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RRC DDx 2 > Neuro > Flashcards

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
At least partly solid posterior fossa mass
``` Primary Intraventricular - Ependymoma / subependymoma - Choroid plexus papilloma Parenchymal - Medulloblastoma (kid) - Pilocytic astrocytoma (kid) - Hemangioblastoma (adult) - ATRT (baby) - Lhermitte-Duclos (dysplastic cerebellar gangliocytoma) Mets / lymphoma ```
26
Supratentorial intraventricular mass
``` 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 ```
27
Bubbly intra-axial mass
``` Dysembryoplastic neuroepithelial tumour Ganglioglioma Pleomorphic xanthoastrocytoma Low grade astrocytoma Oligodendroglioma Mimic (see ddx of parenchymal cysts) ```
28
Nonspecific solid appearing extra-axial mass (broad ddx for CT)
``` Neoplasm (meningioma, hemangiopericytoma, mets/lymphoma) Vascular abnormality (aneurysm, AVM) Mycobacterial / fungal infection Neurosarcoid Collection (hemorrhage / empyema) ```
29
Cystic appearing extra-axial mass
Subdural / epidural collection (old hematoma, hygroma, empyema, effusion) Developmental “cysts” (arachnoid, epidermoid, dermoid) Volume loss
30
Extra-axial solid masses adjacent to brainstem
Benign primary (schwannoma, meningioma) Mets / lymphoma Perineural spread Adjacent tumor (chondrosarcoma, chordoma, glomus jugulare) Non-neoplastic (aneurysm, neurosarcoid, TB)
31
Solid pineal mass (may have cystic / necrotic components)
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
32
Cystic pineal mass
Pineal cyst Arachnoid / epidermoid cyst Cystic appearance of solid mass (see solid pineal mass DDx, most likely pituicytoma)
33
Solid sellar mass
``` 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)
34
Cystic sellar mass
Some solid enhancement - Craniopharyngioma (adamantinomatous - peds) - Cystic macroadenoma - Dermoid cyst - Partially thrombosed aneurysm Cystic - Rathke’s cleft cyst - Arachnoid / epidermoid cyst - Craniopharyngioma - Empty sella
35
Bulky infundibulum
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])
36
Cavernous sinus mass
``` Neoplastic - Meningioma - Nerve sheath tumour - Chondrosarcoma - Mets / Lymphoma Vascular (venous sinus thrombosis, ICA aneurysm, CCF) Inflammatory (Tolosa Hunt, sarcoid) ```
37
Nodular leptomeningeal enhancement
Malignancy (leptomeningeal carcinomatosis [breast, prostate], lymphoma/leukemia) Granulomatous (neurosarcoid, TB) Inflammatory (GPA, LCH – peds)
38
Smooth leptomeningeal enhancement
Meningitis (infectious, chemical) Encephalitis Post SAH / trauma Post intervention (LP, surgery)
39
Smooth pachymeningeal enhancement
``` Intracranial hypotension - Spontaneous - Post intervention (LP, surgery) Granulomatous: TB, sarcoidosis, Wegener/GPA, Erdheim-Chester Meningitis Venous sinus thrombosis Idiopathic hypertrophic pachymeningitis ```
40
Nodular pachymeningeal enhancement
Granulomatous: TB, sarcoidosis, Wegener/GPA, Erdheim-Chester Meningitis Venous sinus thrombosis Idiopathic hypertrophic pachymeningitis
41
Cortical formation problems
``` 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
Way too much CSF in baby
``` Alobar holoprosencephaly Ventriculomegaly / hydrocephalus Hydranencephaly / severe porencephaly Large open lip schizencephaly Interhemispheric cyst ```
43
Missing brain / skull in utero
Anencephaly / severe microcephaly Acrania Amniotic band syndrome
44
Symmetric band of ectopic gray matter
Band heterotopia | Lissencephaly – pachygyria spectrum
45
Etiologies of parenchymal hemorrhage
``` Trauma Hypertension / cocaine if young Amyloid angiopathy Venous sinus thrombosis Vasculitis Vascular malformation (AVM, DAVF, cavernoma) Hemorrhagic mass (primary or secondary) ```
