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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
Craniofaringioma - Prevalência
Pico entre 10-14 anos | Segundo pico: 30-60 anos
26
Craniofaringioma - Distribuição por sexo
Homens > mulheres
27
Craniofaringioma - Divisão histológica
Adamantinomatoso Papilar
28
Craniofaringioma - Qual tipo pediátrico? | Principais aspectos macroscópicos
Adamantinomatoso | Lesão suprasselar sólido-cística (multicística) com calcificações
29
Craniofaringioma adamantinomatoso - Características do sinal em T1 e T2.
T1: cistos com sinal variável (dependendo do conteúdo proteico) T2: hipersinal tanto da porção cística quanto da sólida
30
Craniofaringioma adamantinomatoso - Captação.
Realce heterogêneo da porção sólida | Realce parietal fino das paredes dos cistos
31
Craniofaringioma adamantinomatoso - T2*
Focos de hipossinal (calcificações)
32
Craniofaringioma adamantinomatoso - **Padrão mais característico**.
Massa lobulada com grandes císticos hiperintensos no T1
33
Craniofaringioma papilar - Quais características sugerem mais esse tipo?
Menores, arredondado, predominantemente sólidos, com cistos hipointensos no T1.
34
Germinoma - Percentual de lesões sincrônicas hipotálamo-pineal?
10%
35
Germinoma - Localização
Infundíbulo e assoalho do terceiro ventrículo.
36
Germinoma - Padrão de sinal no T1 e T2.
T1: Hipointenso T2: Iso a Hiperintenso
37
Germinoma - Realce?
Homogêneo e ávido ## Footnote Pode ser heterogêneo em lesões maiores devido à necrose.
38
Hamartoma - Image pattern
Mass in the tuber cinereum
39
Hamartoma - Tipos.
Parahipotalâmico Intrahipotalâmico
40
Hamartoma - Apresentação do parahipotalâmico.
Massa pedunculada presa ao assoalho do terceiro ventrículo
41
Hamartoma - Clínica classica do parahipotalâmico.
Puberdade precoce
42
Hamartoma - Clínica clássica do intrahipotalâmico.
Crises gelásticas
43
Hamartoma - Padrão de imagem do intrahipotalâmico.
Lesão séssil bem definida do túber cinéreo
44
Hamartoma - Qual achado define?
Ausência de realce pelo meio de contraste
45
Osteolipoma - Macroscopic apperance
Central adipose with peripheral osseous tissues
46
Osteolipoma - Location
Tuber cinereum (between infundibulum and the mamillary bodies)
47
Osteolipoma - Imagem pattern
Well-definined mass with both fat and bone signal
48
Osteolipoma - Signal pattern
T1/T2 hyperintensity that supresses on fat sat central with peripheral low signal (bone)
49
Dermoid and Epidermoid cyst - Origin
Inclusion epithelial cysts derived from the neural tube closure
50
Dermoid cyst - Content
Fat Sebaceous glands Hair
51
Dermoid cyst - Signal pattern
High T1 and T2 signal with partial suppression on fat sat | FLAIR: heterogeneous
52
Epidemoid cyst - Location prevalence
Cerebellopontine angle cistern (most common) | Suprasellar (2nd most common)
53
Epidemoid cyst - Signal pattern
T1/T2 heterogeneous signal slightly hyperintense compared with aracnoid cyst
54
Epidemoid cyst - DWI/FLAIR
High signal (heterogeneous)
55
RCC - Origin
Rathke pouch remnants
56
RCC - Location
Partially intrasellar and partially suprasellar
57
RCC - Image pattern
Round, sharply defined intra- or suprasellar mass | Axial: between anterior and posterior pituitary
58
RCC - Signal pattern
Variable May resemble CSF (High T2, Low T1) May show High T1, Low T2 owing to high mucopolysaccharide content
59
RCC - T1 C+
No enhancement
60
Colloid cyst - Most common location
Midline in the foramen of Monro
61
Colloid cyst - Signal intensity
Variable | Most common: T1 high, T2 low
62
Glioma - Prevalence in children
10-15% supratentorial tumors | 2-4 years old
63
Glioma - Disease association
NF 1 (20-50%)
64
Glioma - Signal pattern
T1: hypointense | T2/FLAIR: hyperintense
65
Glioma - Image pattern
Small tumors are solid | Bigger masses may have cystic component
66
Glioma - T1 C+
Heterogenous enhacement
67
Why is the infundibular stalk and the pituitary gland more prone to metastatic disease?
Lack of blood-brain barrier
68
Metastasis - Common primary sites
Woman: breast, lung, stomach, and uterus Man: lung, prostate, urinary bladder, stomach and pancreas
69
Metastasis - Signal pattern
T1: isointense | T1 C+: heterogeneous enhancement
70
Metastasis - Image clue
Destroy adjacent bone unlike adenomas, that show marked sellar enlargement
71
LCH - Prevalence
Children more common (under 15 years of age) | < 30% reported in adults
72
LCH - Anatomic predilection
Hypothalamic-pituitary axis
73
LCH - Most common finding
Thickening (3 mm) of the infundibular stalk
74
LCH - Image pattern
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
LCH - T1 C+
Intense homogeneous enhacement
76
Hypophysitis - Image pattern
Enlargement of the hypothalamus and infundibulum, and sometimes the gland itself
77
Hypophysitis - T1 C+
Uniform contrast enhancement
78
Sarcoidosis - Image Pattern
``` Leptomeningeal disease (basal) Hypothalamic-pituitary axis (thick enhancing infundibulum) ```
79
Sarcoidosis - Signal Pattern
T1: isointense T2: hypointense
80
Age association - < 5 years
Glioma
81
Age association - Children
Craniopharyngioma Hamartoma Germinoma
82
Age association - Young adults
RCC Meningiomas Inflamatory processes
83
Age association - Older patients
Metastasis
84
Clinical association - Gelastic seizures
Hamartomas
85
Clinical association - DI
Germ cell tumors | Granulomatous diseases
86
Clinical association - DI and gliomas
Develop later in the course of the disease
87
Anatomical association - Tuber cinereum
Osteolipoma | Hamartoma
88
Anatomical association - Infundibulum thickening
Germ cell tumors Lymphocytic hypophysitis Sarcoidosis LCH Note: idiopathic in central DI
89
Anatomical association - Optic chiasm and nerves
Hypothalamic-chiasmatic glioma
90
MR spectroscopy - Gliomas
High Coline | Low NAA
91
MR spectroscopy - Craniopharyngiomas
Dominant lipid peak (1 ppm)
92
MR spectroscopy - Hamartoma
Low NAA | High myoinositol
93
Dynamic contrast - Progressive enhancement without washout
Germinomas LCH Hemangioblastomas
94
Dynamic contrast - Sharp rise enhancement with washout
Lymphocytic hypophysitis

Neurorradiologia (19 decks)

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