Neuro Flashcards

1
Q

Bilateral basal ganglia / thalamic signal abnormality (general adult)

A

Infectious (CJD, flavivirus, toxo)
Ischemia (HIE, venous, arterial: Percheron, basilar)
Neoplasm (lymphoma, glioma)
Toxicity (CO, methanol, cyanide)
Electrolyte disorder (hyper/hypoglycemia, hyperammonemia, osmotic myelinolysis)
Mineral disorder (hypermagnesemia / liver disease, Wilson, Wernicke, Fahr, NBIA)

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2
Q

Bilateral signal abnormality in globus pallidi

A

CO toxicity (+ delayed leukoencephalopathy)
Hypermagnesemia / liver disease (T1 bright, + substantia nigra)
Hyperglycemia (T1 bright, + caudate)
NBIA (eye of the tiger)
NF1 FASIs (T1 bright, + other manifestations)

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3
Q

Bilateral signal abnormality in putamina

A
Methanol toxicity (+ WM edema)
Cyanide toxicity
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4
Q

Bilateral signal abnormality in thalami (sparing basal ganglia)

A

Artery of Percheron infarct
Venous infarct from cerebral venous sinus thrombosis
Primary bilateral thalamic glioma
Wernicke encephalopathy (+ periaqueductal gray, mammillary bodies, tectal plate)

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5
Q

Bilateral basal ganglia + cortex +/- thalamus

A

May involve thalamus
- HIE (watershed / diffuse dist’n, delayed WM)
- CJD (pulvinar sign in variant form)
- Flavivirus encephalitis (+ substantia nigra, red nucleus, pons, cerebellum)
Spares thalamus
- Hypoglycemia (+ WM)
- Hyperammonemia (insular distribution, + cingulate gyrus)

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6
Q

Bilateral basal ganglia + hemorrhage

A

Venous infarction
Toxoplasmosis
Flavivirus encephalitis
Methanol or cyanide poisoning

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7
Q

Bilateral basal ganglia + diffusion restriction

A

Infarct / HIE
CO poisoning
CJD
Electrolyte disorder (hypoglycemia, hyperammonemia)
Vitamin / mineral disorder (Wernicke encephalopathy, Wilson disease)

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8
Q

Leukoencephalopathies (nonspecific adult)

A

Infectious (PML, HIV, viral encephalitis, Lyme)
Demyelination (MS, NMO, ADEM)
Vascular (arteriolosclerosis, migraines, HIE, vasculitis – PACNS + 2ndary + Susac, SLE amyloid)
Neoplastic (gliomatosis cerebri)
Toxic (meds, radiation, delayed CO poisoning, heroin inhalation)
Metabolic (PRES, osmotic myelinolysis, Wernicke’s, Marchiafava-Bignami)
Genetic (CADASIL, MELAS)

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9
Q

Symmetric supratentorial leukoencephalopathy

A

Toxic
PRES
HIE
HIV encephalitis

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10
Q

Corpus callosal lesions

A
Demyelination (MS, NMO, ADEM)
Neoplasm (glioma, lymphoma)
Classic CC disease (Marchiafava-Bignami - restricts diffusion acutely, Susac’s)
DAI (blooming on T2*)
[PML]
[CADASIL]
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11
Q

Leukoencephalopathy + hemorrhage

A

Vasculitis (PACNS or secondary)
Amyloid
Hemorrhagic leukoencephalopathy (Hurst disease)
Arteriolosclerosis / CADASIL (micro only)

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12
Q

Leukoencephalopathy + infarcts

A
Arteriolosclerosis / CADASIL
HIE
MELAS
Vasculitis
SLE
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13
Q

Diffuse symmetric white matter signal abnormality (kid)

A
Periventricular leukomalacia
TORCH infection
Congenital leukodystrophy
- Metachromatic leukodystrophy
- Krabbe disease
- X-linked adrenoleukodystrophy
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14
Q

Congenital leukodystrophies

A

Alexander disease (frontal)
X-linked adrenoleukodystrophy (parietooccipital, leading edge enhancement)
Krabbe (parietooccipital)
Metachromatic leukodystrophy (diffuse, tigroid)
Canavan (diffuse, really high NAA peak)

