how different syndromes or diseases are seen

Question 1

Sagging brain charactristica on MRI

Answer 1

• low lying cerebellar tonsills
• utplåning - effacement- of perichiasmatic and prepontine cisterns
• bowing of optic chiasm
• flattening of pons
• ventricular collapse

Question 2

radiological features of chronic hcph

Answer 2

see page 414

Question 3

2 imaging criteria for hcph

Answer 3

1. Size of temporal horns 2mm or more bilaterally at the same time as sylvian and interhemispheric fissures and cerebral fissures are not visible.
2. Both TH are more/equal to 2 mm AND the ratio frontal horn/intracranial diameter (same site) is more than 0.5.

Question 4

What does high intensity signal periventricularly on T2WI suggest?

Answer 4

Probably stasis of fluid in brain adjacent to hcph ventricles.

Obs! it is NOT transependymal absorption of CSF that previously was belived.

Question 5

What is Evans ratio?

Answer 5

frontal horn diameter/maximal biparietal diameter (mellan inre begränsningarna av kraniet) in the same CT slice enligt greenberg. Om mer än 0.3 talar det för hcph. Gäller för vuxna. Underestimerar i barn.

Question 6

Vad kan ske med corpus callosum vid kronisk hcph?

Answer 6

• förtunning
• uppåtböjning.

Question 7

What structure shows Popcorn sign?

Answer 7

cavernomas

Question 8

What tumor show soap bubble appearance?

Answer 8

DNET - dysembryoblastic neuroepithelial tumors.

Question 9

What pediatric tumor show sal-and-pepper appearance?

Answer 9

Polymorphous low-grade neuroepithelial tumor of the young - PLNTY

Question 10

high grade astrocytoma with piloid features

Answer 10

posterior fossa, especially cerebellum.
HIgh T2 signal, low T1 and no diffusion restriction.

Question 11

Typical finding for HSV1?

Answer 11

Transsylvian sign - bilateral high T2 signal in temporal lobe.

Question 12

How does Cysticercosis look?

Answer 12

Like a sweizer-ost

Question 13

What is the primary host of Echinococcus granulosa?

Answer 13

Dog.

Question 14

What animals are intermediate hosts for Echinoccocal larval stage?

Answer 14

Human and sheep

Question 15

How is the cyst of Echinoccocus reaching the human white matter?

Answer 15

The embryonated, infected stage is released in dog feces and eaten by humans. Oncospheres hatches in the human intesine and penetrates the intestinal wall. It travels to multiple organs, among those the brain where it stays as HYDATIDE CYSTS.

Question 16

Is there one or several Hydatide echinoccocal cysts normally in the brain?

Answer 16

If it is a primary cyst, its one.
If its a secondary cyst - embolised from the heart - its multiple.

Question 17

How does a hydatid cyst look on CT?

Answer 17

Its a non-enhancing lesion with little edema and with density similar to CSF. BUT! It contains germinating parasitic particles - “Hydatide sand”.
It grows about 1cm in diameter/year

Question 18

How and when does Hydatide cysts from echinococcosis present?

Answer 18

Late. When they are really big usually. The patient is eosinophilic and show positive serology.

Question 19

WHAT is the treatment of echinococcosis intracranially?

Answer 19

Water dissection! Remove the cyst intact or have a GREAT problem.