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Neurorradiologia > Hypothalamus Lesions > Flashcards

Hypothalamus Lesions Flashcards

1
Q

Lesão hipotalâmica - Principais hipóteses entre as congênitas/desenvolvimento.

A
  • Craniofaringioma
  • Harmatoma
  • Lipoma
  • Cisto dermoide e epidermoide
  • Cisto aracnoide
  • Cisto da bolsa de Rathke
  • Cisto coloide
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2
Q

Lesão hipotalâmica - Principais hipóteses entre os tumores primários do SNC.

A
  • Glioma hipotálamo-quiasmático
  • Ganglioglioma
  • Meningioma perisselar
  • Germinoma
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3
Q

Lesão hipotalâmica - Principais hipóteses entre as lesões vasculares.

A

Hemangioblastoma

Cavernoma

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4
Q

Lesão hipotalâmica - Principais hipóteses entre lesões neoplásicas secundárias.

A
  • Metástase
  • Linfoma
  • Leucemia
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5
Q

Lesão hipotalâmica - Principais hipóteses entre as inflamatórias.

A
  • Histiocitose de células de Langerhans
  • Hipofisite linfocítica
  • Sarcoidose
  • Granulomatose de Wegener
  • Tuberculose
  • Sífilis
  • Encefalite
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6
Q

Lesão hipotalâmica - Principais hipóteses entre lesões de estruturas adjacentes?

A
  • Adenoma hipofisário
  • Neurohipófise ectópica
  • Aneurismas
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7
Q

Quais estruturas delimitam o hipotálamo?

A

**Superior:** linha intercomissural (anterior - posterior)
**Anterior:** lamina terminales
**Floor:** infundíbulo, túber cinéreo e corpos mamilares

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8
Q

Qual estrutura do hipotálamo/sela demonstra realce ávido pelo contraste?

Por que?

A

Haste e glândula hipofisária.

Ausência de barreira hemato-encefálica

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9
Q

Qual a localização clássica dos craniofaringiomas?

A

Porção suprasselar da haste.

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10
Q

Qual a localização clássica dos germinomas?

A

Infundíbulo.

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11
Q

Qual a localização dos hamartomas?

A

Túber cinéreo

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12
Q

Qual a localização clássica dos osteolipomas?

A

Túber cinéreo

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13
Q

Qual a localização clássica dos cistos epidermoides?

A

Parasselar

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14
Q

Qual a localização clássica dos cistos dermoides?

A

Suprasselar/hipotalâmico na linha média.

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15
Q

Qual a localização clássica dos cistos aracnoides?

A

Suprasselar

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16
Q

Qual a localização clássica do cisto da bolsa de Rathke?

A

Intrasellar

Pode, eventualmente, ser suprasselar.

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17
Q

Qual a localização clássica dos gliomas?

A

Hipotalámico-quiasmático

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18
Q

Qual a localização clássica dos meningiomas?

A

Suprasselar

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19
Q

Qual a localização clássica dos hemangioblastomas?

A

Hipotálamo

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20
Q

Qual a localização clássica das metástases?

A

Haste

Hypothalamus

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21
Q

Qual a localização clássica do histiocitose de células de Langerhans?

A

Haste

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22
Q

Qual a localização clássica da sarcoidose?

A

Haste

Cisterna suprasselar

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23
Q

Craniofaringiomas - Derivados de qual estrutura?

A

Remanescentes do ducto craniofaríngeo.

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24
Q

Craniofaringioma - Localização

A

Em qualquer lugar da haste hipofisária

Sobretudo na porção suprasselar.

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25
Q

Craniofaringioma - Prevalência

A

Pico entre 10-14 anos

Segundo pico: 30-60 anos

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26
Q

Craniofaringioma - Distribuição por sexo

A

Homens > mulheres

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27
Q

Craniofaringioma - Divisão histológica

A

Adamantinomatoso
Papilar

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28
Q

Craniofaringioma - Qual tipo pediátrico?

Principais aspectos macroscópicos

A

Adamantinomatoso

| Lesão suprasselar sólido-cística (multicística) com calcificações

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29
Q

Craniofaringioma adamantinomatoso - Características do sinal em T1 e T2.

A

T1: cistos com sinal variável (dependendo do conteúdo proteico)
T2: hipersinal tanto da porção cística quanto da sólida

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30
Q

Craniofaringioma adamantinomatoso - Captação.

A

Realce heterogêneo da porção sólida

Realce parietal fino das paredes dos cistos

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31
Q

Craniofaringioma adamantinomatoso - T2*

A

Focos de hipossinal (calcificações)

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32
Q

Craniofaringioma adamantinomatoso - Padrão mais característico.

A

Massa lobulada com grandes císticos hiperintensos no T1

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33
Q

Craniofaringioma papilar - Quais características sugerem mais esse tipo?

A

Menores, arredondado, predominantemente sólidos, com cistos hipointensos no T1.

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34
Q

Germinoma - Percentual de lesões sincrônicas hipotálamo-pineal?

A

10%

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35
Q

Germinoma - Localização

A

Infundíbulo e assoalho do terceiro ventrículo.

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36
Q

Germinoma - Padrão de sinal no T1 e T2.

A

T1: Hipointenso
T2: Iso a Hiperintenso

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37
Q

Germinoma - Realce?

A

Homogêneo e ávido

Pode ser heterogêneo em lesões maiores devido à necrose.

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38
Q

Hamartoma - Image pattern

A

Mass in the tuber cinereum

39
Q

Hamartoma - Tipos.

A

Parahipotalâmico
Intrahipotalâmico

40
Q

Hamartoma - Apresentação do parahipotalâmico.

A

Massa pedunculada presa ao assoalho do terceiro ventrículo

41
Q

Hamartoma - Clínica classica do parahipotalâmico.