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15
Q

Focal brainstem lesion (adult)

A

Demyelination
Vascular (arterial or venous infarct, malformation – all except AVF)
Neoplasm (mets, high grade glioma, hemangioblastoma)
[Abscess]
[Hypertrophic olivary degeneration]
[Dilated perivascular spaces]

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16
Q

Focal brainstem lesion (peds)

A

Neoplasm (low grade glioma, PNET)
ADEM
Abscess
Hypertrophic olivary degeneration

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17
Q

Diffuse brainstem lesion (adult)

A
Nonspecific
- Infectious (rhombencephalitis, PML)
- Neoplasm (glioma, lymphoma)
- Behçet’s
Entire brainstem
- Hypertensive encephalopathy
Midbrain
- DAI
- Wallerian degeneration
- ALS: amyotrophic lateral sclerosis
- Hepatic encephalopathy
Pons
- MSA: multiple system atrophy 
- Osmotic myelinolysis
- Pontine leukoaraiosis
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18
Q

Diffuse brainstem lesion (peds)

A
Glioma
DAI
Wallerian degeneration
Hepatic encephalopathy
Infectious rhombencephalitis
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19
Q

Multiple parenchymal calcifications

A

Infection (TORCH, Neurocysticercosis)
Hyper/hypoparathyroidism
Genetic (TS, Sturge-Weber, Fahr’s)

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20
Q

Parenchymal cysts

A

Infection (abscess / neurocysticercosis / gelatinous pseudocysts / echinococcus)
Encephalomalacia / porencephaly
Neuroglial cyst
Dilated perivascular spaces

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21
Q

Neuro diseases in immunocompromised adult

A
Opportunistic infection (PML / Toxo / Crypto / TB / syphilis / CMV)
HIV encephalopathy
HIV vasculopathy
CNS Lymphoma
IRIS
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22
Q

Abnormal signal in temporal lobe cortex

A

Encephalitis
- Viral (Herpes vs other)
- Autoimmune (limbic): paraneoplastic, non-neoplastic
Infarct (arterial or venous)
Low grade glioma
Post-ictal status / mesial temporal sclerosis

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23
Q

Nonspecific intra-axial mass (broad ddx for CT)

A

Neoplasm (glioma, mets, lymphoma)
Vascular malformation (AVM, cavernoma) / aneurysm
Collection (hemorrhage, abscess)
Tumefactive demyelination

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24
Q

Rim enhancing lesions

A

Neoplasm (high grade glioma, mets / lymphoma – immunocompromised)
Infection (abscess, septic emboli, neurocysticercosis)
Tumefactive demyelination
Subacute infarct / hemorrhage / contusion
Radiation necrosis

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25
Q

At least partly solid posterior fossa mass

A
Primary
Intraventricular
- Ependymoma / subependymoma
- Choroid plexus papilloma
Parenchymal
- Medulloblastoma (kid)
- Pilocytic astrocytoma (kid) 
- Hemangioblastoma (adult)
- ATRT (baby)
- Lhermitte-Duclos (dysplastic cerebellar gangliocytoma)
Mets / lymphoma
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26
Q

Supratentorial intraventricular mass

A
Primary Intraventricular Neoplasm
- Central neurocytoma
- Ependymoma / subependymoma
- Choroid plexus papilloma / carcinoma
- Meningioma
- SEGA / subependymal hamartomas
Mets / lymphoma
Extraventricular tumour protruding into ventricle
Infection (neurocysticercosis, tuberculoma)
Thrombus
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27
Q

Bubbly intra-axial mass

A
Dysembryoplastic neuroepithelial tumour
Ganglioglioma
Pleomorphic xanthoastrocytoma
Low grade astrocytoma
Oligodendroglioma
Mimic (see ddx of parenchymal cysts)
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28
Q

Nonspecific solid appearing extra-axial mass (broad ddx for CT)

