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frcr 2a flashcards > Neuro > Flashcards

Neuro Flashcards

1
Q

Cause of CN3 (occulor motor) palsy

A

Think posterior communicating artery aneurysm

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2
Q

Cranial nerve 6 (abducens) palsy

A

Think raised ICP (downward displacement of the brainstem = stretching of the 6th CN.

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3
Q

Brain myelination progression order

A

Inferior to superior
Posterior to anterior
Central to peripheral

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4
Q

What is the last part of the brain to myelinate?

A

Subcortical white matter

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5
Q

What parts of the brain are myelinated at birth?

A

Brainstem
Posterior limb internal capsule

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6
Q

How does the corpus callosum form?

A

Front to back
i.e. Rostrum to Splenium

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7
Q

Wide spaced vertical ventricles, dilation of the occipital horns, intracranial lipoma. Diagnosis?

A

Agenesis of the corpus callosum

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8
Q

Vermis (cerebellar) hypoplasia, cystic dilatation of the 4th ventricle, lambdoid inversion of the torcular. Diagnosis?

A

Dandy Walker malformation

Spectrum of disease.
Mega cisterna magna (normal cerebellum and posterior fossa)
to Classic DWM (tiny cerebellum, expanded posterior fossa).

MCM - Blake Pouch - Variant DWM - Classic DWM

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9
Q

Large lateral ventricle on one side, with ipsilateral hamartomatous overgrowth of that cerebral hemisphere. Diagnosis?

A

Hemimegalencephaly

(Ramussen’s encephalitis = BIG ventricle, SMALL cerebral hemispehere)

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10
Q

Types of holoprocencephaly?

A

Lobar - <50% focal fusion of the anterior brain.

SemiLobar - >50% fusion of the anterior brain.

ALobar - Zero midline cleavage. Single ventricle.

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11
Q

What are the different types of Lissenchephaly?

A

Lissencephaly (Type 1) - failure of grey matter migration. Agyria (no gyri), thick cortex, “figure of 8” shaped brain.

Lissencephaly (Type 2) - overmigration of grey matter. Cobblestoned thickened cortex. Associated with congenital muscular dystrophy.

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12
Q

What is Double cortex band heterotopia?

A

Disorganised under migration of grey matter. Double cortex appearance, normal/mildly simplified gyri. Second layer of grey matter seen around the ventricles.

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13
Q

What is periventricular nodular heterotopia?

A

Under migration of grey matter. Nodular grey matter deposited around the periventricular region.

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14
Q

Cleft in the brain extending from ventricle to the surface filled with CSF. The cleft is lined with grey matter. Diagnosis?

A

Schizenchephaly (OPEN LIP) - Congenital split brain, lined with grey matter.

If cleft is not filled with CSF, but still lined with grey matter, then its closed lip schizencephaly.

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15
Q

Cleft in the brain extending from ventricle to the surface filled with CSF. The cleft is NOT lined with grey matter. Diagnosis?

A

Porencephaly - aquired split brain, usually secondary to vascular insult resulting in encephalomalacia. NOT lined with grey matter.

If cleft is lined with grey matter then it’s shizencephaly.

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16
Q

Define Chiari 1 malformation

A

Cerebellar tonsils >5mm below the level of basion-opistion

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17
Q

Features of chiari 2 malformation

A

Myelomeningocele
Low lying cerebellar tonsils and torcular
Thinned corpus callosum
Tectal beaking

If also has occipital encephalocele = Chiari Type 3

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18
Q

Patient with urinary incontinene, confusion, and ataxia. CT head shows ventricles out of proportion to atrophy, and upward bowing of the corpus callosum. Diagnosis?

A

Normal pressure hydrocephalus.

“Wet, Wacky, Wobbly”
Urinary incontinence, confusion, ataxia.

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19
Q

Type of oedema that comes secondary to infarction?

A

Cytotoxic oedema - INTRAcellular fluid secondary to malfunction of the Na/K+ pump. Tends to favour grey matter, causing loss of grey-white matter differentiation.

