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Case review > Neuro > Flashcards

Neuro Flashcards

1
Q

top 2 intradural extramedullary lesions

A

meningioma, schwannoma

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2
Q

top 2 intradural intramedullary tumors

A

ependymoma
astrocytoma
(both make up 70% of total spinal cord tumors, E more common in adults, A in children)

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3
Q

classic presentation of intradural intramedullary lesions

A

insidious, progressive back pain worse with lying down, radicular pain and often neurologic deficits

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4
Q

Intra-dural/intraaxial compartment means what?

A

everything inside the PIA mater (WM, GM, ependymal lining -> embryonic neuroectoderm)

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5
Q

neuroepithelial tumor categories/subtypes

A

glial, neuronal, pineal, embryonal

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6
Q

Glial tumor subtypes

A

astrocytic, oligodendroglial, ependymal, choroid plexus

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7
Q

which is more common in the adult spine - ependymal or astrocytic lesions

A

ependymal

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8
Q

which is more common in the adult brain - ependymal or astrocytic lesions

A

astrocytic

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9
Q

WHO ependymal tumors

A

Grade I: subependymoma/ myxopapillary ependymoma,
Grade II: ependymoma/ ependymoma RELA fusion-positive (grades II and III),
Grade III: anaplastic ependymoma

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10
Q

Classic features of ependymal tumors

A

well circumscribed, non-infiltrative enhancing mass, centrally located in the spinal cord
- T1 hypo/iso, T2 iso/hyper + heterogenous with cystic/blood products
- +/- syrinx formation (CSF flow disruption)
- very heterogenous - think anaplastic

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11
Q

most common intramedullary tumor in adults

A

ependymoma

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12
Q

typical location for astrocytoma in spinal cord - central or eccentric ?

A

eccentric

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13
Q

NF2 common CNS tumor types

A

ependymomas, schwanommas and meningiomas
- frequently present with multiple lesions, at young ages

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14
Q

myxopapillary ependymoma features

A
  • slow growing variant of SC ependymomas, 13% of all spinal ependymal tumors
  • M > F
  • T2 hyperintense enhancing mass, often with cyst/syrinx/hemorrhagic changes
  • +/- hemosiderin cap
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15
Q

subependymoma features

A

slow growing glioma
- benign, WHO Gr 1
- middle age + older (slight M>F)
- most common in 4th and lateral ventricles

  • very rare in the spine
  • T2 hyper, T1 iso/hypo. usually NO enhancement
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16
Q

Astrocytoma grade categories

A

pilocytic (Gr1), diffuse (Gr2), anaplastic (Gr3), glioblastoma (Gr4)

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17
Q

important prognostic marker for astrocytomas

A

IDH (isocitrate dehydrogenase)

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18
Q

most common primary intra-axial tumor of SC in kids

A

pilocytic astrocytoma

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19
Q

intracranial pilocytic astrocytoma features

A
  • young ppl; 75% by 20.
  • 2nd MC primary brain tumor in kids (after medulloblastoma)
    associated with NF1 (optic path)
  • 60% cerebellum, 20-30% CN2
  • well-circumscribed, variable imaging appearance; 67% - large cystic mass with E+ mural nodule , 16% mixed cystic/solid, 17% solid.
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20
Q

spinal astrocytomas

A

eccentrically positioned
appearance depends on subtype
- E+ correlates with tumor grade
- Gr3 and 4 => poor prognosis

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21
Q

ganglioglioma

A

Gr1
- arises MC in the cortex, then GM in hypothalamus/brainstem, rarer in spine
- circumscribed enhancing mass with cystic changes

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22
Q

3rd MC spinal cord tumor

A

hemangioblastoma

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23
Q

hemangioblastoma

A

relatively benign non-aggressive tumors of mensenchymal origin
- often VHL mutations (TSG on Cr 3)
- 80% in cerebellum. <20% in spinal cord (3rd most common intramedullary lesion, 2-6%)

