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a Prometheus book FRCR Part 2A flashcards > Module 6: Central Nervous, head and neck > Flashcards

Module 6: Central Nervous, head and neck Flashcards

1
Q

Incomplete ring enhancement think

A

demyelination

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2
Q

does stroke restrict

A

yes

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3
Q

do hypercellular tumours restrict

A

yes

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4
Q

Herpes encephalitis, does it restrict

A

yes

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5
Q

Don’t restrcit examples

A

met

atypical infeciton (toxo)

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6
Q

GBM vs lymphoma

A

lymphoma enhances homogenously

GBM - heterogenous, aggressive

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7
Q

dawson fingers
Calloso-septal interface

A

MS

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8
Q

Define for MS

A

seperation in space and time

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9
Q

MS relationship with which virus

A

EBV

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10
Q

MS is rarer closer to

A

the equator

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11
Q

MS trickery

calssic differentials

A

Vasculitius

Lyme

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12
Q

Vasculitis favours the

A

basal ganglia
spares the collosal septal interface

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13
Q

Lymes involves more of the

A

cranial nerves

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14
Q

ADEM stands for

A

acute disseminated encephalomyelitis

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15
Q

ADEM present in

A

childhood after vaccination

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16
Q

ADEM appears as

A

large T2 bright

enhance in ring nodular pattern
though incomplete as demyelination

not invovle the collosal

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17
Q

demyelinating disorder of the spine and optic

A

NMO (Devic)

neuomyelitis optica

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18
Q

CSF is dark can be

A

Flair

or

T1

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19
Q

causes of T1 bright basal ganglia

A

liver failure
hyperlaminetation
high blood sugar
wilsons

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20
Q

does stroke restrict

A

yes

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21
Q

PRES is what

A

vascular autoregulation BBB disruption

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22
Q

PRES affects where

A

bilateral
posterior circulation
watershed areas

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23
Q

PRES history
who gets it

A

HTN
Pregnancy
chemo

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24
Q

Central Pontine Myeloonitis

A

rapidly corrected low sodium level

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25
Q

CPM involves which type of cells

A

oligodendroglial cells

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26
Q

distinguish OM from PRES

A

DWI

but location more of a giveaway

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27
Q

Wernickes encephalopathy is caused by

A

thiamine deficiency

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28
Q

Wernickes get enhancement of the

A

mammillary bodies

T2/Flair signal in bilateral medial thalamus
periaqueductal gray

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29
Q

wernickes ddx

think thalamic insult

A

artery of percheron infarction

internal cerebral vein thrombosis

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30
Q

high signal crossing the corpus collosum

A

Marchiafava-Bignami

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31
Q

Marchiafava-Bignami

seen in

A

drunks

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32
Q

carbon monoxide poisoning

A

CT hypdensity
T2 bright globus pallidus

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33
Q

why would things in the brain NOT enhance

A

the BBB
- extra axial
- disrupted the BBB (aggressive infection or high grade tumour)

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34
Q

enahcnement of low vs high grade tumours

A

high grade DO enhance

  • though JPA, grade 1 WHO, this does enhance
  • also ganglioglioma
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35
Q

Do low grades enhance

A

NO

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36
Q

Do high grades enhance

A

YES

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37
Q

astrocytomas
- two types

A

diffuse

circumscribed

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38
Q

circumbscribes astrocytoma

A

JPA - cyst with nodule

Subependymal giant cell
- arise from lateral ventricle
- ax with TS

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39
Q

any intraventricular tumour will enhance or not enhance

A

will enhance

escapes the BBB

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40
Q

Gliomatosis cerebri

A

diffuse
involves at least 3 lobes

extensive T2 signal
no mass effect

low grade so doesn’t enhance

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41
Q

tumour that is crossing the midline

A

GBM
Lymphoma

Tumofactive MS plaque
Radiation

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42
Q

Tumours that restrict diffusion

A

lyphoma
GBM
medulloblastoma

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43
Q

lymphoma will enhance

A

uniformaly

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44
Q

choroid plexus xanthogranulomas

A

benign
7% of people have it

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45
Q

GBM vs Lymphoma

enhancement

A

GBM - heterogenous rim enhancement

vs

lympohma - homogeous

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46
Q

GBM vs Lymphoma

crossing miudline

A

both can

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47
Q

restrict

GBM vs Lymphoma

A

GBM can restrict but lymphoma is classic for restricting

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48
Q

intravascular angiocentric lymphoma

A

stroke presentation
mutlifocal infarcts

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49
Q

calcium in a brain tumour

most common

A

Oligodendroglioma
- always calcify

but in real life Astrocytoma so much more common that it could be this

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50
Q

which tumours calcify

A

Oligodendrogliomas
Ependyomomas
Astrocytoma
GBM

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51
Q

oligodendrogliomas trivia

A

Ca+2
cortically based

expands the cortex

frontal lobe

has calcium within it

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52
Q

Oligodendrogliomas, prognostic facotr

A

1P, 19Q deletion, how responsive to radiotherapy

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53
Q

Cortically based tumour

A

Dysembryolploastic neuroepithelial Tumour (*DNET)