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20
Q

Type of oedema that comes secondary to tumour/infection?

A

Vasogenic oedema - EXTRAcellular fluid. Oedema tracking through the white matter. Spares the grey matter.

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21
Q

Alcoholic, low Na which is rapidly corrected. Now encephalopathic, low GCS, quadraparesis.
MRI shows T2 bright in central pons. Restricted diffusion in central pons.
Diagnosis?

A

Osmotic demyelination syndrome

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22
Q

Alcoholic. Confusion, ataxia, seizures, and spasticity.
CT head shows hypoattenuating regions of the corpus callosum.
MR shows T2 hyperintensities in the corpus callosum.
Diagnosis?

A

Marchiafava-bignami disease - demyelination of the corpus callosum.

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23
Q

Acute symptoms of headache, dizzyness, memory loss.
CT shows low density in the globus pallidus.
MR shows T2/FLAIR high signal in globus pallidus.
Diagnosis?

A

Carbon monoxide poisoning

Carbon monoxide causes “Globus warming”

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24
Q

Headache, dizziness, optic neuritis, vomiting.
CT shows low density in putamen bilaterally.
MRI shows high T2/FLAIR signal in the putamen.
Diagnosis?

A

Methanol poisoning

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25
Q

Previous chemoetherapy. Bilateral asymettric subcortical white matter oedema within the occipital lobe. Does not restrict on DWI.
Diagnosis?

A

PRES (Posterior Reversible Encephalopy Syndrome)

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26
Q

Post chemotherapy. New confusion.
MRI shows bilateral diffuse, confluent high T2/FLAIR signal in the subcortical white matter centrum semiovale.
Diagnosis?

A

Methotrexate induced leukoencephalopathy

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27
Q

IVDU. New cerebellar ataxia, and pseudo bulbar symptoms.
MRI shows symmetrical “butterfly” high T2 signal in centrum semiovale, posterior limb internal capsule, and deep cerebellar white matter.
Diagnosis?

A

Heroin induced leukoencephalopathy (Chasing the dragon)

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28
Q

Common locations for MS white matter lesions?

A

Juxtacortical
Corpus callosum
Periventricular
Infratentorial

Basal ganglia rare.

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29
Q

McDonald Diagnostic criteria for MS?

A

> 1 lesion disseminated in space (juxtacortical, Corpus callosal, periventricular, infratentorial).

> 1 lesion disseminated in time - >1 month

Active lesions enhance on MR
Old lesions do not enhance (both are T2 bright)

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30
Q

Female patient, 37 y/o, presents with seizure.
MR brain shows large ring enhancing lesion with incomplete ring sign. Minimal mass effect for the size of the lesion.
Diagnosis?

A

Tumefactive Demyelination.

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31
Q

15 y/o presents with seizure after having a vaccine.
MR shows multiple “incomplete ring” enhancing lesions, sparing the calloso-septal interface.
Diagnosis?

A

ADEM - Acute Disseminated Encephalomyelitis.

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32
Q

60y/o presents with dementia like symptoms.
MRI shows multiple, small, confluent high T2 signal in centrum semiovale sparing the subcotical U fibres.
Diagnosis?

A

Subcortical Arteriosclerotic Encephalopathy (small vessel dementia)

CADASIL - cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy - presents at a younger age due to hereditary nature.

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33
Q

5 year old present with progressive impariment of motor/cognitive function.
MRI shows high FLAIR signal in parieto-occipital white matter sparing subcortial U fibres, and extends across the corpus callosum.
Diagnosis?

A

Adrenoleukodytrophy.
(ALD)

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34
Q

18 month old, convulsions, loss of vision, muscle rigidity.
MRI shows high FLAIR signal in the periventricular white matter in a “tiger stripe” pattern.
Diagnosis?

A

Metachromatic Leukodystrophy.