A
Neoplasm (meningioma, hemangiopericytoma, mets/lymphoma)
Vascular abnormality (aneurysm, AVM)
Mycobacterial / fungal infection
Neurosarcoid
Collection (hemorrhage / empyema)
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29
Q

Cystic appearing extra-axial mass

A

Subdural / epidural collection (old hematoma, hygroma, empyema, effusion)
Developmental “cysts” (arachnoid, epidermoid, dermoid)
Volume loss

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30
Q

Extra-axial solid masses adjacent to brainstem

A

Benign primary (schwannoma, meningioma)
Mets / lymphoma
Perineural spread
Adjacent tumor (chondrosarcoma, chordoma, glomus jugulare)
Non-neoplastic (aneurysm, neurosarcoid, TB)

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31
Q

Solid pineal mass (may have cystic / necrotic components)

A

Neoplastic
Primary pineal
- Pineal parenchymal tumours (pineocytoma / pineoblastoma)
- Germ cell tumours (germinoma, non-germinomatous - teratoma, choriocarcinoma, embryonal, endodermal sinus)
Adjacent glioma (tectal plate / thalamus / corpus callosum)
Meningioma
Mets / lymphoma

Vein of Galen malformation / thrombosis

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32
Q

Cystic pineal mass

A

Pineal cyst
Arachnoid / epidermoid cyst
Cystic appearance of solid mass (see solid pineal mass DDx, most likely pituicytoma)

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33
Q

Solid sellar mass

A
Neoplastic
Primary sellar
- Macroadenoma
- Craniopharyngioma (papillary – adult)
- Pituicytoma
Primary para-sellar
- Meningioma
- Chiasmatic glioma
- Germinoma
Mets / lymphoma

Aneurysm
Granulomatous (TB / sarcoid)
Autoimmune (lymphocytic hypophysitis, Tolosa-Hunt)

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34
Q

Cystic sellar mass

A

Some solid enhancement

  • Craniopharyngioma (adamantinomatous - peds)
  • Cystic macroadenoma
  • Dermoid cyst
  • Partially thrombosed aneurysm

Cystic

  • Rathke’s cleft cyst
  • Arachnoid / epidermoid cyst
  • Craniopharyngioma
  • Empty sella
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35
Q

Bulky infundibulum

A

Neoplasm (several possible, e.g. germinoma, hypothalamic glioma, mets [breast & lung], lymphoma/leukemia)
Infection (TB, meningitis)
Inflammatory (sarcoid, Langerhans cell histiocytosis [children], lymphocytic hypophysitis [3rd trimester pregnancy or postpartum])

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36
Q

Cavernous sinus mass

A
Neoplastic
- Meningioma
- Nerve sheath tumour
- Chondrosarcoma
- Mets / Lymphoma
Vascular (venous sinus thrombosis, ICA aneurysm, CCF)
Inflammatory (Tolosa Hunt, sarcoid)
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37
Q

Nodular leptomeningeal enhancement

A

Malignancy (leptomeningeal carcinomatosis [breast, prostate], lymphoma/leukemia)
Granulomatous (neurosarcoid, TB)
Inflammatory (GPA, LCH – peds)

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38
Q

Smooth leptomeningeal enhancement

A

Meningitis (infectious, chemical)
Encephalitis
Post SAH / trauma
Post intervention (LP, surgery)

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39
Q

Smooth pachymeningeal enhancement

A
Intracranial hypotension
- Spontaneous
- Post intervention (LP, surgery)
Granulomatous: TB, sarcoidosis, Wegener/GPA, Erdheim-Chester
Meningitis
Venous sinus thrombosis
Idiopathic hypertrophic pachymeningitis
40
Q

Nodular pachymeningeal enhancement

A

Granulomatous: TB, sarcoidosis, Wegener/GPA, Erdheim-Chester
Meningitis
Venous sinus thrombosis
Idiopathic hypertrophic pachymeningitis

41
Q

Cortical formation problems

A
Proliferation
- Over: hemimegaloencephaly
- Under: microlissencephaly
- Weird: focal cortical dysplasia
Migration
- Over: cobblestone lissencephaly (muscular dystrophies)
- Under: classic lissencephaly
- Weird: subependymal or band heterotopia
Organization
- Schizencephaly
- Polymicrogyria
42
Q