Oligdendrogliomas
gangliogliomas

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54
Q

refactroy seizures

bubbly T2 lesion

A

DNET

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55
Q

Oligodendroglioma

A

calcified tumour expands the cortex of frontal lobe

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56
Q

gangliogliomas

A

cyst with a nodule

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57
Q

differentials for Cyst with a nodule

by location

A

INfratent

JPA
Haemangioblastomas

Supratent
Pleomorhpic Xanthoastrocytoma
Ganglioglioma

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58
Q

dural tail

A

PXA
- invades leptomeninges

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59
Q

CP angle tumour

does not go into auditory canal

A

Meningioma
-0 enhances homogenously

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60
Q

CP angle tumour

goes into the auditory cancal

A

schwannoma

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61
Q

CP angle tumour

restrict

A

epidermoid

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62
Q

if CP angle tumour schwanna and bilateral think of

A

NF-2

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63
Q

low enhancing pituitary lesion

A

microadenoma

if T2 bright go with RCC

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64
Q

large pituitary

A

macroadinoma - more than 10mm

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65
Q

Apoplexy will be

A

T1 bright

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66
Q

sheehans syndrome is

A

post partum haemorrhage

cant lactate

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67
Q

next step pituitary quesiton

A

often CT
- for a craniopharyngioma

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68
Q

types of craniopharyngioma

A

childhood
- calcifies

adult
- pappillary subtype

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69
Q

hypothalamic hamartoma

A

hamartoma of the tuber cinereum (part of the hypothalamus)

gelastic seizures
precoscious puberty

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70
Q

toothpaste tumour

A

ependymoma

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71
Q

hard ball tumour

A

medulloblastoma

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72
Q

age for medulloblastoma

A

under 10

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73
Q

medulloblastoma are highly cellular and therefore

A

restrict diffusion

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74
Q

Ependymoma age group

A

bimodal <5 and > 30

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75
Q

subependymoma

how does it enhance
size

A

it doesn’t
<2cm

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76
Q

subependymoma age

A

adult

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77
Q

most paeds tumours

A

are infratentorial

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78
Q

most paeds are infratentorium except for

A

Choroid plexus papilloma

lateral trigone

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79
Q

why hydrocephalus in choroid plexus papilloma

A

secrete CSF

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80
Q

Features in NF1

A

sphenoid dysplasia
renal vascular stenosis
lateral meningocele
antermedial tibial bowing

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81
Q

NF1 CNS tumour

A

optic pathway
pilocytic astrocytomas

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82
Q

NF2 cranial features

A

meningiomas
ependymomas
schwannomas

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83
Q

T2 bright
nodules along ventricles

Subependymal giant cell tumour
renal AML
lung thin walled cysts

A

Tuberous sclerosis
- subependymal nodules

Cortical tubers
- t2 bright bands

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84
Q

endolymph sac tumour found in

A

temporal bone

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85
Q

features fo VHL in pancreas

A

serous cystadenoma
regular cysts
islet cell tumours

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86
Q

features of VHL in CNS

A

haemangioblastomas in brain and spine
endolymphatic sac tumour

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87
Q

vHL in abdo

A

phaeo
RCC
renal cysts

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88
Q

corduroy sign, next step

A

get a mammogram
then thyroid exam

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89
Q

Cowden syndrome

A

Hamartomas
Breast Ca
Thyroid Ca

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90
Q

Lhermitte-Dulcos

A

wears corduroy.

enlarged cerebellar hemisphere

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91
Q

SAH along the vertex

A

truama or vasculopathy

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92
Q

SAH

Basilar

A

think aneurysm

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93
Q

interpeduncular cistern haemorrhage can be from which aneurysm location

A

basilar tip

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94
Q

PICA bleeds will go

A

posterior fossa or intraventricular

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95
Q

MCA aneurysm bleeds go where

A

sylvian fissure

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96
Q

early s.e of SAH

A

hydrocephalus due to blood blocking the csf

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97
Q

mid timeframe of SAH

A

absent vessels

diffuse vasospasms

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98
Q

Vasospasm
- Fischer score

A

grades risk of vasospasm

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99
Q

1mm of SAH thickness risk of

A

vasospasm
fleishcherscore of II

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100
Q

why vasospasm with blood

A

Oxyhemoglobin fownregulates the NO

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101
Q

othe irritants to cuase vasospasm

A

meningitis - pus
PRES
Reversible cerebral vasospasm syndrome (pregnant thunderclap headache)
Migraine

