Module 6: Central Nervous, head and neck Flashcards
1
Q
Incomplete ring enhancement think
A
demyelination
2
Q
does stroke restrict
A
yes
3
Q
do hypercellular tumours restrict
A
yes
4
Q
Herpes encephalitis, does it restrict
A
yes
5
Q
Don’t restrcit examples
A
met
atypical infeciton (toxo)
6
Q
GBM vs lymphoma
A
lymphoma enhances homogenously
GBM - heterogenous, aggressive
7
Q
dawson fingers
Calloso-septal interface
A
MS
8
Q
Define for MS
A
seperation in space and time
9
Q
MS relationship with which virus
A
EBV
10
Q
MS is rarer closer to
A
the equator
11
Q
MS trickery
calssic differentials
A
Vasculitius
Lyme
12
Q
Vasculitis favours the
A
basal ganglia
spares the collosal septal interface
13
Q
Lymes involves more of the
A
cranial nerves
14
Q
ADEM stands for
A
acute disseminated encephalomyelitis
15
Q
ADEM present in
A
childhood after vaccination
16
Q
ADEM appears as
A
large T2 bright
enhance in ring nodular pattern
though incomplete as demyelination
not invovle the collosal
17
Q
demyelinating disorder of the spine and optic
A
NMO (Devic)
neuomyelitis optica
18
Q
CSF is dark can be
A
Flair
or
T1
19
Q
causes of T1 bright basal ganglia
A
liver failure
hyperlaminetation
high blood sugar
wilsons
20
Q
does stroke restrict
A
yes
21
Q
PRES is what
A
vascular autoregulation BBB disruption
22
Q
PRES affects where
A
bilateral
posterior circulation
watershed areas
23
Q
PRES history
who gets it
A
HTN
Pregnancy
chemo
24
Q
Central Pontine Myeloonitis
A
rapidly corrected low sodium level
25
CPM involves which type of cells
oligodendroglial cells
26
distinguish OM from PRES
DWI
but location more of a giveaway
27
Wernickes encephalopathy is caused by
thiamine deficiency
28
Wernickes get enhancement of the
mammillary bodies
T2/Flair signal in bilateral medial thalamus
periaqueductal gray
29
wernickes ddx
think thalamic insult
artery of percheron infarction
internal cerebral vein thrombosis
30
high signal crossing the corpus collosum
Marchiafava-Bignami
31
Marchiafava-Bignami
seen in
drunks
32
carbon monoxide poisoning
CT hypdensity
T2 bright globus pallidus
33
why would things in the brain NOT enhance
the BBB
- extra axial
- disrupted the BBB (aggressive infection or high grade tumour)
34
enahcnement of low vs high grade tumours
high grade DO enhance
- though JPA, grade 1 WHO, this does enhance
- also ganglioglioma
35
Do low grades enhance
NO
36
Do high grades enhance
YES
37
astrocytomas
- two types
diffuse
circumscribed
38
circumbscribes astrocytoma
JPA - cyst with nodule
Subependymal giant cell
- arise from lateral ventricle
- ax with TS
39
any intraventricular tumour will enhance or not enhance
will enhance
escapes the BBB
40
Gliomatosis cerebri
diffuse
involves at least 3 lobes
extensive T2 signal
no mass effect
low grade so doesn't enhance
41
tumour that is crossing the midline
GBM
Lymphoma
Tumofactive MS plaque
Radiation
42
Tumours that restrict diffusion
lyphoma
GBM
medulloblastoma
43
lymphoma will enhance
uniformaly
44
choroid plexus xanthogranulomas
benign
7% of people have it
45
GBM vs Lymphoma
enhancement
GBM - heterogenous rim enhancement
vs
lympohma - homogeous