Way too much CSF in baby

A
Alobar holoprosencephaly
Ventriculomegaly / hydrocephalus
Hydranencephaly / severe porencephaly
Large open lip schizencephaly
Interhemispheric cyst
43
Q

Missing brain / skull in utero

A

Anencephaly / severe microcephaly
Acrania
Amniotic band syndrome

44
Q

Symmetric band of ectopic gray matter

A

Band heterotopia

Lissencephaly – pachygyria spectrum

45
Q

Etiologies of parenchymal hemorrhage

A
Trauma
Hypertension / cocaine if young
Amyloid angiopathy
Venous sinus thrombosis
Vasculitis
Vascular malformation (AVM, DAVF, cavernoma)
Hemorrhagic mass (primary or secondary)
46
Q

Etiologies of subarachnoid hemorrhage

A
Trauma
Aneurysm (including mycotic)
CAA
AVM / DAVF
Vasculitis / vasospasm / RCVS
Dural venous sinus thrombosis 
Perimesencephalic hemorrhage
47
Q

Cervical or intracranial arterial stenosis / occlusion

A
Atherosclerosis
Dissection
FMD (cervical only)
Vasospasm / RCVS (intracranial only)
Vasculitis (cervical = Takayasu, GCA; intracranial = PACNS and CTD or cocaine)
Thrombophilia
48
Q

Etiologies of infarct

A

Thromboembolic (cardiac, carotid, paradoxical, septic)
Cervical or intracranial arterial stenosis / occlusion (inflow problem)
Venous sinus thrombosis (outflow problem)
Poor cardiac output (pump problem)
Genetic disorder (CADASIL, MELAS, Fabry’s)

49
Q

Multiple microhemorrhages

A

Trauma (DAI)
HTN
CAA
Vasculitis
Neoplasm (hemorrhagic mets, multiple cavernomas)
Arteriolosclerosis / CADASIL
Mimic: metal emboli from mechanical valve replacement

50
Q

Vascular malformations

A
AVM
Aneurysm
Cavernoma
Capillary telangiectasia
DVA
DAVF
51
Q

Distal cerebral aneurysms

A

Mycotic
Vasculitis
Dissection

52
Q

Intramedullary solid mass

A
Primary neoplasm
- Ependymoma
- Astrocytoma
- Hemangioblastoma
- Ganglioglioma (1-5 yo)
- ATRT (<2 yo)
Mets / lymphoma
Vascular malformation (cavernoma, AVM)
Granulomatous (mycobacterial / fungal phlegmon, sarcoid)
53
Q

Intradural extramedullary masses

A
Nerve sheath tumour
Meningioma
Mets / lymphoma 
Myxopapillary ependymoma
Spinal paraganglioma / neuroendocrine tumour
54
Q

Extradural masses (similar to posterior mediastinal masses)

A
Herniated disc
Mets / lymphoma
Epidural abscess / hematoma
Osseous lesion
Extramedullary hematopoiesis
Lipomatosis
55
Q

Multiple masses in the cord / canal

A
Neoplastic
Primary
- PNSTs (NF1 or 2)
- Meningiomas (NF1)
- Hemangioblastomas (VHL)
Mets
- Drop (medulloblastoma, ependymoma, GBM, pineal tumours)
- Systemic (breast, lung, melanoma, prostate)
Lymphoma

Non-neoplastic

  • Sarcoid
  • TB / fungal meningitis
56
Q

Cystic collection in neural foramina

A
Meningocele
Pseudomeningocele with nerve root avulsion
Neurenteric cyst
Synovial cyst
Cystic nerve sheath tumour
57
Q

Anterior tethering / posterior indentation of the cord

A

Arachnoid cyst / epidermoid / dermoid cyst
Spinal dural herniation
Arachnoid web

58
Q

Central cord high signal

A
NMO / ADEM / MS
Transverse myelitis (primary or secondary: viral, syphilis, vaccine, etc.)
Infarct / venous HTN (DAVF)
Contusion / compressive myelopathy
Astrocytoma
59
Q