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102
Q

when does vasospasm happen after SAH

A

4- 14 days

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103
Q

Late complications of SAH

A

superficial siderosis

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104
Q

Superfical siderosis appears as

A

curvilinear low signal on gradient coating the surface of the brain

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105
Q

sensorineurla hearing loss and ataxia and SAH

A

haemosiderin deposits causes it as a longer term complication of SAH

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106
Q

How does pseudo SAH manifest

A

brain is dark due to oedema
dura look bright in comparison, mistaken for SAH

look at the sulci, no sulcal density

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107
Q

SAH HU is

A

60

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108
Q

common locations of hypertensive haemorrhage

A

basal ganglia (putamen)
pons
cerebellum

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109
Q

T1, white matter is

A

white

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110
Q

scattered microbleeds on gradient

subcorticol location

lobar bleed with normal BP

dialysis patient

A

amyloid

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111
Q

how does cytotxic oedema end up hitting the brain

A

death of sodium potasssium transporter
end up leaking with oedema resultant

normally seen about 3 hours after a stroke

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112
Q

area of restricted diffusion
- its a stroke

but FLAIR is normal.

what could that mean

A

hyperacute - within first 6 hours

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113
Q

MCA infarcts will normally involve which structure

A

basal ganglia

(herpes woudn’t)

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114
Q

hypothalamic bilateral infarct

A

artery of Percharon

wernicker
internal cerebral vein thrombosis

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115
Q

recurrent artery of heubner

A

branch of proximal ACA

infarct to caudate head

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116
Q

haemorrhagic conversion after strokes

who is at risk

A

TPA
Anti caog
large territories (1/3MCA distribution)
venous infarcts more likely to bleed

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117
Q

t1 bright

A

sub acute blood
fat
melanin
proteinacious material
halonised calcium

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118
Q

kids T1 won’t look like an adults until age

A

1

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119
Q

kids wont’ have the same T2 brain as an adult until

A

2

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120
Q

types of watershed areas

A

external and internal

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121
Q

external watershed from

A

embolic

better prognosis.

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122
Q

internal watershed from

A

hypoxia
arterial occlusion

deep perforators have few collatorals

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123
Q

i say sickle cell

you say

A

Moya moya

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124
Q

what is moya moya

A

proximal ICA / supraclinoid stenosis, chronic so multiple collaterols.

high grade narrowing/occlusion

kid - stroke
adult - bleed

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125
Q

haemosiderin MRI sequence to look for what option

A

Amyloid
Cavernoma
Blood

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126
Q

Venous malformation in the pons

A

Capillary telangiectasia

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127
Q

40 year old with migraine

temporal lobe

white matter scarring

normal MRA
not involving the occipital

A

Cadasil

Cerebral AD arteriopathy subcorticol infarcts and leukencephalopathy

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128
Q

central sulcus seperates which lobes

A

frontal from parietal

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129
Q

how to find central sulcus

A

pars bracket sign is immediately behind the central sulcus

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130
Q

inverted omega on the central sulcus represents the

A

motor hand

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131
Q

Homonculous, the legs are supplied by the

A

ACA

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132
Q

why does hippocampus look brighter on FLAIR compared to normal cortex

A

cortex is 6 layers
hippo is 3

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133
Q

what are virchow robins spaces

A

fluid filled spaces next to perforating vessles.

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134
Q

CSF gets reabsorbed at the

A

arachnoid granulations

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135
Q

cavum velum interpositum

A

extension of quadrigeminal plate cistern to foramen of munro

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136
Q

supracellar cisterns look like a

A

pentagon

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137
Q

sylvian vs ambient cisterns

what are their location

A

sylvian point anteriorly

ambient point posteriory

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138
Q

MRi appearance of babies

A

T1 looks like an adult T2

T2 looks like an adult T1

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139
Q

immature myelin has what component compared to mature myelin

A

more water

therefore is brighter on T2 and darker on T1

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140
Q

last part of the brain to myelinate?

A

subcortical

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141
Q

which bits of brain are myelinated at birth?

A

braisntem and posterior limb of the internal capsule

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142
Q

corpus collosum forms in what direction

A

front to back

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143
Q

cortpus collosum hypoplasia will be absence of which bit ?