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35
Q

Infant with large head, has progressive quadrapaerisis and seizure.
MRI shows high FLAIR signal in the frontal white matter bilaterally.
Diagnosis?

A

Alexander disease

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36
Q

Ashkenazi Jewish infant with big head. Bloods show elevated NAA.
MR shows diffuse high FLAIR signal throughout the white matter involving the subcortical U fibres.
Diagnosis?

A

Canavan disease

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37
Q

Infant with a small head.
MRI shows high FLAIR signal in the centrum semiovale and periventricular white matter, with parieto occipital predominance.
Diagnosis?

A

Krabbe leukodystrophy

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38
Q

MEN 1

A

Pituitary
Parathyroid
Pancreatic

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39
Q

MEN 2a

A

PMP

Pheochromocytoma
Medullary thyroid tumour
Parathyroid hyperplasia

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40
Q

MEN 2b

A

Pheochromocytoma
Medullary thyroid cancer
Mucosal neuroma
Marfanoid features

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41
Q

Patient with cerebellar ataxia, autonomic dysfunction, and parkinsonism.
MRI T2 shows cruciate high signal within the pons, high signal in middle cerebellar peduncles, and cerebellum.
Diagnosis?

A

Multi system atrophy
(Hot cross bun sign + autonomic dysfunction)

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42
Q

What runs through the cavernous sinus?

A

CN 3, 4, 5 (V1+2), 6, and the carotid artery

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43
Q

What travels through superior orbital fissure + inferior orbital fissure?

A

Superior orbital fissure - CN 3, 4, V1, 6
Inferior orbital fissure - V2

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44
Q

What are the Parkinson plus syndromes?

A

Dementia with Lewy bodies
Multisystem atrophy
Progressive supra nuclear palsy
Cortico-basal degeneration

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45
Q

Patient with abnormal eye movements, instability and falls.
MRI head shows midbrain atrophy with sparing of the pedicles, and flattening of the superior aspect of the midbrain.
Diagnosis?

A

Mickey mouse sign
Hummingbird sign

Progressive supranuclear palsy.

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46
Q

Patient with alien limb syndrome, asymmetric movement disorders has an MR brain showing asymmetric cortical atrophy, basal ganglia atrophy, and atrophy of the corpus callosum.

A

Corticobasal degeneration

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47
Q

Patient presents with glioblastomas and intestinal polyps. What is the diagnosis?

A

Turcot syndrome

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48
Q

16 year old boy with progressive dementia symptoms. MRI shows eye of tiger sign with high signal around the globus pallidus. Diagnosis?

A

PKAN - Hallervoden Spatz

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49
Q

What is dolichoectasia and it’s associated diseases?

A

Dilated and ectatic intracranial vessels.
Most commonly vertebro-basilar or internal carotid.
Can cause compression of cranial nerves.
Associated with Marfans, Ehlers-Dahnlos

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50
Q

What is the most common CNS metastases in a child?

A

Neuroblastoma.

51
Q

What are the cortically based tumours?

A

P-DOG

Pleomorphic xanthoastrocytoma
DNET
Oligodendroglioma
Ganglioglioma

52
Q

What are the imaging appearances of pleomorphic xanthoastrocytoma?

A

Supratentorial
Cyst with enhancing nodule.

53
Q

How can you tell the difference between pleomorphic xanthoastrocytoma, pilocytic astrocytoma, and haemangioblastoma?

A

All 3 appear as cyst with enhancing nodule.

Pleo - Supratentorial, in temporal lobe
Pilocytic - Posterior fossa in kids
Haemangioblastoma - Posterior fossa in adults

54
Q

Typical radiological appearance of a DNET?

A

Paediatric temporal lobe lesions
T2 Bright and Bubbly appearance
Minimal enhancement

55
Q

Typical radiological appearance of an oligodendroglioma?

A

Typically occurs in adults
Calcification - ribbon like
Frontal lobe predominant
Expands the cortex

56
Q

Typical radiological appearance of a ganglioglioma?