Dorsal column high signal

A

Subacute combined degeneration (B12 deficiency)
Copper deficiency
Infectious (HIV, Syphilis)
Demyelination
Ischemia (tends to be unilateral when posterior due to paired spinal arteries)

60
Q

Owl eye sign

A
Anterior spinal artery infarct
Polio
Chronic compressive myelopathy
NMO
Spinal muscular atrophy
61
Q

Disc and two adjacent vertebrae problems

A
Osteomyelitis / discitis
- Pyogenic
- TB
Neuropathic joint
Amyloid spondylo-arthropathy (dialysis spine)
Mets / myeloma / lymphoma
62
Q

Three things you can add to any neck mass ddx

A

Minor salivary gland tumor
Rhabdomyosarcoma
Adenopathy

63
Q

Cystic / necrotic neck nodes

A
Mets: H&N SCC, thyroid ca
Bacterial / suppurative / pyogenic lymphadenitis
Tuberculous adenitis 
Lymphoma (pre or post treatment)
Other: Kawasaki / Kikuchi
64
Q

Frontonasal mass

A

Cephalocele
Nasal glioma
Hemangioma
Dermoid

65
Q

Nonaggressive nasal cavity mass

A
Nasal polyp
Antrochoanal polyp
Inverted papilloma
Mucocele
Juvenile nasopharyngeal angiofibroma (JNA)
66
Q

Aggressive sinonasal mass

A
SCC
SNUC
Enthesioneuroblastoma
Mets / lymphoma
Mucormycosis
GPA
67
Q

Cystic floor of mouth mass

A
Abscess
Ranula (simple, diving)
Lymphangioma
Epidermoid / dermoid
Sialocele
68
Q

Nonenhancing stuff filling sinuses

A
Allergic fungal sinusitis / fungal mycetoma
Inspissated secretions
Mucous retention cyst
Blood
Polyp
69
Q

Cystic structure in larynx

A

Laryngocele / pyolaryngocele
Thyroglossal duct cyst
Cystic neoplasm
Saccule – normal

70
Q

Nasal septal perforation

A
Trauma
Cocaine use 
GPA
Sarcoidosis
Non Hodgkin lymphoma
Invasive fungal sinusitis
71
Q

Mass in masticator space

A
Odontogenic abscess
Neoplasm:
- mandible lesion (cystic and solid DDx)
- soft tissue sarcoma
- SCC
- perineural tumour spread 
- schwannoma 
Pseudolesion - masticator muscle hypertrophy
72
Q

Mass in parapharyngeal space

A

Salivary origin / deep parotid: pleomorphic adenoma / BMT (widens stylomandibular notch)
Neurogenic: schwannoma, neurofibroma, paraganglioma
Mets / lymphoma

73
Q

Mass in parotid space

A
Pleomorphic adenoma
Warthin tumour
Nodal mets / lymphoma
Minor salivary gland tumour
Lipoma
First branchial cleft cyst
74
Q

Mass in carotid space

A
Carotid body paraganglioma
Glomus vagale paraganglioma (displaces ICA/ECA anteriorly w/o splaying)
Vagal schwannoma
Neurofibroma
Jugular vein thrombosis
Pseudoaneurysm
75
Q

Mass in retropharyngeal space

A
Reactive lymph node
Metastatic lymph node
Lymphoma
Ectopic parathyroid adenoma
Sympathetic schwannoma
76
Q

Mass in pharyngeal mucosal space

A
Nasopharyngeal carcinoma
Minor salivary gland tumour
Lymphoma
Lymphoid hyperplasia
Tornwaldt cyst
Juvenile nasal angiofibroma
77
Q

Enlarged extra-ocular muscles

A

Thyroid orbitopathy
Pseudotumour
Lymphoma / mets
Sarcoid

78
Q

Intraorbital mass

A
Venolymphatic malformation (hemangioma, lymphangioma, varix)
Benign neoplasm (schwannoma, meningioma)
Mets / lymphoma / rhabdomyosarcoma
Inflammatory (pseudotumour, sarcoid, GPA)
Collection (hematoma, subperiosteal abscess)
79
Q