A

splenium

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144
Q

what goes through foramen ovale

A

V3 Accessory meingeal artery

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145
Q

what goes through Foramen rotundum

A

V2

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146
Q

what goes through superior orbital fissure

A

CN3 Cn4 CN V1 CNVI

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147
Q

inferior orbital fissure

what goes through

A

V2
Orbital and zygomatic branches

148
Q

foramen spinosum

149
Q

jugular foramen

splits into two

what goes through

A

pars nervosa - J vein, CN 9 and Jacobsons Nerve

para vascularis , CN 10 with auricular branch Arnolds Nerve and 11

150
Q

hypoglossal canal

151
Q

optic canal
what goes through

A

CN2 and opthalmic artery

152
Q

what exists in the cavernous sinus

A

CN3, 4
CN V1
V2
CN6

3456

153
Q

why get a lateral rectus palsy

A

V6 runs next to the carotid artery in cavernous sinus
aneurysm could compress

154
Q

skull fusion is also called

A

craniosynostosis

155
Q

IAC nerve orientation

A

7up
8 down

nerves anterior

superior and inferior vestibular nerves adjacent

156
Q

branches of the external carotid

A

Superior thyroid
Aascending pharyngeal
Lingual
Facial
Occipital
Pposterior auricular
M - maxillary
S - superifical temporal

157
Q

Common carotid bifurcation at

158
Q

C5 portion of internal carotid is called clinoid, an aneurysm here cdan cause

A

compression of optic nerve and cause blindness

159
Q

aberrant carotid artery can cause

A

tinnitus as it courses through the tympanic cavity and joint the horizontal carotid canal

160
Q

Anastomtic vein of Trolard is where

A

Top

superficial middle vein and the superior saggital sinus

161
Q

Anostomatic vein of Labbe

A

connects the superficial middle vein and the transverse sinus

162
Q

what are the deep brain veins

A

basal vein of Rosenthal
Vein of Galen
Inferior petrosal sinus

163
Q

middle concha is pneumonzied in the nose

A

Concha bullosa

164
Q

what is the monro-kellie doctrine

A

skull is a fixed volume

dynamic between brain, blood and csf

165
Q

if get leaking CSF what will happen

A

more blood to accomadate the loss

meningeal engorement.

may get subdural bleeds

166
Q

Idiopathic intracranial HTN

A

the csf will decrease to compensate for extra blood pressure.
- slit like ventricles
- pituitary shrinks
- sinuses of blood will appear small

167
Q

intracranial hypertension in the eys on CT

A

vertical tortuosity of the optic nerves
flattening of the posterior sclera

168
Q

what is cytotoxic edema

A

intracellular swelling
Na/K pump malfunction - stroke/trauma

lose grey white differentiation

169
Q

What is vasogenic oedema

A

extracellular due to BBB disruption.
tumour and infection

170
Q

complicatin of midline shift

A

copmression of the ACA

171
Q

what is the first sign o descending trantentorial herniation

A

effacement of the ipsilateral suprasellar cistern

172
Q

descending trantentorial herniation

why get pupil dilatation and ptosis

A

CN3 compression between PCA and superior cerebellar artery

173
Q

ascending transtentorial erniation will get

A

smile of the quadrigeminal cistern

spinning top appearance of the midbrain

bad hydrocephalus

174
Q

involvement of which interface is 98% specific for MS

A

calloso-septal

175
Q

Devics MS

A

Trasnverse myelitis and optic neuritis

176
Q

PREs is seen in patients with

177
Q

How does PRES behave on diffusion

A

does not restrict (ie not a stroke)

178
Q

Osmotic demyleination syndrome

A

T2 bright in the central pons

extra pontine presentation involving the basal ganglia, capsule, amygdala, cerebellum

179
Q

Carbon monoxide poisoning, MRI features

A

T2 bright globus

CT hypodensity

180
Q

Alcohol causes brain atrophy, especially the

A

cerebellar vermis

181
Q

How will Methanol poisoning show on imaging

A

optic nerve atrophy
haemorrhagic putaminal and subcortical white matter necrosis

182
Q

Patient undergoing chem oand radiation may get

A

dissemintated necrotizing leukoencephalopathy

183
Q

alzheimers get atrophy of what

A

hippocampal

temporal horn >3mm

184
Q

what is crossed cerebellar diaschisis (CCD)

A

Depressed blood flow and metabolism affecting the cerebellar hemisphere after a contralateral supratentorial insult

185
Q

Dementia with Lewy body

cingulate island sign

A

decreased FDG uptake in the lteral ocipital cortex with sparing of the mid posterior cingulate gyrus