46
GBM vs Lymphoma
crossing miudline
both can
47
restrict
GBM vs Lymphoma
GBM can restrict but lymphoma is classic for restricting
48
intravascular angiocentric lymphoma
stroke presentation
mutlifocal infarcts
49
calcium in a brain tumour
most common
Oligodendroglioma
- always calcify
but in real life Astrocytoma so much more common that it could be this
50
which tumours calcify
Oligodendrogliomas
Ependyomomas
Astrocytoma
GBM
51
oligodendrogliomas trivia
Ca+2
cortically based
expands the cortex
frontal lobe
has calcium within it
52
Oligodendrogliomas, prognostic facotr
1P, 19Q deletion, how responsive to radiotherapy
53
Cortically based tumour
Dysembryolploastic neuroepithelial Tumour (*DNET)
Oligdendrogliomas
gangliogliomas
54
refactroy seizures
bubbly T2 lesion
DNET
55
Oligodendroglioma
calcified tumour expands the cortex of frontal lobe
56
gangliogliomas
cyst with a nodule
57
differentials for Cyst with a nodule
by location
INfratent
JPA
Haemangioblastomas
Supratent
Pleomorhpic Xanthoastrocytoma
Ganglioglioma
58
dural tail
PXA
- invades leptomeninges
59
CP angle tumour
does not go into auditory canal
Meningioma
-0 enhances homogenously
60
CP angle tumour
goes into the auditory cancal
schwannoma
61
CP angle tumour
restrict
epidermoid
62
if CP angle tumour schwanna and bilateral think of
NF-2
63
low enhancing pituitary lesion
microadenoma
if T2 bright go with RCC
64
large pituitary
macroadinoma - more than 10mm
65
Apoplexy will be
T1 bright
66
sheehans syndrome is
post partum haemorrhage
cant lactate
67
next step pituitary quesiton
often CT
- for a craniopharyngioma
68
types of craniopharyngioma
childhood
- calcifies
adult
- pappillary subtype
69
hypothalamic hamartoma
hamartoma of the tuber cinereum (part of the hypothalamus)
gelastic seizures
precoscious puberty
70
toothpaste tumour
ependymoma
71
hard ball tumour
medulloblastoma
72
age for medulloblastoma
under 10
73
medulloblastoma are highly cellular and therefore
restrict diffusion
74
Ependymoma age group
bimodal <5 and > 30
75
subependymoma
how does it enhance
size
it doesn't
<2cm
76
subependymoma age
adult
77
most paeds tumours
are infratentorial
78
most paeds are infratentorium except for
Choroid plexus papilloma
lateral trigone
79
why hydrocephalus in choroid plexus papilloma
secrete CSF
80
Features in NF1
sphenoid dysplasia
renal vascular stenosis
lateral meningocele
antermedial tibial bowing
81
NF1 CNS tumour
optic pathway
pilocytic astrocytomas
82
NF2 cranial features
meningiomas
ependymomas
schwannomas
83
T2 bright
nodules along ventricles
Subependymal giant cell tumour
renal AML
lung thin walled cysts
Tuberous sclerosis
- subependymal nodules
Cortical tubers
- t2 bright bands
84
endolymph sac tumour found in
temporal bone
85
features fo VHL in pancreas
serous cystadenoma
regular cysts
islet cell tumours
86
features of VHL in CNS
haemangioblastomas in brain and spine
endolymphatic sac tumour
87
vHL in abdo
phaeo
RCC
renal cysts
88
corduroy sign, next step
get a mammogram
then thyroid exam
89
Cowden syndrome
Hamartomas
Breast Ca
Thyroid Ca
90
Lhermitte-Dulcos
wears corduroy.