Intra-ocular mass

A

to do

80
Q

Petrous apex mass

A
Congenital cholesteatoma
Cholesterol granuloma
Petrous apicitis
Trapped fluid / mucocele
Mets / myeloma / lymphoma / endolymphatic sac tumor / bone tumor
81
Q

Diffusely weird skull

A
Paget’s
Fibrous dysplasia
Hyperparathyroidism
Mets / myeloma
Thalassemia
82
Q

Skull lesions in kid

A
Neoplastic
- Fibrous dysplasia
- Osteoma
- Chondrosarcoma
- Chordoma
Non-neoplastic
- LCH
- Osteomyelitis
- Hemangioma
- Growing fracture / leptomeningeal cyst
83
Q

Mandibular and maxillary lucent lesions

A

Cysts (dentigerous, periapical cysts)
Neoplasm (odontogenic keratocyst, ameloblastoma)
Giant cell granuloma
Dentigerous infection / abscess

84
Q

Chiari II

A
Spine
- Myelomeningocele
- Sometimes syringohydromyelia
- Sometimes vertebral anomalies
Posterior fossa (too small)
- Low lying torcula
- Towering cerebellum
- Downward displacement of the cerebellum / tonsillar herniation
- Narrow 4th ventricle
- Kinking of the brainstem
- Tectal beaking
Supratentorial
- Dysgenesis of the corpus callosum
- Absent septum pellucidum
- Deficient falx
- Interdigitation of the supratentorial medial hemispheric gyri
- Stenogyria posteriorly
- Large massa intermedia
- Gray matter heterotopia
85
Q

Cowden

A

Dysplastic cerebellar gangliocytoma (Lhermitte-Duclos disease)
Thyroid, breast, GI, GU cancers

86
Q

Septo-optic dysplasia

A
Small optic nerves, abnormal fundoscopy
Deficiency septum pellucidum
Sometimes
- Schizencephaly
- Gray matter heterotopia
- Cortical dysplasia
- Ventriculomegaly
- Hypothalamic / pituitary issues
- Olfactory hypoplasia
- Midline facial malformations
87
Q

Multisystem atrophy

A

Atrophy of cerebellum, pons, middle cerebellar peduncles (MSA – C)
High signal in the pontocerebellar fibers (hot cross bun) (MSA – C)
Putaminal atrophy, low T2, with high T2 signal at the margins (MSA – P)

88
Q

Lumbar region anomalies that go together

A
Spinal dysraphism
Tethered cord
Fatty filum terminale
(Lipo)myelomenigocele
Dermoid / epidermoid
Dorsal dermal sinus
89
Q

Gorlin syndrome (basal cell nevus)

A
Mandibular / maxillary cysts
Dural calcification
Basal cell skin cancer
Medulloblastoma
Bifid ribs
Kyphoscoliosis
Ovarian fibromas
90
Q

Jugular foramen lesion

A

Glomus jugulare
Schwannoma (CN IX, X, or XI)
Necrotizing otitis externa
Skull base lesions: meningioma, mets, myeloma, chondrosarcoma

91
Q

Mass in oropharynx

A
Tonsil SCC
Palatine tonsil inflammation/abscess
Lymphoma
Minor salivary gland tumour
Crohn's
92
Q

Mass in posterior cervical space

A

Lymphadenopathy
Third branchial cleft cyst: posterolateral to carotid space
Nerve sheath tumour
Nodular fasciitis

93
Q

Diffuse retropharyngeal space abnormality

A
Abscess
Effusion
Suppurative adenopathy
Longus colli calcific tendonitis 
Hypopharyngeal SCC
94
Q

Mass in oral mucosal space

A

SCC
Minor salivary gland carcinoma
Radiation mucositis

95
Q

Mass in root of tongue

A
Abscess
SCC 
Thyroglossal duct cyst
Dermoid/epidermoid
Lingual/ectopic thyroid tissue
96
Q

Transspatial neck lesion

A

Venous / lymphatic / venolymphatic malformation
Infection
SCC
Plexiform neurofibroma