186
Q

Binswanger disease

A

old people
subcorticol leukencephalopathy

ax with HTN

187
Q

Huntingtons on FDG PET

A

low activity in caudate nucleus and putmen

188
Q

fetus

CMV infection causes what

A

periventricular tissue necrosis –> calc

can be ax with polymicrogyria

189
Q

toxoplasmosis seen in

A

women who clean up cat poo

190
Q

calc location in toxoplasmosis infeciton

it causes what

A

basal ganglia

hydrocephalus

191
Q

MRI features of rubella brian infection

A

focal high T2 relates to the ischaemic injury and vasculopathy

192
Q

HSV2 infection in neonatal

A

thrombus and haemorrhagic infarction

results in encephalomalacia and atrophy

193
Q

neontal HIV get

A

brain atrophy in the frontal lobes

194
Q

AIDS patients get what infection in brain

195
Q

AIDS get what fungal infection

A

cryptococcus

196
Q

HIV encephalitis affects patietns with a CD4 count

A

less than 200

197
Q

MRI findings of HIV encephalitis

A

T2 /flair increase symmetric signal in deep white matter

spare the subcorticol U fibres

198
Q

Progressive Multifocal Leukencephalitis caused by

199
Q

PML affects people with a CD4 count less than

200
Q

PML imaging findings

progressive multifocal leukoencephalopathy

A

hyppodensities with T1 hypodensity
T2 hyperintensity out of proportion to mass effect

love the U fibres
Asymmetry

201
Q

ependymal enhancement

202
Q

cryptococcous

cryptococcomas in the basal ganglia MRI features

A

T1 dark, T2 bright with ring enhance

203
Q

Toxo vs lymphoma

A

toxo is thalium cold

lymphoma thallium hot

204
Q

Abscess do what with diffusion

205
Q

cryptococcus imaging features

A

dilated perivascular spaces

basilar meningitis

206
Q

T2 MRI will show what

207
Q

IS T2 mri in brain useful

A

no, as tumor, stroke, MS and infections all have oedema

208
Q

DWI what restrict

A

abscess
stroke
hypercellular tumours (lymphoma)

209
Q

Types of MRI enhancement

Tumour

A

hetero or homo, if high grade

210
Q

Types of MRI enhancement

abscess

A

ring pattern

211
Q

Types of MRI enhancement

MS

A

incomplete ring

212
Q

blank

A

corticol ribbon

213
Q

TB meningitis affects where

A

basal cisterns

otherwise same as regular meningitis

214
Q

HSV types by kids and adult

A

HSV 2 in neonates

HSV 1 in adults

215
Q

what is limbic encephalitis?

A

paraneoplastic syndrome

small cell lung cancer

looks similar to HSV

216
Q

Viruses that involve the basal ganglia

A

Japanese Encephalitis, murray valley fever, west nile

t2 bright basal gangla

217
Q

CJD - can show on DWI as

A

cortical gyriform restricted signal

218
Q

CJD will be seen on multiple imaging over time as

A

rapid atrophy

219
Q

neurocysticercosis caused by

A

eating pig poo

Tinea solium

220
Q

4 stages of neuocysticercosis

A

Vesicular - thin walled cysts
Colloidal - hyperdense cyst
granular - cyst shrinks
nodular - small calcified lesion

221
Q

4 different types of meningitis

A

bacterial
viral
chronic
non infective

222
Q

the majortiy of empyema subdurals are a result of

A

frontal sinusitis

223
Q

intraventricular extension of asbcess is…

A

a pre-terminal event

224
Q

the signs of extra-axial location of brain tumour

A

CSF cleft
Displaced subarachnoid vessels
Corticol gray matter between mass and white matter
displaced and expanded subarachnoid spaces
Broad dural base/tail
bony reaction

225
Q

multiple masses in brain differential is between

A

infection and mets

226
Q

multiple masses in brain - what to use to discern them

A

Diffusion

infection will restrict

227
Q

most common CNS metastasis in a Kid

A

Neuroblastoma

(bone, dura, orbit)

228
Q

why do mets commonly sit at the grey white interface

A

lot of blood flow and abrupt calibre change

229
Q

Mets can be multiple or

A

singular.