enlarged cerebellar hemisphere
91
SAH along the vertex
truama or vasculopathy
92
SAH
Basilar
think aneurysm
93
interpeduncular cistern haemorrhage can be from which aneurysm location
basilar tip
94
PICA bleeds will go
posterior fossa or intraventricular
95
MCA aneurysm bleeds go where
sylvian fissure
96
early s.e of SAH
hydrocephalus due to blood blocking the csf
97
mid timeframe of SAH
absent vessels
diffuse vasospasms
98
Vasospasm
- Fischer score
grades risk of vasospasm
99
1mm of SAH thickness risk of
vasospasm
fleishcherscore of II
100
why vasospasm with blood
Oxyhemoglobin fownregulates the NO
101
othe irritants to cuase vasospasm
meningitis - pus
PRES
Reversible cerebral vasospasm syndrome (pregnant thunderclap headache)
Migraine
102
when does vasospasm happen after SAH
4- 14 days
103
Late complications of SAH
superficial siderosis
104
Superfical siderosis appears as
curvilinear low signal on gradient coating the surface of the brain
105
sensorineurla hearing loss and ataxia and SAH
haemosiderin deposits causes it as a longer term complication of SAH
106
How does pseudo SAH manifest
brain is dark due to oedema
dura look bright in comparison, mistaken for SAH
look at the sulci, no sulcal density
107
SAH HU is
60
108
common locations of hypertensive haemorrhage
basal ganglia (putamen)
pons
cerebellum
109
T1, white matter is
white
110
scattered microbleeds on gradient
subcorticol location
lobar bleed with normal BP
dialysis patient
amyloid
111
how does cytotxic oedema end up hitting the brain
death of sodium potasssium transporter
end up leaking with oedema resultant
normally seen about 3 hours after a stroke
112
area of restricted diffusion
- its a stroke
but FLAIR is normal.
what could that mean
hyperacute - within first 6 hours
113
MCA infarcts will normally involve which structure
basal ganglia
(herpes woudn't)
114
hypothalamic bilateral infarct
artery of Percharon
wernicker
internal cerebral vein thrombosis
115
recurrent artery of heubner
branch of proximal ACA
infarct to caudate head
116
haemorrhagic conversion after strokes
who is at risk
TPA
Anti caog
large territories (1/3MCA distribution)
venous infarcts more likely to bleed
117
t1 bright
sub acute blood
fat
melanin
proteinacious material
halonised calcium
118
kids T1 won't look like an adults until age
1
119
kids wont' have the same T2 brain as an adult until
2
120
types of watershed areas
external and internal
121
external watershed from
embolic
better prognosis.
122
internal watershed from
hypoxia
arterial occlusion
deep perforators have few collatorals
123
i say sickle cell
you say
Moya moya
124
what is moya moya
proximal ICA / supraclinoid stenosis, chronic so multiple collaterols.
high grade narrowing/occlusion
kid - stroke
adult - bleed
125
haemosiderin MRI sequence to look for what option
Amyloid
Cavernoma
Blood
126
Venous malformation in the pons
Capillary telangiectasia
127
40 year old with migraine
temporal lobe
white matter scarring
normal MRA
not involving the occipital
Cadasil
Cerebral AD arteriopathy subcorticol infarcts and leukencephalopathy
128
central sulcus seperates which lobes
frontal from parietal
129
how to find central sulcus
pars bracket sign is immediately behind the central sulcus
130
inverted omega on the central sulcus represents the
motor hand
131
Homonculous, the legs are supplied by the
ACA
132
why does hippocampus look brighter on FLAIR compared to normal cortex
cortex is 6 layers
hippo is 3
133
what are virchow robins spaces
fluid filled spaces next to perforating vessles.
134
CSF gets reabsorbed at the
arachnoid granulations
135
cavum velum interpositum
extension of quadrigeminal plate cistern to foramen of munro
136
supracellar cisterns look like a
pentagon
137
sylvian vs ambient cisterns
what are their location
sylvian point anteriorly
ambient point posteriory
138
MRi appearance of babies
T1 looks like an adult T2
T2 looks like an adult T1
139
immature myelin has what component compared to mature myelin
more water
therefore is brighter on T2 and darker on T1
140
last part of the brain to myelinate?
subcortical
141
which bits of brain are myelinated at birth?
braisntem and posterior limb of the internal capsule
142
corpus collosum forms in what direction
front to back
143
cortpus collosum hypoplasia will be absence of which bit ?
