J. Mandell & D. Marchiori

Question 1

Epidural hematoma can occur within the spine or skull, with blood accumulating where?

Answer 1

Between the dura and bone

Question 2

Which artery is most commonly involved when there is skull trauma?

Answer 2

Middle meningeal artery

Question 3

What percentage of people with epidural hematoma experience a coexisting skull fracture?

Answer 3

> 90%

Question 4

Subdural hematomas are more often caused by _____ rather than arterial damage

Answer 4

More often caused by venous damage

Often slow to develop

Question 5

Subdural hematomas are more common in elderly patients who take what kind of medication?

Answer 5

Anti-coagulants

As well as those with alcoholism

Question 6

Most non-traumatic subarachnoid hemorrhage is related to what condition?

Answer 6

Aneurysmal rupture

Question 7

Acute encephalitis is most commonly associated with which organism?

Answer 7

Herpes simplex type I

Arbovirus

Question 8

An intracranial epidural abscess (IEA) is most likely caused by what?

Answer 8

Secondary to direct extension from a local:
Paranasal sinus infection
Sinusitis
Otitis media
Matoiditis 
Dental abscess

Question 9

What is the most common cause of spinal epidural abscess (SEA)?

Answer 9

Hematogenous spread (2/3 of cases)

Question 10

Neurosarcoidosis is an uncommon manifestation of the disease. What is needed for definitive diagnosis?

Answer 10

Biopsy

Question 11

Gliomas comprise of approximately what percentage of all primary brain tumors?

Answer 11

60%

Meningiomas make up 20%

Question 12

What kind of gliomas are most prevalent?

Answer 12

Astrocytomas account for 2/3 of cases of gliomas

Question 13

Glial tumors include the following

Answer 13

Astrocytomas
Ependymomas
Oligodendrogliomas
Mixed astrocytomas

Question 14

Which glial tumor is considered the most malignant?

Answer 14

Glioblastoma multiforme

Question 15

Glioblastomas frequently displays the following

Answer 15

Mitosis
Endothelial proliferation
Necrosis
Abnormal neovascularity

Question 16

What is the most common location for intracranial ependymomas?

Answer 16

Roof of the 4th ventricle

Question 17

Intracranial ependymomas have a predilection for which population?

Answer 17

Children

Question 18

Spinal ependymomas are more common in which age range?

Answer 18

Adults

Question 19

Spinal astrocytomas are more common in which age range?

Answer 19

Children

Question 20

Oligodendrogliomas are most frequently diagnosed in which decade of life?

Answer 20

4th decade

Question 21

Intense gadolinium contrast enhancement occurs homogeneously in approximately what percentage of meningiomas?

Answer 21

85%

Question 22

Meningiomas are generally slow growing and does not produce symptoms until when?

Answer 22

Until critical neural structures become compressed upon

Meningiomas are frequently large when diagnosed

Question 23

What is the most common type of intracranial schwannoma?

Answer 23

Acoustic neuroma

Trigeminal neuroma is second most common but occurs much less frequently

Question 24

Pituitary adenomas arise from what kind of cells located where?

Answer 24

Epithelial cells of the adenohypophysis (anterior lobe)

Question 25

What is the peak age range seen in pituitary adenomas?

Answer 25

20-60 years old

Question 26

Pituitary adenomas can be designated my size as follows

Answer 26

Microadenomas (< 10mm) | Macroadenomas (> 10mm)

Question 27

Medulloblastoma is a type of intracranial glioma, it is known as the following

Answer 27

Most common malignant posterior fossa tumor of childhood

Question 28

Where do most medulloblastomas arise?

Answer 28

Floor of the 4th ventricle and vermis cerebelli in younger children Hemispheres of cerebellum in older children

Question 29

Craniopharyngioma evolves from what kind of cells?

Answer 29

Epithelial cells within Rathke clef, the embryonal anatomic precursor to adenohypophysis (anterior lobes f pituitary gland)

Question 30

Common locations for craniopharyngiomas include the following

Answer 30

Suprasellar cistern Third ventricle Within the sella turcica

Question 31

What is a common complication of craniopharyngiomas?

Answer 31

Hydrocephalus

Question 32

Craniopharyngiomas are found most frequently in which population?

Answer 32

Pediatric population

Question 33

What is considered the normal measurement of cerebellar tonsils below the foramen magnum?

Answer 33

No more than 3mm

Question 34

A Chiari malformation is herniation of the cerebellar tonsils through the foramen magnum, at what measurement do we consider it a true herniation?

Answer 34

5mm past the foramen magnum

Question 35

With a Chiari malformation of greater than 12mm, what percentage of patients experience symptoms?

Answer 35

100% | In those with between 5-10mm of herniation, 70% will experience symptoms

Question 36

Describe Chiari malformation type I

Answer 36

Wedge/peg-shaped inferior displacement of cerebellar tonsils Exceeds > 3mm Crowding of the craniocervical junction Basilar invagination (seen in 25%) Associated with occipitalization of C1 Associated with Klippel-Feil syndrome Associated with diminished size of 4th ventricle

Question 37

Chiari malformation type II involves the following

Answer 37

Cephalocaudad elongation of 4th ventricle Hydrocephalus Syringomyelia Lumbar meningoencephalocele

Question 38

Describe Chiari malformation type III

Answer 38

Herniation of cerebellum through foramen magnum Often associated with uninvited neural arch in cervical spine Possible encephalocele

Question 39

Describe Chiari malformation type IV

Answer 39

Severe form of cerebellar hypoplasia without tonsillar ectopic May not represent true Chiari-type malformation

Question 40

Describe the "empty sella" syndrome

Answer 40

Presence of CSF within cavity of sella turcica

Question 41

What causes primary "empty sella" syndrome?

Answer 41

Likely develops from a defect in the diaphragmatic sella, allowing CSF to enter the sella

Question 42

What other conditions are associated with primary "empty sella" syndrome?

Answer 42

Obesity Past pregnancy High blood pressure

Question 43

Secondary "empty sella" syndrome is created by what?

Answer 43

``` A space void created when pituitary gland shrinks Often a result of: Radiation therapy Injury Surgery ```

Question 44

A Tarlov cyst is dilatation of which space?

Answer 44

Subarachnoid space surrounding a spinal nerve root

Question 45

Approximately what percentage of Tarlov cysts are asymptomatic?

Answer 45

80%

Question 46

What location is the most common for Tarlov cysts?

Answer 46

S2 | Bone erosion is a common feature of large cysts