A

Typically found in temporal lobe in teenagers.
Typically presents with seizures.
Mixed solid cystic appearance.
Can have bony remodeling

57
Q

What are the intraventricular lesions?

A

MESS-C

Medulloblastoma
Ependymoma
Subependymoma
SEGA
-
Central neurocytoma

58
Q

How do you differentiate between an ependymoma Vs medulloblastoma?

A

Both classically 4th ventricle tumours.

Ependymoma arises from the floor of 4th ventricle, squeezing out of it (toothpaste sign).
Calc + haemorrhage - enhance heterogeneously.

Medulloblastoma arises from the roof of 4th ventricle, protruding into it. Enhance more homogenously.

59
Q

Which tumour is most likely to metastases to the spine? Ependymoma or medulloblastoma?

A

Medulloblastoma - metastases
Need to image rest of spine

60
Q

What condition are Subependymal Giant Cell Astrocytomas associated with?

A

Tuberous sclerosis.

61
Q

Where are SEGAs typically located?

A

At the base of the lateral ventricles near the foramen of Munro.
Hydrocephalus is commonly present.

62
Q

What age group do SEGAs appear in Vs Subependymoma?

A

SEGAs appear in children Vs Subependymoma appears in adults.

63
Q

What is the classical imaging appearance for a Central neurocytoma?

A

Cystic “Swiss cheese” appearance.

Interventricular lesion.
Tend to calcify a lot (like oligodendroglioma)
Internal haemorrhage is common.

64
Q

Name two brain tumours that classically calcify?

A

Oligodendroglioma
Central neurocytoma

65
Q

Classic imaging appearance for a choroid plexus papilloma?

A

Cauliflower appearance.
Hydrocephalus due to excess CSF secretion
Homogeneous enhancement

66
Q

Classic imaging appearances of a meningioma?

A

Extra axial (CSF cleft sign)
Classically have a dural tail

67
Q

What is the most common CPA angle masses?

A

Vestibular Schwannoma (75%)
Meningioma (10%)
Epidermoid (5%)
Dermoid

68
Q

What condition are Schwannoma associated with?

A

NF 2

69
Q

How can you differentiate between a dermoid Vs an epidermoid CPA angle mass?

A

Dermoids are classically midline
Epidermoids are classically off midline.

70
Q

What is the classical imaging appearances of an AT/RT?

A

Typically occur in the posterior fossa.
Aggressive large heterogenous mass with necrosis

71
Q

Which low grade tumours classically enhance?

A

GPS

Ganglioglioma
Pilocytic astrocytoma
SEGA

72
Q

Classic imaging features of primary CNS lymphoma?

A

Periventricular
Crosses the corpus callosum
Homogeneously enhancing

73
Q

What causes gelastic seizures?

A

Hypothalamic hamartoma

74
Q

What are the pineal lesions?

A

GPPP

Germinoma (most common)
Pineal cyst
Pineocytoma
Pineoblastoma

75
Q

Typical imaging appearances of a germinoma?

A

Pineal lesion
Heterogeneous mass containing fat and calcification.

76
Q

Classic imaging features of a pineoblastoma?

A

PineoBLASToma - “Exploded” calcification
Highly invasive compared to pineocytoma

77
Q

Classic imaging features of adult Toxoplasmosis CNS infection?

A

Ring enhancing lesion with LOTS of oedema

78
Q

Classical imaging features of an Adamantinous Craniopharyngioma?

A

Supra sella lesion.
- Cystic.
- Peripheral calcification.
- Mostly seen in children.

(Papillary craniopharyngioma is solid, with no calc, in adults)

79
Q

What are the differences between Adamantinous Craniopharyngioma and Papillary craniopharyngioma?

A

Both are suprasellar lesion

Adamantinous are cystic with peripheral calcification, seen in kids.

Papillary are mainly solid, with no calc, seen in adults.

80
Q

What are the leukodystrophies from frontal predominance to occipital predominance?