splenium
144
what goes through foramen ovale
V3 Accessory meingeal artery
145
what goes through Foramen rotundum
V2
146
what goes through superior orbital fissure
CN3 Cn4 CN V1 CNVI
147
inferior orbital fissure
what goes through
V2
Orbital and zygomatic branches
148
foramen spinosum
MMA
149
jugular foramen
splits into two
what goes through
pars nervosa - J vein, CN 9 and Jacobsons Nerve
para vascularis , CN 10 with auricular branch Arnolds Nerve and 11
150
hypoglossal canal
CN 12
151
optic canal
what goes through
CN2 and opthalmic artery
152
what exists in the cavernous sinus
CN3, 4
CN V1
V2
CN6
3456
153
why get a lateral rectus palsy
V6 runs next to the carotid artery in cavernous sinus
aneurysm could compress
154
skull fusion is also called
craniosynostosis
155
IAC nerve orientation
7up
8 down
nerves anterior
superior and inferior vestibular nerves adjacent
156
branches of the external carotid
Superior thyroid
Aascending pharyngeal
Lingual
Facial
Occipital
Pposterior auricular
M - maxillary
S - superifical temporal
157
Common carotid bifurcation at
C3 / C4
158
C5 portion of internal carotid is called clinoid, an aneurysm here cdan cause
compression of optic nerve and cause blindness
159
aberrant carotid artery can cause
tinnitus as it courses through the tympanic cavity and joint the horizontal carotid canal
160
Anastomtic vein of Trolard is where
Top
superficial middle vein and the superior saggital sinus
161
Anostomatic vein of Labbe
connects the superficial middle vein and the transverse sinus
162
what are the deep brain veins
basal vein of Rosenthal
Vein of Galen
Inferior petrosal sinus
163
middle concha is pneumonzied in the nose
Concha bullosa
164
what is the monro-kellie doctrine
skull is a fixed volume
dynamic between brain, blood and csf
165
if get leaking CSF what will happen
more blood to accomadate the loss
meningeal engorement.
may get subdural bleeds
166
Idiopathic intracranial HTN
the csf will decrease to compensate for extra blood pressure.
- slit like ventricles
- pituitary shrinks
- sinuses of blood will appear small
167
intracranial hypertension in the eys on CT
vertical tortuosity of the optic nerves
flattening of the posterior sclera
168
what is cytotoxic edema
intracellular swelling
Na/K pump malfunction - stroke/trauma
lose grey white differentiation
169
What is vasogenic oedema
extracellular due to BBB disruption.
tumour and infection
170
complicatin of midline shift
copmression of the ACA
171
what is the first sign o descending trantentorial herniation
effacement of the ipsilateral suprasellar cistern
172
descending trantentorial herniation
why get pupil dilatation and ptosis
CN3 compression between PCA and superior cerebellar artery
173
ascending transtentorial erniation will get
smile of the quadrigeminal cistern
spinning top appearance of the midbrain
bad hydrocephalus
174
involvement of which interface is 98% specific for MS
calloso-septal
175
Devics MS
Trasnverse myelitis and optic neuritis
176
PREs is seen in patients with
HTN
Chemo
177
How does PRES behave on diffusion
does not restrict (ie not a stroke)
178
Osmotic demyleination syndrome
T2 bright in the central pons
extra pontine presentation involving the basal ganglia, capsule, amygdala, cerebellum
179
Carbon monoxide poisoning, MRI features
T2 bright globus
CT hypodensity
180
Alcohol causes brain atrophy, especially the
cerebellar vermis
181
How will Methanol poisoning show on imaging
optic nerve atrophy
haemorrhagic putaminal and subcortical white matter necrosis
182
Patient undergoing chem oand radiation may get
dissemintated necrotizing leukoencephalopathy
183
alzheimers get atrophy of what
hippocampal
temporal horn >3mm