50% of mets in brain are found solitary

230
Q

Bleeding mets are

A

MRCT

Melanoma
RCC
Carcinoid
Thyroid

231
Q

Mets will have more WHAT compared to primary lesion

232
Q

primary tumours that could be multiple

A

Gliomatosis Cerebri

Multicentric gbm
lymphoma

233
Q

Tumours ax with

NF1

A

Optic Gliomas
Astrocytomas

234
Q

Tumours ax with

NF2

A

Multiple schwannomas

meningiomas

ependymomas

235
Q

Tumours ax with

Tuberous sclerosis

A

Subependymal tubers

IV giant cell astrocytomas

236
Q

brain Tumours ax with

VHL

A

haemagnioblastomas

237
Q

mnemonic for cortically based tumours

A

P - DOG (round the outside)

PXA
DNET
Oligodendroglioma
Ganglioglioma

238
Q

seizure,
temporal lobe mass
cystic with solid

focal calcifications

A

Ganglioglioma

239
Q

what are the locations for interventricular tumours

A

Septum pellucidem and ventricular wall

choroid plexus

misc

240
Q

Septum pellucidem and ventricular wall tumours

A

Ependymoma

Medulloblastoma

Subependymal giant cell astrocytoma

Central neurocytoma

241
Q

tumours o the choroid plexus

A

Papilloma

Carcinoma

Xanthogranuloma

242
Q

Misc ventricular tumour

A

Mets

Meningioma

Colloid cyst

243
Q

tooth paste tumour

A

ependyomoma

244
Q

age of ependymoma

A

less than 6 and >30

245
Q

age of medullblastoma

A

less than 10

246
Q

do medulloblastoma restrict

A

yes

tightly packed cells

247
Q

what are the mets called for medulloblastoma in the spine

248
Q

posterior fossa neoplasm in a child, next step

A

image the whole spine

249
Q

where do medulloblastoma and ependyomoma orginate within the ventricles

A

medulloblastoma - vermis, 4th vent roof

ependyomoma - floor of the 4th ventrcile

250
Q

adult intraventricular tumours are

A

subependyomoma

Central neurocytoma

251
Q

Subependyoma - imaging features

A

don’t enahce.
T2 bright as are most tumours.

252
Q

Swiss chesse appearance of Intraventricular mass in an adult

A

central neurocytoma

253
Q

Choroid plexus origin tumours

A

Papilloma

Carcinoma

Xanthogranuloma

254
Q

Choroid plexus papilloma/carcinoma

what expesion to a rule is this cancer

A

exists in the supratentorium in KIDS

255
Q

choroid plexus papilloma in kids

A

doesn’t exists.
only the carcinoma type

found in the lateral ventricle/trigone

256
Q

risk of having a colloid cyst

A

sudden death from rapid onset hydrocephalus

dense

257
Q

what nuclear medicine test is there for meningiomas

A

octreotide and Tc-MDP on nuclear medicine tests

258
Q

dermoid cysts found where

A

midline
30s

259
Q

dermoid cysts imaging features

A

contain lipoid materal and are usually hypodense on CT and very bright on T1

ax with NF2

260
Q

Epidermoid vs dermoid

A

epidermoid behave like CSF

dermoid behave like fat

261
Q

arachnoid cysts - restriciton pattern

A

do not restrict

262
Q

full list of infratetnorial malignancies

A

Atypical teratoma

JPA

Diffuse brain stem glioma

gnaglioglioma

medulloblastoma

ependymoma

haemangioblastoma

263
Q

diffuse brain cell glioma imaging appearance

A

T2 bright, subtle to no enhancement

4th ventricle will be flattened

264
Q

most common supratentorial mass

265
Q

midline sacrum tumour

266
Q

tumours of the Dura

A

Meningioma

Hemangiopericytoma

Mets (breast)

267
Q

pituitary secrets what

A

FLAT PEG

FSH
LSH
ADH
TSH

prolactin
endorphins
gsh

268
Q

sella / parasella in adults tuour

A

Adenoma

Apoplexy

Rathke cleft cyst

epidermoid

craniopharyngioma

269
Q

sella / parasella in kids tumours

A

Craniopharyngioma

Hypothalamic hamartoma

270
Q

dorsal parinaud syndromes are what kind

A

vertical gaze palsy

271
Q

3 pineal tumours

A

Germinoma

Pineoblastoma

Pineocytoma

272
Q

germinoma may secrete what causing….

A

hCG causing precocious puberty

273
Q

germinoma has what make up

A

fat and calcifiations

274
Q

pineoblastoma is what

275
Q

pineoblastoma is ax with

A

retinoblastoma

276
Q

NF2 cranial lesions

A

MSME

Multiple Schwannomas
Meningiomas
Ependymomas

277
Q

Cowdens has what issues

A

hamartomas everywhere

278
Q

if the brain scrapes against the skull base in a collision can cause

A

parenchymal contusion

anterior temporal lobes
inferior frontal lobes

279
Q

diffuse axonal injury - locations

A

posterior corpus callosum
GM - WM junction in frontal and temporal

280
Q

DAI - on MRI

A

multiple small T2 bright foci

281
Q

how many le fort fractures are there?