A

Alexander disease - frontal
Canavan disease - Diffuse subcortical U
Metachromatic - Periventricular, tigroid
Krabbe - Centrum semiovale and occipital
ALD - Parieto Occipital

81
Q

What is CADASIL?

A

CADASIL - cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy - Severe small vessel disease that presents at a young age due to hereditary nature.

82
Q

How can you differentiate choroid plexus papilloma from choroid plexus carcinoma?

A

Choroid plexus papilloma enhances homogeneously

Choroid plexus carcinoma enhances heterogeneously

83
Q

Where do CNS hemangioblastomas occur?

A

Posterior fossa
Supratentorial (in VHL patients)

84
Q

Imaging features of optic nerve gliomas

A

Enlargement of the optic nerve
Enlargement of the optic canal
Kinking of the optic nerve

T2 bright

85
Q

Typical imaging appearance of vestibular schwannoma

A

CPA angle mass

Low T1
Heterogeneous High T2
Intense heterogeneous enhancement

86
Q

How does vein of Galen malformation typically present?

A

Neonatal high output cardiac failure
Obstructive hydrocephalus

87
Q

Where does diffuse axonal injury typically occur

A

Grey white matter junction

88
Q

Most common brain metastases in adult?

A

Long Runs? Be My Guest.

  1. Lung
  2. Renal
  3. Breast
  4. Melanoma
  5. GI
89
Q

What is Pick’s disease?

A

Frontotemporal atrophy
Typically in young men
Type of tauopathy

90
Q

Classic imaging appearance of Huntington’s disease

A

Caudate head and putamen atrophy with compensatory dilatation, of the frontal horns of lateral ventricles.

High signal within caudate and putamen

91
Q

Suprasellar lesions?

A

SATCHMO

S - sarcoid
A - aneurysm
T - teratoma, TB
C - craniopharyngioma, chordoma, cleft cyst (rathke)
H - hypothalamic hamartoma/glioma, histiocytosis
M - meningioma, metastases
O - optic nerve glioma

92
Q

Imaging features of CNS cytomegalovirus.

A

High T2 oedema typically in a PERIVENTRICULAR distribution.
No enhancement.
Can affect the whole neuro axis.

93
Q

What is diastematomyelia?

A

Split cord malformation

Splitting of the distal spinal canal with a bony cleft, resulting in two spinal cords.

94
Q

What is Moyamoya disease?

A

Idiopathic, non inflammatory, not atherosclerotic, vascular occlusive disease.

Seen in kids.

Present with hemispheric ischaemic strokes, and watershed infarcts

95
Q

How can you age subdural haematoma based on MRI blood signal?

A

Type - Time - T1 sig - T2 sig

Oxy Hb - Immediate - Iso - Iso

Deoxy Hb - 1-2 days - iso - low

Intracellular Met Hb - 2-7 days - high - low

Extracellular Met Hb - 7-28 days - high - high

Hemosiderin - chronic - low - low

96
Q

Typical MRI appearance of a Rathke Cleft Cyst?

A

Congenital intrasellar lesion found in kids.
60% have suprasellar extension

T1 - 50% high, 50% low due to protein content
T2- 70% high
Gd - No enhancement

An intracystic nodule is present in 75%

97
Q

Where are germinomas typically found

A

Pineal gland
Suprasellar
Periventricular

98
Q

Typical imaging findings for cerebral abscess

A

Thin enhancing rim of uniform thickness.

Double rim sign:
- outer low signal rim (fibrous capsule), inner high signal rim (enhancing capsule)

99
Q

What are the types of hypothalamic hamartomas?

A

Sessile - attached to mammillary region, near mammillary bodies

Pedunculated - attached to the tuber cinereum and projects into the suprasellar cistern

100
Q

How to differentiate between spinal schwannoma Vs neurofibroma?