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24
Q

hemangioblastoma imaging features

A

hypervascular enhancing tumor at the pial surface
- ‘cyst with nodule’ in >50%
- T1 variable, T2 iso/hyper, vivid enhancement
- may have ++flow voids, vasogenic edema

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25
Q

intramedullary SC mets

A

typically enhancing lesions with circumscribed margins and surrounding edema
- lung, breast CA
- very poor prognosis, median 4/12

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26
Q

Cavernous malformation of the SC

A

low flow capillary malformation with spongy ectatic blood-filled channels.
- anywhere along neuroaxis
- T1/T2 heterogenous hyper with peripheral T2 hypo from hemosiderin
- no sig E+

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27
Q

spinal epidermoid

A

cystic tumors lined by Sq epithelium derived from ectoderm
- rare to be IM (case reports)
- can be congenital, many acquired (post LP)
- well defined, match CSF ( T1 hypo, T2 hyper, FLAIR hyper, no E+, DWI bright)

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28
Q

commonest causes of multiple dural based masses

A

meningioma, metastases, neurosarcoid, extramedullary hematopoeisis, LHC (can look like anything)

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29
Q

what is a lipomyelomeningocele?

A

spinal dysraphism - lipoma + dorsal defect
- elongated SC ends in attachment to lipomatous tissue
+/- syrinx, split cord, segmental anomalies, caudal agenesis
- anorectal/GU malformations in 5-10%

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30
Q

spinal meningioma features

A

F>M, thoracic spine most common, usually located laterally
T1 iso/hypo, T2 slightly hyper to cord, intense E+, Ca2+ sometimes

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31
Q

spinal schwannoma

A

associated with NF2, typical location dorsal spinal nerve root, common to extend into foramina
well-circumscribed T1 hypo/T2 hyper to cord, intense E+ but heterogenous in larger lesions

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32
Q

malignant peripheral nerve sheath tumor

A

rare. 30-60 yo, 50% inn NF1, prior radiation 10%. paraspinal location most common. can mimc benign nerve sheath tumors.

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33
Q

most common cystic IDEM lesion in the lumbar spine

A

schwannoma

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34
Q

Common IDEM neoplasms

A

Meningioma
Nerve sheath tumors (Schwannoma, neurofibroma),
paraganglioma,
filum terminale ependymomas,
subarachnoid seeding (usually CNS primary)

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35
Q

anaplastic astrocytoma features

A

heterogenous T2 hyper. often no E+. elevated Cho, decreased NAA

  • diffusely infiltrating malignant mass
    DDx diffuse astro, GBM, oligodendroglioma, cerebritis
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36
Q

most common IDEM lesion type?

A

nerve sheath tumors

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37
Q

types of nerve sheath tumors

A

schwannoma, neurofibroma, malignant peripheral NST

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38
Q

NF1 characteristic lesion

A

neurofibroma

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39
Q

meniscus CSF sign

A

widening of the CSF space at the margins of the lesion => IDEM!!

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40
Q

cystic degeneration of schwannoma - common?

A

yes

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41
Q

masses extending through neural foramina

A

schwannoma, neurofibroma, MPNST, lymphoma, mets

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42
Q

intradural-extradural lesion

A

schwannomas extending rhough neural foramen

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43
Q

NF2 lesion locations in spine

A

Extradural, intradural extramedullary (NST), IDIM (ependymoma)

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44
Q

neurofibromatosis 1

A

14% have hamartomas, low grade astrocytomas
20% have IDEX masses (neurofibromas)

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45
Q

neurofibroma imaging features

A
  • similar to Schwannoma,
  • ‘target sign’ can sometimes have low T2 centrally, and usually no cystic
  • more likely to degenerate to malignancy (2-12%)
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46
Q

NF1 features

A

enlarged NF, dural ectasia, arachnoid cyst, neurofibromas
meningocele (thoracic)
10% scalloping of post vert body from dural ectasia

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47
Q

spinal meningioma features (clinical)