184
what is crossed cerebellar diaschisis (CCD)
Depressed blood flow and metabolism affecting the cerebellar hemisphere after a contralateral supratentorial insult
185
Dementia with Lewy body
cingulate island sign
decreased FDG uptake in the lteral ocipital cortex with sparing of the mid posterior cingulate gyrus
186
Binswanger disease
old people
subcorticol leukencephalopathy
ax with HTN
187
Huntingtons on FDG PET
low activity in caudate nucleus and putmen
188
fetus
CMV infection causes what
periventricular tissue necrosis --> calc
can be ax with polymicrogyria
189
toxoplasmosis seen in
women who clean up cat poo
190
calc location in toxoplasmosis infeciton
it causes what
basal ganglia
hydrocephalus
191
MRI features of rubella brian infection
focal high T2 relates to the ischaemic injury and vasculopathy
192
HSV2 infection in neonatal
thrombus and haemorrhagic infarction
results in encephalomalacia and atrophy
193
neontal HIV get
brain atrophy in the frontal lobes
194
AIDS patients get what infection in brain
toxo
195
AIDS get what fungal infection
cryptococcus
196
HIV encephalitis affects patietns with a CD4 count
less than 200
197
MRI findings of HIV encephalitis
T2 /flair increase symmetric signal in deep white matter
spare the subcorticol U fibres
198
Progressive Multifocal Leukencephalitis caused by
JC virus
199
PML affects people with a CD4 count less than
50
200
PML imaging findings
progressive multifocal leukoencephalopathy
hyppodensities with T1 hypodensity
T2 hyperintensity out of proportion to mass effect
love the U fibres
Asymmetry
201
ependymal enhancement
CMV
202
cryptococcous
cryptococcomas in the basal ganglia MRI features
T1 dark, T2 bright with ring enhance
203
Toxo vs lymphoma
toxo is thalium cold
lymphoma thallium hot
204
Abscess do what with diffusion
restrict
205
cryptococcus imaging features
dilated perivascular spaces
basilar meningitis
206
T2 MRI will show what
oedema
207
IS T2 mri in brain useful
no, as tumor, stroke, MS and infections all have oedema
208
DWI what restrict
abscess
stroke
hypercellular tumours (lymphoma)
209
Types of MRI enhancement
Tumour
hetero or homo, if high grade
210
Types of MRI enhancement
abscess
ring pattern
211
Types of MRI enhancement
MS
incomplete ring
212
blank
corticol ribbon
213
TB meningitis affects where
basal cisterns
otherwise same as regular meningitis
214
HSV types by kids and adult
HSV 2 in neonates
HSV 1 in adults
215
what is limbic encephalitis?
paraneoplastic syndrome
small cell lung cancer
looks similar to HSV
216
Viruses that involve the basal ganglia
Japanese Encephalitis, murray valley fever, west nile
t2 bright basal gangla
217
CJD - can show on DWI as
cortical gyriform restricted signal
218
CJD will be seen on multiple imaging over time as
rapid atrophy
219
neurocysticercosis caused by
eating pig poo
Tinea solium
220
4 stages of neuocysticercosis
Vesicular - thin walled cysts
Colloidal - hyperdense cyst
granular - cyst shrinks
nodular - small calcified lesion
221
4 different types of meningitis
bacterial
viral
chronic
non infective
222
the majortiy of empyema subdurals are a result of
frontal sinusitis
223
intraventricular extension of asbcess is...
a pre-terminal event
224
the signs of extra-axial location of brain tumour
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
multiple masses in brain differential is between
infection and mets
226
multiple masses in brain - what to use to discern them
Diffusion
infection will restrict
227
most common CNS metastasis in a Kid
Neuroblastoma
(bone, dura, orbit)
228
why do mets commonly sit at the grey white interface
lot of blood flow and abrupt calibre change
229
Mets can be multiple or
singular.
