Neuro Flashcards
Bilateral basal ganglia / thalamic signal abnormality (general adult)
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)
Bilateral signal abnormality in globus pallidi
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)
Bilateral signal abnormality in putamina
Methanol toxicity (+ WM edema) Cyanide toxicity
Bilateral signal abnormality in thalami (sparing basal ganglia)
Artery of Percheron infarct
Venous infarct from cerebral venous sinus thrombosis
Primary bilateral thalamic glioma
Wernicke encephalopathy (+ periaqueductal gray, mammillary bodies, tectal plate)
Bilateral basal ganglia + cortex +/- thalamus
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)
Bilateral basal ganglia + hemorrhage
Venous infarction
Toxoplasmosis
Flavivirus encephalitis
Methanol or cyanide poisoning
Bilateral basal ganglia + diffusion restriction
Infarct / HIE
CO poisoning
CJD
Electrolyte disorder (hypoglycemia, hyperammonemia)
Vitamin / mineral disorder (Wernicke encephalopathy, Wilson disease)
Leukoencephalopathies (nonspecific adult)
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)
Symmetric supratentorial leukoencephalopathy
Toxic
PRES
HIE
HIV encephalitis
Corpus callosal lesions
Demyelination (MS, NMO, ADEM) Neoplasm (glioma, lymphoma) Classic CC disease (Marchiafava-Bignami - restricts diffusion acutely, Susac’s) DAI (blooming on T2*) [PML] [CADASIL]
Leukoencephalopathy + hemorrhage
Vasculitis (PACNS or secondary)
Amyloid
Hemorrhagic leukoencephalopathy (Hurst disease)
Arteriolosclerosis / CADASIL (micro only)
Leukoencephalopathy + infarcts
Arteriolosclerosis / CADASIL HIE MELAS Vasculitis SLE
Diffuse symmetric white matter signal abnormality (kid)
Periventricular leukomalacia TORCH infection Congenital leukodystrophy - Metachromatic leukodystrophy - Krabbe disease - X-linked adrenoleukodystrophy
Congenital leukodystrophies
Alexander disease (frontal)
X-linked adrenoleukodystrophy (parietooccipital, leading edge enhancement)
Krabbe (parietooccipital)
Metachromatic leukodystrophy (diffuse, tigroid)
Canavan (diffuse, really high NAA peak)
Focal brainstem lesion (adult)
Demyelination
Vascular (arterial or venous infarct, malformation – all except AVF)
Neoplasm (mets, high grade glioma, hemangioblastoma)
[Abscess]
[Hypertrophic olivary degeneration]
[Dilated perivascular spaces]
Focal brainstem lesion (peds)
Neoplasm (low grade glioma, PNET)
ADEM
Abscess
Hypertrophic olivary degeneration
Diffuse brainstem lesion (adult)
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
Diffuse brainstem lesion (peds)
Glioma DAI Wallerian degeneration Hepatic encephalopathy Infectious rhombencephalitis
Multiple parenchymal calcifications
Infection (TORCH, Neurocysticercosis)
Hyper/hypoparathyroidism
Genetic (TS, Sturge-Weber, Fahr’s)
Parenchymal cysts
Infection (abscess / neurocysticercosis / gelatinous pseudocysts / echinococcus)
Encephalomalacia / porencephaly
Neuroglial cyst
Dilated perivascular spaces
Neuro diseases in immunocompromised adult
Opportunistic infection (PML / Toxo / Crypto / TB / syphilis / CMV) HIV encephalopathy HIV vasculopathy CNS Lymphoma IRIS
Abnormal signal in temporal lobe cortex
Encephalitis
- Viral (Herpes vs other)
- Autoimmune (limbic): paraneoplastic, non-neoplastic
Infarct (arterial or venous)
Low grade glioma
Post-ictal status / mesial temporal sclerosis
Nonspecific intra-axial mass (broad ddx for CT)
Neoplasm (glioma, mets, lymphoma)
Vascular malformation (AVM, cavernoma) / aneurysm
Collection (hemorrhage, abscess)
Tumefactive demyelination
Rim enhancing lesions
Neoplasm (high grade glioma, mets / lymphoma – immunocompromised)
Infection (abscess, septic emboli, neurocysticercosis)
Tumefactive demyelination
Subacute infarct / hemorrhage / contusion
Radiation necrosis
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
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
Bubbly intra-axial mass
Dysembryoplastic neuroepithelial tumour Ganglioglioma Pleomorphic xanthoastrocytoma Low grade astrocytoma Oligodendroglioma Mimic (see ddx of parenchymal cysts)
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)
Cystic appearing extra-axial mass
Subdural / epidural collection (old hematoma, hygroma, empyema, effusion)
Developmental “cysts” (arachnoid, epidermoid, dermoid)
Volume loss
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)
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
Cystic pineal mass
Pineal cyst
Arachnoid / epidermoid cyst
Cystic appearance of solid mass (see solid pineal mass DDx, most likely pituicytoma)
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)
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
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])
Cavernous sinus mass
Neoplastic - Meningioma - Nerve sheath tumour - Chondrosarcoma - Mets / Lymphoma Vascular (venous sinus thrombosis, ICA aneurysm, CCF) Inflammatory (Tolosa Hunt, sarcoid)
Nodular leptomeningeal enhancement
Malignancy (leptomeningeal carcinomatosis [breast, prostate], lymphoma/leukemia)
Granulomatous (neurosarcoid, TB)
Inflammatory (GPA, LCH – peds)
Smooth leptomeningeal enhancement
Meningitis (infectious, chemical)
Encephalitis
Post SAH / trauma
Post intervention (LP, surgery)