A

Both are low T1 and high T2

Schwannoma displaces nerve roots
Neurofibroma encases nerve roots

Neurofibroma - target sign (central low signal)

101
Q

How does syringomyelia normally present?

A

Cape like loss of pain and temperature sensation along back and upper arms

102
Q

What are the intradural but extramedullary tumours?

A

No More Spinal Masses

Neurofibroma
Meningioma
Schwannoma
Metastases

103
Q

Typical imaging findings of CNS amyloidosis?

A

Cortical, sub cortical and cerebellar micro-haemorrhages, sparing the basal ganglia.

104
Q

How can you tell the difference between amyloid micro-haemorrhage Vs hypertensive micro-haemorrhage?

A

Hypertensive micro-haemorrhage typically affects the basal ganglia whereas amyloid micro-haemorrhage spares the basal ganglia

105
Q

MRI brain findings of Wilson’s disease?

A

High T2 signal in basal ganglia

106
Q

Clinical presentation of Wilson’s disease?

A

Parkinsonism, ataxia and gait abnormalities.

107
Q

Acute stroke findings on MRI?

A

T2 bright
Restricted diffusion

ADC values pseudo-normalise as time progresses (~2 weeks)

108
Q

Most common viral encephalitis?

A

Herpes simplex virus encephalitis

109
Q

Typical findings in HSV encephalitis?

A

Involvement of:
- Fronto-temporal lobes.
- Insular cortex.
- Limbic system.

Haemorrhage is frequent.

110
Q

Imaging findings in Wernicke’s encephalopathy?

A

High T2 signal:
- mammillary bodies
- thalamus
- periaqueductal grey matter

111
Q

What is Lhermitte-Duclos disease?

A

Dysplastic cerebellar gangliocytoma
Associated with Cowden disease

112
Q

Typical imaging findings for Dysplastic cerebellar gangliocytoma

A

Thickening of the cerebellar cortex (Tigroid cerebellum)
High T2 signal.
No enhancement.

Dysplastic cerebellar gangliocytoma = Lhermitte-Duclos disease.

Associated with Cowden syndrome

113
Q

What is Dysplastic cerebellar gangliocytoma associated with?

A

Cowden syndrome

114
Q

What is progressive multifocal leukoencephalopathy?

A

AIDS related with low CD4 count

Demyelinating disease that affects the subcortical FRONTAL and PARIETO-OCCIPITAL lobes.

115
Q

Intradural, intramedullary spinal neoplasms?

A

Energetic Astronauts Have Lively Parties

Ependymoma (60%)
Astrocytoma (33%)
Hemangioblastoma
Lymphoma
Paraganglioma

116
Q

Spinal ependymoma imaging appearance?

A

Location cervical or upper thoracic spine (75%), within the central cord

Symmetrical widening of the cord with associated syrinx
Haemorrhage causing “cap sign”

T1 - iso
T2 - high
Gd - strong enhancement

117
Q

What are spinal ependymomas associated with?

A

NF2

118
Q

Spinal cord astrocytoma imaging appearance?

A

Location cervical and thoracic spine

Eccentric as they originate from cord parenchyma.
Poorly defined margins

T1 - iso
T2 high
Gd - patchy enhancement

119
Q

Astrocytoma is associated with which condition?

A

NF1

120
Q

How to differentiate between spinal cord ependymoma Vs astrocytoma?

A

Ependymoma adult
Astrocytoma kids

Ependymoma centrally located within cord
Astrocytoma eccentrically located within cord

Ependymoma diffuse enhancement
Astrocytoma patchy enhancement

121
Q

What do cortical tubers look like on MRI?

A

Cortical and subcortical high T2 signal.
Rarely enhance.

122
Q

What is gliomatosis cerebri?

A

Growth pattern if diffuse glioma that involves at least 3 lobes.

123
Q

What is Lissencephaly type 2 associated with?

A

Congenital muscular dystrophy.

124
Q

Most common association with Chiari 1 malformation?

A

Syrinx

frcr 2a flashcards (11 decks)

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