50% of mets in brain are found solitary
230
Bleeding mets are
MRCT
Melanoma
RCC
Carcinoid
Thyroid
231
Mets will have more WHAT compared to primary lesion
oedema
232
primary tumours that could be multiple
Gliomatosis Cerebri
Multicentric gbm
lymphoma
233
Tumours ax with
NF1
Optic Gliomas
Astrocytomas
234
Tumours ax with
NF2
Multiple schwannomas
meningiomas
ependymomas
235
Tumours ax with
Tuberous sclerosis
Subependymal tubers
IV giant cell astrocytomas
236
brain Tumours ax with
VHL
haemagnioblastomas
237
mnemonic for cortically based tumours
P - DOG (round the outside)
PXA
DNET
Oligodendroglioma
Ganglioglioma
238
seizure,
temporal lobe mass
cystic with solid
focal calcifications
Ganglioglioma
239
what are the locations for interventricular tumours
Septum pellucidem and ventricular wall
choroid plexus
misc
240
Septum pellucidem and ventricular wall tumours
Ependymoma
Medulloblastoma
Subependymal giant cell astrocytoma
Central neurocytoma
241
tumours o the choroid plexus
Papilloma
Carcinoma
Xanthogranuloma
242
Misc ventricular tumour
Mets
Meningioma
Colloid cyst
243
tooth paste tumour
ependyomoma
244
age of ependymoma
less than 6 and >30
245
age of medullblastoma
less than 10
246
do medulloblastoma restrict
yes
tightly packed cells
247
what are the mets called for medulloblastoma in the spine
drop mets
248
posterior fossa neoplasm in a child, next step
image the whole spine
249
where do medulloblastoma and ependyomoma orginate within the ventricles
medulloblastoma - vermis, 4th vent roof
ependyomoma - floor of the 4th ventrcile
250
adult intraventricular tumours are
subependyomoma
Central neurocytoma
251
Subependyoma - imaging features
don't enahce.
T2 bright as are most tumours.
252
Swiss chesse appearance of Intraventricular mass in an adult
central neurocytoma
253
Choroid plexus origin tumours
Papilloma
Carcinoma
Xanthogranuloma
254
Choroid plexus papilloma/carcinoma
what expesion to a rule is this cancer
exists in the supratentorium in KIDS
255
choroid plexus papilloma in kids
doesn't exists.
only the carcinoma type
found in the lateral ventricle/trigone
256
risk of having a colloid cyst
sudden death from rapid onset hydrocephalus
dense
257
what nuclear medicine test is there for meningiomas
octreotide and Tc-MDP on nuclear medicine tests
258
dermoid cysts found where
midline
30s
259
dermoid cysts imaging features
contain lipoid materal and are usually hypodense on CT and very bright on T1
ax with NF2
260
Epidermoid vs dermoid
epidermoid behave like CSF
dermoid behave like fat
261
arachnoid cysts - restriciton pattern
do not restrict
262
full list of infratetnorial malignancies
Atypical teratoma
JPA
Diffuse brain stem glioma
gnaglioglioma
medulloblastoma
ependymoma
haemangioblastoma
263
diffuse brain cell glioma imaging appearance
T2 bright, subtle to no enhancement
4th ventricle will be flattened
264
most common supratentorial mass
mets
265
midline sacrum tumour
chordoma
266
tumours of the Dura
Meningioma
Hemangiopericytoma
Mets (breast)
267
pituitary secrets what
FLAT PEG
FSH
LSH
ADH
TSH
prolactin
endorphins
gsh
268
sella / parasella in adults tuour
Adenoma
Apoplexy
Rathke cleft cyst
epidermoid
craniopharyngioma
269
sella / parasella in kids tumours
Craniopharyngioma
Hypothalamic hamartoma
270
dorsal parinaud syndromes are what kind
vertical gaze palsy
271
3 pineal tumours
Germinoma
Pineoblastoma
Pineocytoma
272
germinoma may secrete what causing....
hCG causing precocious puberty
273
germinoma has what make up
fat and calcifiations
274
pineoblastoma is what
invasive
275
pineoblastoma is ax with
retinoblastoma
276
NF2 cranial lesions
MSME
Multiple Schwannomas
Meningiomas
Ependymomas
277
Cowdens has what issues
hamartomas everywhere
278
if the brain scrapes against the skull base in a collision can cause
parenchymal contusion
anterior temporal lobes
inferior frontal lobes
279
diffuse axonal injury - locations
posterior corpus callosum
GM - WM junction in frontal and temporal
280
DAI - on MRI
multiple small T2 bright foci
281
how many le fort fractures are there?