282
Q

Describe LeFOrt 1 - 3

A

1 - maxilla
2 - pyarmaidal
3. face falls off

283
Q

most common facial fracture

A

nasal bone

284
Q

with temporal bone fractures you should describe what

A

whether there is otic involvement.

285
Q

Blood on CT has what timeframe density changes

A

hyperacute - <1 hr –> hypodense

acute up to 3 days –> hyperdense

subacute 4days to 3 weeks –> progressively less dense

Chronic is more than 3 weeks - hypodense

286
Q

swirl sign bleed

A

badness

active bleeding

287
Q

MRI blood signal through time

A

swirl graph

288
Q

most sensitive sequence on mri for SAH

289
Q

benign non-aneurysm perimesencephalic haemorrhage

A

NOT ax with aneurysm but with venous bleed.

Classic appearance of around the midbrain and pons with extension into the lateral sylvian cisterns

290
Q

superficial siderosis from repeated SAH can cause what

A

hearing loss and ataxia

291
Q

hypertensive haemorrhage location

A

basal ganglia

292
Q

duret haemorrhage

A

herniation causes mesial temporal lobe to herniate down through tentorium.

haemorrhage of the medulla and pons

293
Q

Petrous bone, fracture types

A

Longitudinal and transverse

294
Q

Longitudinal fracture through the petrous bone

what kind of hearing loss

A

conductive hearing loss as it hits the ossicles

295
Q

Transverse petrous fracture can damage which nerve

A

facial nerve

296
Q

violate the otic capsule

what can happen

A

increwased risk of the following

csf leak
facial nerve damage
increase sensorineural hearing loss

297
Q

What is FLAIR

A

inversion sequence to null CSF

298
Q

fake out SAH on FLAIR

A

metal stops the inversion.
- so can still see bright CSF

inhaled oxygen therapy

infection

propofol

299
Q

airless exapnded sinus

300
Q

MRI features of mucocele

A

T1 bright
maybe peripheral enhancement

301
Q

pulsatile exmopthalmos

A

look to the cavernous sinus
prominent superior opthalmic vein

carotid cavernous fistula

302
Q

indirect carotid cavernous fistula

A

between cavernous sinus and meningeal branch of the External carotid artery

303
Q

what fracture do all le fort have in common

A

Pterygoid processes

304
Q

inferior orbit fracture

what Le Fort

305
Q

Lateral orbital wall and zyg arch

le fort type?

306
Q

circumferential calcification around the ventricles

307
Q

basal ganglia calcifications
hydrocephalus
infection

308
Q

asymmetric, peripheral
involves the U fibres

T1 is normal

A

JC virus

(PML)

309
Q

Symmetric and central lesionson on MRI

A

HIV encephalitis

310
Q

mucoid gelatinus cysts

will be presented as a meningitis with affecting the base of the brain

A

cryptococcus

311
Q

ring enhancing lesion with LOADS of edema

doesn’t restrict

312
Q

toxo v lymphoma

A

thallium cold on toxo

lymphoma hot

313
Q

if there is lots of Basilar tissue enhancement think

A

Sarcoid
TB meningitis

314
Q

cortical gyriform restricted diffusion

315
Q

nec fascitis in face

A

Ludwigs angina

start as a tooth infection

316
Q

odontogenic abscess more common from extracted or intact tooth

317
Q

mylohyoid line seperates what

A

infection from back teeth goes to submandibular space

if anterior to the 2/3 molar will be sublingual space

318
Q

grandenigo syndrome

A

lateral rectus palso
ottomastoiditis
face pain

Petrous apex infection case

319
Q

watershed infarcts in a kid

A

moya moya

sickle cell

320
Q

what is the insular ribbon sign

A

loss of normal high density insular cortex from cytotoxic oedmea

321
Q

post stroke mass effect will peak at

322
Q

what is fogging

A

appearance post stroke of brain looking fnormal

2-3 weeks

323
Q

in context of stroke

restricted diffusion without bright signal on FLAIR consider

A

subacute <6hrs stroke

324
Q

what things restrict?