A
  • 2nd MC IDEM primary
  • usuallyT region (80%)&raquo_space; C > lumbar
    F>M, 20-60, located dorsal to cord
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48
Q

spinal meningioma imaging

A

IDEM lesion (meniscus sign)
iso to cord on T1 and T2, avid E+
broad dural base
+/- E+ dural tail, calcs, bone rxn

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49
Q

features of fibrous dysplasia of temporal bone

A

younger pppl (<30), expansile, mixed lucent and sclerotic/GG matrix density, rarely involves otic capsule
- rarely destructive

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50
Q

osseous temporal bone lesions

A

FD, Paget’s, otosclerosis, meningioma, osteoma, osteopetrosis, endolymphatic sac tumor, osteogenesis imperfecta

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51
Q

what is a CAPNON?

A

calcifying pseudoneoplasm of neuraxis
- benign, non-neoplastic fibroosseous mass
intra or extra-axial
- can mimic meningioma

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52
Q

types of otosclerosis

A

cochlear and fenestral

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53
Q

1st and 2nd most common pediatric brain tumor?

A

1st: gliomas
2nd: medulloblastoma

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54
Q

Peds: 4th ventricle mass DDx

A

medulloblastoma (30-40%)
ATRT (<3yo)
brainstem glioma
posterior pilocytic astrocytoma (25-35%)
posterior fossa ependymoma

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55
Q

medulloblastoma features

A
  • usually midline mass along roof 4th V
  • mass effect & hydroceph common
  • T1 low, T2 iso/hyper to GM, hypercellular tumor (bright DWI), 90% E+
  • usually does not extend into basal cisterms
  • prognosis depends on genetics/ molecular subgroup (4)
    COMMON TO HAVE DROP METS
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56
Q

if intracranial medulloblastoma, image what?

A

whole neuroaxis

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57
Q

posterior fossa ependymoma features

A
  • glial tumor
  • usually midline floor 4th V or lateral recess near obex
  • often squeezes out foramen of Luschka/Magendi
  • heterogenous masses: necrosis/calcs/hemorrhage/cystic
  • T1 iso/hypo, T2 hyper, E+ heterogenous,
    IMAGE WHOLE NEUROAXIS
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58
Q

intracranial subependymoma

A

uncommon, benign, slow growing lesions, usually middle/older age (50+)
- well defined, usually <2cm,
- T1 iso/hypo to WM, T2 hyper, E+ usually NONE/minimal

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59
Q

DDx for a subependymoma

A

ependymoma (E+)
choroid plexus papilloma (avid E+)
central neurocytoma (uncommon)
subependymal GCA and nodules (TS+ patients)

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60
Q

spinal hemangioblastomas - basic features (location, appearance, rule of 1/3rds?)

A
  • extradural, pial, intradural, intramedullary
  • 60% T spine, 30% C spine.
  • cauda = usually (>90%) solid. 75% elsewhere mural nodule + cyst
  • 1/3 of pts with VHL have spinal HGB, 1/3 of pts with spinal HGB have VHL
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61
Q

DDx multiple enhancing nodules on surface of spinal cord?

A

subarachnoid seeding of mets, hemangioblastomas, infection, sarcoid

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62
Q

where specifically to look in VHL?

A
  • temporal bone - look for endolymphatic sac tumors
  • retinal angiomas
  • renal
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63
Q

myxopapillary ependymoma - clinical features

A

usually IDEM,
- exclusive conus medullaris and filum terminale
- slight M>F
- benign WHO gr 1, slow growing, relatively ASx
- cystic change and E+, & location in FT and central thecal sac are best clues

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64
Q

DDx cystic lesions of the cauda/filum terminale

A

myxopapillary ependymoma, cystic Schwannoma, filum terminale cyst

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65
Q

can myxopapillary ependymoma erode and invade bone?