3
282
Describe LeFOrt 1 - 3
1 - maxilla
2 - pyarmaidal
3. face falls off
283
most common facial fracture
nasal bone
284
with temporal bone fractures you should describe what
whether there is otic involvement.
285
Blood on CT has what timeframe density changes
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
swirl sign bleed
badness
active bleeding
287
MRI blood signal through time
swirl graph
288
most sensitive sequence on mri for SAH
FLAIR
289
benign non-aneurysm perimesencephalic haemorrhage
NOT ax with aneurysm but with venous bleed.
Classic appearance of around the midbrain and pons with extension into the lateral sylvian cisterns
290
superficial siderosis from repeated SAH can cause what
hearing loss and ataxia
291
hypertensive haemorrhage location
basal ganglia
292
duret haemorrhage
herniation causes mesial temporal lobe to herniate down through tentorium.
haemorrhage of the medulla and pons
293
Petrous bone, fracture types
Longitudinal and transverse
294
Longitudinal fracture through the petrous bone
what kind of hearing loss
conductive hearing loss as it hits the ossicles
295
Transverse petrous fracture can damage which nerve
facial nerve
296
violate the otic capsule
what can happen
increwased risk of the following
csf leak
facial nerve damage
increase sensorineural hearing loss
297
What is FLAIR
inversion sequence to null CSF
298
fake out SAH on FLAIR
metal stops the inversion.
- so can still see bright CSF
inhaled oxygen therapy
infection
propofol
299
airless exapnded sinus
mucocele
300
MRI features of mucocele
T1 bright
maybe peripheral enhancement
301
pulsatile exmopthalmos
look to the cavernous sinus
prominent superior opthalmic vein
carotid cavernous fistula
302
indirect carotid cavernous fistula
between cavernous sinus and meningeal branch of the External carotid artery
303
what fracture do all le fort have in common
Pterygoid processes
304
inferior orbit fracture
what Le Fort
2
305
Lateral orbital wall and zyg arch
le fort type?
3
306
circumferential calcification around the ventricles
CMV
307
basal ganglia calcifications
hydrocephalus
infection
Toxo
308
asymmetric, peripheral
involves the U fibres
T1 is normal
JC virus
(PML)
309
Symmetric and central lesionson on MRI
HIV encephalitis
310
mucoid gelatinus cysts
will be presented as a meningitis with affecting the base of the brain
cryptococcus
311
ring enhancing lesion with LOADS of edema
doesn't restrict
Toxo
312
toxo v lymphoma
thallium cold on toxo
lymphoma hot
313
if there is lots of Basilar tissue enhancement think
Sarcoid
TB meningitis
314
cortical gyriform restricted diffusion
CJD
315
nec fascitis in face
Ludwigs angina
start as a tooth infection
316
odontogenic abscess more common from extracted or intact tooth
extracted
317
mylohyoid line seperates what
infection from back teeth goes to submandibular space
if anterior to the 2/3 molar will be sublingual space
318
grandenigo syndrome
lateral rectus palso
ottomastoiditis
face pain
Petrous apex infection case
319
watershed infarcts in a kid
moya moya
sickle cell
320
what is the insular ribbon sign
loss of normal high density insular cortex from cytotoxic oedmea
321
post stroke mass effect will peak at
day 3-5
322
what is fogging
appearance post stroke of brain looking fnormal
2-3 weeks
323
in context of stroke
restricted diffusion without bright signal on FLAIR consider
subacute <6hrs stroke
324
what things restrict?