A

stroke

abscess
CJD
Herpes

Hypercellular tumours (lymphoma)

MS lesions

oxyhaemoglobin
Post ictal states

325
Q

Enhancement post stroke

rule of 3s

A

starts day 3

peaks 3 weeks

gone 3 months

326
Q

predictors of patients getting haemorrhagic transformation from stroke when on TPA

A

Multiple strokes
prox MCA occluded
1/3 territory of MCA territory

more than 6 hours since onset to recanalization

absent collateral flow

327
Q

venous infarction associations in kids

A

babies - dehydration

in kids - mastoiditis

328
Q

what can happen after a chronic venous thrombosis

A

get a dural AVF

or high CSF pressures if impaired drainage

329
Q

berry aneurysms are seen at

A

bifurcation points

330
Q

Fusiform aneurysm is ax with

A

PAN
Connective tissue disease
Syphilis

Seen in posterior circulation

331
Q

pseudo aneurysm how to spot

A

odd location
outpouching

focal haematoma next to the vessel

332
Q

pedicle aneurysm is an aneurysm ax with a

333
Q

mycotic aneurysm found in X

History will include what

A

distal MCAs

endocarditis, meningitis, thrombophlebitis

334
Q

what puts a high flow AVM at a higherbleeding risk

A

small size
single draining vein
intranidal aneurysm

location
- basal ganglia, thalamic/periventricular locations

335
Q

dural AVF involving the sigmoid sinus can cuase

A

pulsatile tinnitus

336
Q

cavernous malformaiton

A

low flow lesions with a dilated capillary bed

WITHOUT intervening normal brain tissue

337
Q

capillery telengiectasia

A

low flow

DOES have intervening normal brian tusse

338
Q

vascular dissection from blunt vs pentrating truama

A

penetrating think carotids

blunt look at vertebrals

339
Q

how to categorise vasculitis in brain

A

primary

secondary

Systemic vasculitis disease hitting the brain

CNS vasculitis from systemic disease

340
Q

Primary causes of brain vasculitis

A

Primary Angiitis of the CNS

(P A C N S )

341
Q

Seocndary causes of brain vasculitis

A

Meningitis
Septic embolus
Sarcoid

342
Q

Systemic vasculitis disease hitting the brain

A

PAN
Temporal arteritis
Wegeners
Takayasy’s

343
Q

CNS vasculitis from systemic disease

A

Cocains use
RA
SLE
Lyme’s

344
Q

segmental areas of vessel narrowing with beaded appearance

A

vasculitis

345
Q

colpocephaly is what

A

asymmetric dilation of the occipital horns

346
Q

when seing colpocephaly think

A

corpus callosum agenesis

pericallosal lipoma

347
Q

intracranial lipoma is most often found in

A

interhemispheric fissure

348
Q

probst bundles are what

A

dense packed white matter tracts, would cross the CC if present, if Corpus Callosum not present they run parallel and make the ventricles appear far from each other

349
Q

anencephaly is what

A

neural tube fails to close on cranial end.

reduced or absent cerebrum/cerebellum.

hind brain present

350
Q

MR SPECT

NAA corresponds to what

A

neuronal integrity

351
Q

what is the exception for high NAA being normal

A

will be super high in Canavans

352
Q

MR SPECT
Choline is high with what

A

cell turnover

tumour, infarct or inflammation

353
Q

with what TE will you see a double Lcatate lipid peak ?

A

Long TE (280)

354
Q

in which normal circumstance is lactate seen in the head

A

hours after birth

355
Q

what is raised in alzheimers and low grade gliomas

MR SPECT

A

Myoinositol

356
Q

Alanine elevation is specific to which tumour

MR SPECT

A

meningiomas

357
Q

mengiomas have a raised what and absent what on

MR SPECT

A

have alanine elevation

but absent NAA

358
Q

MR SPECT

Glutamine elevation is sign of what

A

hepatic encephalopathy

359
Q

High grade tumour
MR SPECT

choline, NAA, lactate and lipids

A

choline up
NAA down
lactate and lipids are up

360
Q

LOW grade tumour
MR SPECT

choline, NAA, lactate and lipids

A

choline down,
NAA down,
Inositol UP

361
Q

Paeds heads

How to discern between a BESSI and a subdural

A

Cortical veins

Subdural bleed, bleeds displaced away from the inner table

BESSI: Cortical veins are adjacent to the inner table

362
Q

paeds heads

extra axial fluid spaces are considered enlarged if greater than

363
Q

BESSI stands for

A

benign enlargement of the subdural spaces in infancy

364
Q

choanal atresia might cause what situation to arise for the patient?

A

resp distress whilst feeding

Unable to pass an NG tube

365
Q

what associations are there for choanal atrsia

A

CHARGE
Crouzons
DiGeorge
Treacher COlins
Getal Alcohol syndrome

366
Q

what is MELAS (paeds condition)

A

Mitochondrial disorder with lactic acidosis and stroke like episodes

a Prometheus book FRCR Part 2A flashcards (9 decks)

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