A

Puberdade precoce

42
Q

Hamartoma - Clínica clássica do intrahipotalâmico.

A

Crises gelásticas

43
Q

Hamartoma - Padrão de imagem do intrahipotalâmico.

A

Lesão séssil bem definida do túber cinéreo

44
Q

Hamartoma - Qual achado define?

A

Ausência de realce pelo meio de contraste

45
Q

Osteolipoma - Macroscopic apperance

A

Central adipose with peripheral osseous tissues

46
Q

Osteolipoma - Location

A

Tuber cinereum (between infundibulum and the mamillary bodies)

47
Q

Osteolipoma - Imagem pattern

A

Well-definined mass with both fat and bone signal

48
Q

Osteolipoma - Signal pattern

A

T1/T2 hyperintensity that supresses on fat sat central with peripheral low signal (bone)

49
Q

Dermoid and Epidermoid cyst - Origin

A

Inclusion epithelial cysts derived from the neural tube closure

50
Q

Dermoid cyst - Content

A

Fat
Sebaceous glands
Hair

51
Q

Dermoid cyst - Signal pattern

A

High T1 and T2 signal with partial suppression on fat sat

FLAIR: heterogeneous

52
Q

Epidemoid cyst - Location prevalence

A

Cerebellopontine angle cistern (most common)

Suprasellar (2nd most common)

53
Q

Epidemoid cyst - Signal pattern

A

T1/T2 heterogeneous signal slightly hyperintense compared with aracnoid cyst

54
Q

Epidemoid cyst - DWI/FLAIR

A

High signal (heterogeneous)

55
Q

RCC - Origin

A

Rathke pouch remnants

56
Q

RCC - Location

A

Partially intrasellar and partially suprasellar

57
Q

RCC - Image pattern

A

Round, sharply defined intra- or suprasellar mass

Axial: between anterior and posterior pituitary

58
Q

RCC - Signal pattern

A

Variable
May resemble CSF (High T2, Low T1)
May show High T1, Low T2 owing to high mucopolysaccharide content

59
Q

RCC - T1 C+

A

No enhancement

60
Q

Colloid cyst - Most common location

A

Midline in the foramen of Monro

61
Q

Colloid cyst - Signal intensity

A

Variable

Most common: T1 high, T2 low

62
Q

Glioma - Prevalence in children

A

10-15% supratentorial tumors

2-4 years old

63
Q

Glioma - Disease association

A

NF 1 (20-50%)

64
Q

Glioma - Signal pattern

A

T1: hypointense

T2/FLAIR: hyperintense

65
Q

Glioma - Image pattern

A

Small tumors are solid

Bigger masses may have cystic component

66
Q

Glioma - T1 C+

A

Heterogenous enhacement

67
Q

Why is the infundibular stalk and the pituitary gland more prone to metastatic disease?

A

Lack of blood-brain barrier

68
Q

Metastasis - Common primary sites

A

Woman: breast, lung, stomach, and uterus
Man: lung, prostate, urinary bladder, stomach and pancreas

69
Q

Metastasis - Signal pattern

A

T1: isointense

T1 C+: heterogeneous enhancement

70
Q

Metastasis - Image clue

A

Destroy adjacent bone unlike adenomas, that show marked sellar enlargement

71
Q

LCH - Prevalence

A

Children more common (under 15 years of age)

< 30% reported in adults

72
Q

LCH - Anatomic predilection

A

Hypothalamic-pituitary axis

73
Q

LCH - Most common finding

A

Thickening (3 mm) of the infundibular stalk

74
Q

LCH - Image pattern

A

Mild thickening to a frank mass centered in the superior aspect of the stalk
Loss of the high T1 signal in the posterior pituitary gland

75
Q

LCH - T1 C+

A

Intense homogeneous enhacement

76
Q

Hypophysitis - Image pattern

A

Enlargement of the hypothalamus and infundibulum, and sometimes the gland itself

77
Q

Hypophysitis - T1 C+

A

Uniform contrast enhancement

78
Q

Sarcoidosis - Image Pattern

A 
Leptomeningeal disease (basal)
Hypothalamic-pituitary axis (thick enhancing infundibulum)
79
Q

Sarcoidosis - Signal Pattern

A

T1: isointense
T2: hypointense

80
Q

Age association - < 5 years

A

Glioma

81
Q

Age association - Children

A

Craniopharyngioma
Hamartoma
Germinoma

82
Q

Age association - Young adults

A

RCC
Meningiomas
Inflamatory processes

83
Q

Age association - Older patients

A

Metastasis

84
Q

Clinical association - Gelastic seizures

A

Hamartomas

85
Q

Clinical association - DI

A

Germ cell tumors

Granulomatous diseases

86
Q

Clinical association - DI and gliomas

A

Develop later in the course of the disease

87
Q

Anatomical association - Tuber cinereum

A

Osteolipoma

Hamartoma

88
Q

Anatomical association - Infundibulum thickening

A

Germ cell tumors
Lymphocytic hypophysitis
Sarcoidosis
LCH

Note: idiopathic in central DI

89
Q

Anatomical association - Optic chiasm and nerves

A

Hypothalamic-chiasmatic glioma

90
Q

MR spectroscopy - Gliomas

A

High Coline

Low NAA

91
Q

MR spectroscopy - Craniopharyngiomas

A

Dominant lipid peak (1 ppm)

92
Q

MR spectroscopy - Hamartoma

A

Low NAA

High myoinositol

93
Q

Dynamic contrast - Progressive enhancement without washout

A

Germinomas
LCH
Hemangioblastomas

94
Q

Dynamic contrast - Sharp rise enhancement with washout

A

Lymphocytic hypophysitis

Neurorradiologia (19 decks)

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