46
Etiologies of subarachnoid hemorrhage
``` Trauma Aneurysm (including mycotic) CAA AVM / DAVF Vasculitis / vasospasm / RCVS Dural venous sinus thrombosis Perimesencephalic hemorrhage ```
47
Cervical or intracranial arterial stenosis / occlusion
``` Atherosclerosis Dissection FMD (cervical only) Vasospasm / RCVS (intracranial only) Vasculitis (cervical = Takayasu, GCA; intracranial = PACNS and CTD or cocaine) Thrombophilia ```
48
Etiologies of infarct
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
Multiple microhemorrhages
Trauma (DAI) HTN CAA Vasculitis Neoplasm (hemorrhagic mets, multiple cavernomas) Arteriolosclerosis / CADASIL Mimic: metal emboli from mechanical valve replacement
50
Vascular malformations
``` AVM Aneurysm Cavernoma Capillary telangiectasia DVA DAVF ```
51
Distal cerebral aneurysms
Mycotic Vasculitis Dissection
52
Intramedullary solid mass
``` Primary neoplasm - Ependymoma - Astrocytoma - Hemangioblastoma - Ganglioglioma (1-5 yo) - ATRT (<2 yo) Mets / lymphoma ``` ``` Vascular malformation (cavernoma, AVM) Granulomatous (mycobacterial / fungal phlegmon, sarcoid) ```
53
Intradural extramedullary masses
``` Nerve sheath tumour Meningioma Mets / lymphoma Myxopapillary ependymoma Spinal paraganglioma / neuroendocrine tumour ```
54
Extradural masses (similar to posterior mediastinal masses)
``` Herniated disc Mets / lymphoma Epidural abscess / hematoma Osseous lesion Extramedullary hematopoiesis Lipomatosis ```
55
Multiple masses in the cord / canal
``` 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
Cystic collection in neural foramina
``` Meningocele Pseudomeningocele with nerve root avulsion Neurenteric cyst Synovial cyst Cystic nerve sheath tumour ```
57
Anterior tethering / posterior indentation of the cord
Arachnoid cyst / epidermoid / dermoid cyst Spinal dural herniation Arachnoid web
58
Central cord high signal
``` NMO / ADEM / MS Transverse myelitis (primary or secondary: viral, syphilis, vaccine, etc.) Infarct / venous HTN (DAVF) Contusion / compressive myelopathy Astrocytoma ```
59
Dorsal column high signal
Subacute combined degeneration (B12 deficiency) Copper deficiency Infectious (HIV, Syphilis) Demyelination Ischemia (tends to be unilateral when posterior due to paired spinal arteries)
60
Owl eye sign
``` Anterior spinal artery infarct Polio Chronic compressive myelopathy NMO Spinal muscular atrophy ```
61
Disc and two adjacent vertebrae problems
``` Osteomyelitis / discitis - Pyogenic - TB Neuropathic joint Amyloid spondylo-arthropathy (dialysis spine) Mets / myeloma / lymphoma ```
62
Three things you can add to any neck mass ddx
Minor salivary gland tumor Rhabdomyosarcoma Adenopathy
63
Cystic / necrotic neck nodes
``` Mets: H&N SCC, thyroid ca Bacterial / suppurative / pyogenic lymphadenitis Tuberculous adenitis Lymphoma (pre or post treatment) Other: Kawasaki / Kikuchi ```
64
Frontonasal mass
Cephalocele Nasal glioma Hemangioma Dermoid
65
Nonaggressive nasal cavity mass
``` Nasal polyp Antrochoanal polyp Inverted papilloma Mucocele Juvenile nasopharyngeal angiofibroma (JNA) ```
66
Aggressive sinonasal mass
``` SCC SNUC Enthesioneuroblastoma Mets / lymphoma Mucormycosis GPA ```
67
Cystic floor of mouth mass
``` Abscess Ranula (simple, diving) Lymphangioma Epidermoid / dermoid Sialocele ```
68
Nonenhancing stuff filling sinuses
``` Allergic fungal sinusitis / fungal mycetoma Inspissated secretions Mucous retention cyst Blood Polyp ```
69
Cystic structure in larynx
Laryngocele / pyolaryngocele Thyroglossal duct cyst Cystic neoplasm Saccule – normal
70
Nasal septal perforation
``` Trauma Cocaine use GPA Sarcoidosis Non Hodgkin lymphoma Invasive fungal sinusitis ```
71
Mass in masticator space