stroke
abscess
CJD
Herpes
Hypercellular tumours (lymphoma)
MS lesions
oxyhaemoglobin
Post ictal states
325
Enhancement post stroke
rule of 3s
starts day 3
peaks 3 weeks
gone 3 months
326
predictors of patients getting haemorrhagic transformation from stroke when on TPA
Multiple strokes
prox MCA occluded
1/3 territory of MCA territory
more than 6 hours since onset to recanalization
absent collateral flow
327
venous infarction associations in kids
babies - dehydration
in kids - mastoiditis
328
what can happen after a chronic venous thrombosis
get a dural AVF
or high CSF pressures if impaired drainage
329
berry aneurysms are seen at
bifurcation points
330
Fusiform aneurysm is ax with
PAN
Connective tissue disease
Syphilis
Seen in posterior circulation
331
pseudo aneurysm how to spot
odd location
outpouching
focal haematoma next to the vessel
332
pedicle aneurysm is an aneurysm ax with a
AVM
333
mycotic aneurysm found in X
History will include what
distal MCAs
endocarditis, meningitis, thrombophlebitis
334
what puts a high flow AVM at a higherbleeding risk
small size
single draining vein
intranidal aneurysm
location
- basal ganglia, thalamic/periventricular locations
335
dural AVF involving the sigmoid sinus can cuase
pulsatile tinnitus
336
cavernous malformaiton
low flow lesions with a dilated capillary bed
WITHOUT intervening normal brain tissue
337
capillery telengiectasia
low flow
DOES have intervening normal brian tusse
338
vascular dissection from blunt vs pentrating truama
penetrating think carotids
blunt look at vertebrals
339
how to categorise vasculitis in brain
primary
secondary
Systemic vasculitis disease hitting the brain
CNS vasculitis from systemic disease
340
Primary causes of brain vasculitis
Primary Angiitis of the CNS
(P A C N S )
341
Seocndary causes of brain vasculitis
Meningitis
Septic embolus
Sarcoid
342
Systemic vasculitis disease hitting the brain
PAN
Temporal arteritis
Wegeners
Takayasy's
343
CNS vasculitis from systemic disease
Cocains use
RA
SLE
Lyme's
344
segmental areas of vessel narrowing with beaded appearance
vasculitis
345
colpocephaly is what
asymmetric dilation of the occipital horns
346
when seing colpocephaly think
corpus callosum agenesis
pericallosal lipoma
347
intracranial lipoma is most often found in
interhemispheric fissure
348
probst bundles are what
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
anencephaly is what
neural tube fails to close on cranial end.
reduced or absent cerebrum/cerebellum.
hind brain present
350
MR SPECT
NAA corresponds to what
neuronal integrity
351
what is the exception for high NAA being normal
will be super high in Canavans
352
MR SPECT
Choline is high with what
cell turnover
tumour, infarct or inflammation
353
with what TE will you see a double Lcatate lipid peak ?
Long TE (280)
354
in which normal circumstance is lactate seen in the head
hours after birth
355
what is raised in alzheimers and low grade gliomas
MR SPECT
Myoinositol
356
Alanine elevation is specific to which tumour
MR SPECT
meningiomas
357
mengiomas have a raised what and absent what on
MR SPECT
have alanine elevation
but absent NAA
358
MR SPECT
Glutamine elevation is sign of what
hepatic encephalopathy
359
High grade tumour
MR SPECT
choline, NAA, lactate and lipids
choline up
NAA down
lactate and lipids are up
360
LOW grade tumour
MR SPECT
choline, NAA, lactate and lipids
choline down,
NAA down,
Inositol UP
361
Paeds heads
How to discern between a BESSI and a subdural
Cortical veins
Subdural bleed, bleeds displaced away from the inner table
BESSI: Cortical veins are adjacent to the inner table
362
paeds heads
extra axial fluid spaces are considered enlarged if greater than
5mm
363
BESSI stands for
benign enlargement of the subdural spaces in infancy
364
choanal atresia might cause what situation to arise for the patient?
resp distress whilst feeding
Unable to pass an NG tube
365
what associations are there for choanal atrsia
CHARGE
Crouzons
DiGeorge
Treacher COlins
Getal Alcohol syndrome
366
what is MELAS (paeds condition)
Mitochondrial disorder with lactic acidosis and stroke like episodes
