

Griesingers sign

A

Oedema of post auricular soft tissues due to thrombosis of mastoid emissary vein

40
Q

Types of MS

5

A

Clinically isolated Xd ( 85%)
Relapsing-remitting
Secondary progressive MS
Benign MS ( 10-20%, relapsing ms with no long term disability)
Primary progressive ( 15%) - steady progression without clear cut relapses)

41
Q

MS characteristic locations

A 
Juxtacortical
Periventricular ( Dawsons)
Infratentorial ( dentate)
Spinal cord < 2 segments
Visual pathways
42
Q

Paraganglioma of neck types based on location

4

A

Tympanic : glomus tympanicum

Jugular foramen : glomus jugulare

2cm below skull base (nodose ganglion): glomus vagale, does not enter jug foramen.

Carotid body tumour

43
Q

Kallman Xd

A

M:F 5:1
Olfactory agenesis
Hypogonadotrophic hypogonadism

44
Q

Intrinsic malignancy of olfactory tract

A

Esthesioneuroblastoma
… v rare
…PNET malignancy
…two peaks - paed , > 50yrs

45
Q

Olfactory sulcus

depth to rule out congenital anosmia

A

8mm

46
Q

Vestibular Schwannomas
arise in..
location..

A

Vestibular nerve only

At junction of neuroglial and schwann cells in IAC/porus 95% of time

47
Q

Uncommon features of Vestibular Schwannoma

A

Almost totally cystic (larger tumours are solid/cystic)
Medial (5%) in CPA cistern
Associated peripheral arachnoid cyst

48
Q

Pathognomonic feature of meningioma

A

focal enostosis ( bony spur) marks entrance of mengieal vascular pedicle

49
Q

CSF like lesions in CPA

5

A 
Epidermoid
Arachnoid
Cystic schwannoma
Post op secondary arachnoid
VS with peripheral arachnoid cyst
50
Q

Extension pattern of glomus tumours

A

tympanicum : bone between hypotympanum and jugular foramen

Lateral : mastoid , salt/pepper appearance

anterior : filling up middle ear, pars petrosum towards apex

Intra/extra axial extension

51
Q

Radiological features of glomus tumour

CT
MRI
Angio
Ddx

A

CT : enlargement of jugular foramen with bone erosion

MR : intratumoral vessels

Fixed extension patterns

Angio : very vascular

DDx : schwannoma, meningioma

52
Q

H & N manifestations of Wegeners

A 
Laryngeal involvement - usually subglottic stenosis ( circumferential thickening CE + non sp.)
Sore throat
Laryngitis
OM,
Sinusitis
Saddle nose deformity
53
Q

Sign of chronic VC denervation palsy on CT

A

posterior cricoarytenoid muscle atrophy

atrophy of muscles(fat replacement) adjacent to VC

Rad video (10 decks)

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