Lecture Flashcards
Three categories of intradural tumors
Intradural intramedullary, intradural extramedullary, cauda equine tumors
Most common intramedullary tumors
Ependymom and astrocytoma (pilocytic, low grade fibrillary)
Intra-medullary processes that can mimic neoplasms (4)
- vascular malformations
- infections
- demyelination
- radiation changes.
Common pathological subtypes of ependymoma (2)
- cellular
2. myxopapillary
E;pendymoma appearance on imaging (4)
- multi-segmental expansion of spinal cord
- isointense on T1 and hyperintense on T2
- hemosiderin deposition is common.
- intense sharply defined enhancement patterns.
Pathological subtypes of astrocytoma (2)
- fibrillary (grade II through IV)
2. pilocytic (I) (54%)
True or false: astrocytoma cannot involve the entire cord
False
Disease associated with hemangioblastoma
Von Hippel-Lindau syndrome
Common locations of hemangioblastoma (2)
Thoracic and cervical
Appearance of hemangioblastoma (4)
- expansile spinal cord mass
- prominent flow voids
- cyst and syrinx formation
- intensely enhancing pial-based mural nodule or solid mass. (ie usually not in center of cord***)
Common intradural tumors (2)
- Nerve sheath tumors (schwannoma, NF)
2. meningioma
True or false, most intradural tumors are malignant
False
Classic findings of intradural extramedullary tumors
widening of the ipsilateral subarachnoid space
Two subtypes of nerve sheath tumors
- schwannoma (sporadic, NF2)
2. neurofibroma (NF 1)
Origin of nerve sheath tumors
Sensory nerve roots
Most common location of nerve sheath tumors
Lumbar > thoracic = cervical
Appearance of nerve sheatlh tumors on imaging
- isointense on T1 and hyperintense T2
- Common cystic degeneration and hemorrhage
- intense and sharply defined enhancement
Intradural metastases aka….
drop metasteses
Two common cauda equina tumors
- Nerve sheath tumors
2. ependymoma (myxopapillary)
Desribe pre-styloid parapharyngeal space
Composed primarily of fat. Shaped like an inverted pyramid (widest at top)
Contents of pre-styloid paraphryngeal space (3)
- Fat
- CN V3
- ectopic salivary gland
Lesions of the pre-styloid paraphryngeal space (4)
- Lipoma (rare)
- schwannoma
- salivary gland neoplasm
- inflammation/abscess
Contents of the post-styloid parapharyngeal space (5)
- carotid artery
- jugular vein
- CN IX, X, XI, XII
- sympathetic plexus
- lymph nodes
Lesions of the post styloid parapharyngeal space (5)
- pseudoaneurysm
- jugular v. thrombosis
- schwannoma
- paraganglioma
- lymphadenopathy
Where is vagus relative to carotid in post styloid parapharyngeal space?
Posterior
Salt and pepper appearance on MR
Paraganglioma. Bright from enhancement, dark from high vascular flow voids.
Conents of parotid space (4)
- Parotid gland
- parotid duct
- CN VII
- lymph nodes
Lesions of parotid space (4)
- salivary gland neoplasms/cyst
- duct dilatation, infection/abscess
- schwannoma
- lymphadenopathy.
Contents of the masticator space (3)
- mandible
- muscles of mastication
- CN V3
Lesions of the masticator space (4)
- Infection/abscess
- Venous vascular malformation
- ?
- ?
How does a retropharyngeal space lesion displace muscles?
Longus colli and capitis muscles displaced posteriorly
If forward, lesion usually in prevertebral space
Separates prevetertebral and paraspinal spaces
Transverse processes.
From which artery does the middle meningeal artery arise?
Maxillary artery
Which foramen does middle meningeal enter through
Foramen spinosum
Artery supplies the caudate and where do they come from
Medial lenticulostriate from A1
Artery that supplies the posterior limb of the internal capsule
Anterior choroidal artery (off of internal carotid)
First artery arising from the ICA after it passes through the dura
Ophthalmic artery
Artery that supplies the medial temporal lobes
Posterior cerebral artery
Supplies head of caudate, anterior lentiform nucleus, anterior internal capsule
Recurrent artery of Heubner
True or false: does fenestration increase the likelihood of aneurysm?
True
Single ACA is called?
Azygous ACA
True or false: azygous ACA increases likelihood of aneurysm?
True
True or false: hypoplastic ACA increases likelihood of aneurysm
False
DVA
Developmental venous anomaly
Which other vascular lesions is a/w DVA?
Cavernous malformation.
Grisel’s syndrome
Non traumatic atlantoaxial subluxation due to hematogenous seeding of the CV junction through pharnygovertebral veins after URI, retropharyngeal abscess or other head/neck infection.
Deposition of calcium of longus colli with secondary inflammation and retropharyngeal effusion
Acute calcific prevertebral tendinitis.