A

yes! often remodel VBodies (scalloping), but can also grow extradurally into the bones

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66
Q

spinal paragangliomas - clinical features

A

origin of neural crest cells
typical locations - Cauda E or terminal filum

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67
Q

spinal paraganglioma imaging features

A

T1 iso, T2 hyper, intense E+
50% FLOW VOIDS
rarely cystic change

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68
Q

spinal paraganglioma in lumbar region DDx

A

myxopapillary ependymoma, schwannoma, meningioma, hemangioblastoma

69
Q

intradural mets in peds DDx

A

medulloblastoma, ependymoma, pineal tumors, primitive GCTs, leukemia

70
Q

intradural mets in adults DDx

A

lymphoma, melanoma/lung/breast/gastric

71
Q

where does the vein of Labbe run?

A

sylvian fissure to transverse sinue.

72
Q

superficial anastamotic veins (3)

A

superficial middle cerebral vein, vein of Trolard, vein of Labbe

73
Q

Lhermitte Duclos aka?

A

dysplastic cerebellar gangliocytoma

74
Q

Lhermitte Duclos imaging features

A

alternating bands of T1 and T2 hyperintense signal. No/minimal enhancement, no DR.
little mass effect for the size of the lesion

75
Q

Big 3 peds posterior fossa

A

Pilocytic astrocytoma, medulloblastoma, ependymoma

76
Q

classic peds pilocytic astrocytoma features

A
  • low grade = low cellularity.
  • large cystic component, enhancing nodule
  • High T2, low T1, low DWI, external to 4th V, eccentric location
  • often cerebellum (60%), 4th V expands around it. 2nd most common is optic nerve pathway
77
Q

classic peds medulloblastoma

A
  • 2nd MC malignant brain tumor in peds (2nd to astrocytoma)
  • hypercellular, intermediate/low T2, HIGH DWI/low ADC, 90% enhance heterogenously
  • ROOF 4th V

GET NEUROAXIS IMAGES FOR DROP METS

78
Q

classic peds ependymoma location

A

floor of the 4th V

79
Q

Classic PRES

A

subcortical and juxtacortical WM T2/FLAIR high SI, classically parietoocciptal region
- generally not a lot of E+ (may be leptomeningeal), not really DR,
- 40% hemorrhagic component

80
Q

ADEM clinic + imaging features

A
  • acute monophasic inflammation/demyelination of WM
  • Typically bilateral, asymmetric iT2 high SI in subcortical WM/thalami/BS.
  • E+ -> punctate/rin/arc enhancement (open ring sign along leading edge)
  • peripheral DR (not central!)
81
Q

treatment/prognosis for ADEM

A

50-60% recover w/in 1/12
sequelae in 20-30%, 10% relapse.
10-20% fulminant course

82
Q

ADEM vs MS

A

MS: callososeptal interphase, deep WM spinal cord, brainstem, more focal neurologic, uncommon to have viral/immunization before.
ADEM: more asymmetric subcortical WM

83
Q

acute hemorrhagic leukoencephalitis (Hurst disease)

A

fulminant ADEM

84
Q

PML

A

multifocal asymmetric WM, subcortical U fiber involvement, immunocompromised
NO ENHANCEMENT, little mass effect.

85
Q

hypoglycemic encephalopathy

A

bilateral involvement, cortex (parieto-occipital, insula, neonates - posterior fossa)

86
Q

Spine MS features

A

multiple, short segment (<2 VB), T2/FLAIR high SI, mild E+.

87
Q

McDonald Criteria

A
  • disseminated in space: periventricular, cortical/juxtacortical, infratentorial, SC lesion
  • disseminated in time - new lesions, or some lesions with E+ and some not, some with DR+ some note. (ie, different age of lesions)
88
Q

MIMSE

A

NF2
- meningioma, schwanoma, ependymoma

89
Q

Owl’s Eye sign

A

cord ischemia! central location of abnormal SI

90
Q

long segment T2 high SI in SC

A

transverse myelitis
cord edema from compression
intramedullary lesion (astrocytoma)

91
Q

subacute combined cord degeneration

A

dorsal columns demonstrate high T2 SI
causes: B12 def, Vit E def, intrathecal MTX toxicity, copper overload, HIV, neurosyphilis

92
Q

cystic IDEM lesions in spine

A

arachnoid cyst (matches CSF, no DR)
epidermoid cyst (FLAIR HI, DR+)
spinal neurenteric cyst (ventral)
ventral SC herniation
dural ectasia (Lumbar region, vertebral scalloping)