``` Odontogenic abscess Neoplasm: - mandible lesion (cystic and solid DDx) - soft tissue sarcoma - SCC - perineural tumour spread - schwannoma Pseudolesion - masticator muscle hypertrophy ```
72
Mass in parapharyngeal space
Salivary origin / deep parotid: pleomorphic adenoma / BMT (widens stylomandibular notch) Neurogenic: schwannoma, neurofibroma, paraganglioma Mets / lymphoma
73
Mass in parotid space
``` Pleomorphic adenoma Warthin tumour Nodal mets / lymphoma Minor salivary gland tumour Lipoma First branchial cleft cyst ```
74
Mass in carotid space
``` Carotid body paraganglioma Glomus vagale paraganglioma (displaces ICA/ECA anteriorly w/o splaying) Vagal schwannoma Neurofibroma Jugular vein thrombosis Pseudoaneurysm ```
75
Mass in retropharyngeal space
``` Reactive lymph node Metastatic lymph node Lymphoma Ectopic parathyroid adenoma Sympathetic schwannoma ```
76
Mass in pharyngeal mucosal space
``` Nasopharyngeal carcinoma Minor salivary gland tumour Lymphoma Lymphoid hyperplasia Tornwaldt cyst Juvenile nasal angiofibroma ```
77
Enlarged extra-ocular muscles
Thyroid orbitopathy Pseudotumour Lymphoma / mets Sarcoid
78
Intraorbital mass
``` Venolymphatic malformation (hemangioma, lymphangioma, varix) Benign neoplasm (schwannoma, meningioma) Mets / lymphoma / rhabdomyosarcoma Inflammatory (pseudotumour, sarcoid, GPA) Collection (hematoma, subperiosteal abscess) ```
79
Intra-ocular mass
to do
80
Petrous apex mass
``` Congenital cholesteatoma Cholesterol granuloma Petrous apicitis Trapped fluid / mucocele Mets / myeloma / lymphoma / endolymphatic sac tumor / bone tumor ```
81
Diffusely weird skull
``` Paget’s Fibrous dysplasia Hyperparathyroidism Mets / myeloma Thalassemia ```
82
Skull lesions in kid
``` Neoplastic - Fibrous dysplasia - Osteoma - Chondrosarcoma - Chordoma Non-neoplastic - LCH - Osteomyelitis - Hemangioma - Growing fracture / leptomeningeal cyst ```
83
Mandibular and maxillary lucent lesions
Cysts (dentigerous, periapical cysts) Neoplasm (odontogenic keratocyst, ameloblastoma) Giant cell granuloma Dentigerous infection / abscess
84
Chiari II
``` 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
Cowden
Dysplastic cerebellar gangliocytoma (Lhermitte-Duclos disease) Thyroid, breast, GI, GU cancers
86
Septo-optic dysplasia
``` 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
Multisystem atrophy
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
Lumbar region anomalies that go together
``` Spinal dysraphism Tethered cord Fatty filum terminale (Lipo)myelomenigocele Dermoid / epidermoid Dorsal dermal sinus ```
89
Gorlin syndrome (basal cell nevus)
``` Mandibular / maxillary cysts Dural calcification Basal cell skin cancer Medulloblastoma Bifid ribs Kyphoscoliosis Ovarian fibromas ```
90
Jugular foramen lesion
Glomus jugulare Schwannoma (CN IX, X, or XI) Necrotizing otitis externa Skull base lesions: meningioma, mets, myeloma, chondrosarcoma
91
Mass in oropharynx
``` Tonsil SCC Palatine tonsil inflammation/abscess Lymphoma Minor salivary gland tumour Crohn's ```
92
Mass in posterior cervical space
Lymphadenopathy Third branchial cleft cyst: posterolateral to carotid space Nerve sheath tumour Nodular fasciitis
93
Diffuse retropharyngeal space abnormality
``` Abscess Effusion Suppurative adenopathy Longus colli calcific tendonitis Hypopharyngeal SCC ```
94
Mass in oral mucosal space
SCC Minor salivary gland carcinoma Radiation mucositis
95
Mass in root of tongue
``` Abscess SCC Thyroglossal duct cyst Dermoid/epidermoid Lingual/ectopic thyroid tissue ```
96
Transspatial neck lesion
Venous / lymphatic / venolymphatic malformation Infection SCC Plexiform neurofibroma

RRC DDx 2 (8 decks)

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