93
Q

neurenteric cyst features

A

developmental abnormality - persistent neuro-enteric canal
IMID, or EMED!
associated with spinal vertebral anomalies (fusion, butterfly)
high protein content in the fluid - not CSF signal

94
Q

transdural spinal cord herniation

A

transdural herniation - defect in the thecal sac (most common trauma/DDD related) resulting in SC herniation
best seen on myelograms

95
Q

spinal arachnoid cyst

A

IDEM, CSF signal on all sequences. no enhancement

96
Q

Fatty lesions in the spinal cord DDx

A

lipoma
lipomyelomeningocele
dermoids
fatty infiltration of the filum

97
Q

lipoma of the filum terminale association?

A

tethering of the cord/low-lying cord

98
Q

fatty infiltration of the filum

A

not associated with tethering of cord. just fat signal in the filum, will suppress on STIR

99
Q

dural ectasia - features

A

de novo or associated with syndromes
expansion of the intraspinal dural spaces, with scalloping of the VB

100
Q

dural ectasia associated syndromes

A

NF1, lateral thoracic meningocele, Marfan syndrome, mucopolysaccharidoses
achondroplasia

101
Q

Spetzler classification of spinal dAVF - # classes?

A

4

102
Q

dural AVF

A

arteriovenous shunts
variable presentation with hemorrhage/venous congestion & HTN
70% of spine vascular malformations
60-70yo. M>F

103
Q

dural AVF typical features?

A

typically cord enlargement
flow voids on cord surface
consider angiogram

104
Q

differential for spinal nerve root enhancement?

A

infection (WNV, CMV, HZV, lyme disease, TB, fungals)
inflammatory (GBS)
post-op,
subarachnoid seeding (cancer, neurosarcoid)

105
Q

Differential for spinal vascular malformation?

A

hemangioma
cavernoma
AVFs
capillary telangiectasia

106
Q

GBS findings in the spine?

A

acquired demyelinating polyneuropathy
diffuse NR E+ common
selective anterior NR E+ also possible

107
Q

neurosarcoid features

A

CNS involvement in 15% of sarcoid cases
variable T2 SI, but enhances - usually surface of neural element, may be nodular. can also grow into the spinal cord (IM)
DDx: SubA seeding

108
Q

spinal dAVF vs spinal AVM

A

both ABN arteriovenous connections
- dAVF : MC spinal vascular anomaly, DURAL vessels. extramedullary location. age 60-70, M>F, RARE
hemorrhage.
- dAVM: AV shunts with a true nidus, 25% of vasc malformations, IM and EM locations, usually younger presentation, more common to hemorrhage, cause myelopathy, arterial steal if high flow

109
Q

chronic inflammatory demyelinating polyradiculoneuropathy?

A

autoimmune disorder
- cause of myelopathy and nerve root enlargement (may NOT enhance!)
Rx: steroids and plasmaphoresis
DDx: hereditary neuropathy syndrome (MCT), mucopolysaccharidoses

110
Q

differential for enlarged nerve roots?

A

subarachnoid seeding
infections
sarcoid
neurofibromatosis
chronic inflammatory demyelinating polyradiculoneuropathy

111
Q

intraaxial cyst with mural nodule DDx

A

hemangioblastoma
pilocytic astrocytoma
ganglioglioma
cystic ependymoma

112
Q

IDIM differential

A

astrocytoma
ependymoma
hemangioblastoma
metastasis
ganglioglioma
cord edema
demyelination
syrinx
cavernoma ?

113
Q

spinal cord hemangioblastoma

A

solid enhancing nodule with surrounding cystic changes
IDIM location
look for prominent blood vessels on the surface of the SC

114
Q

spinal cord ganglioglioma

A

rare, <1% SC tumors in adults, more common in peds (15%)
cervical > thoracic
long segments of cord, eccentric,
T1 mixed, T2 high, patchy enhancement/no enhancement. COMMON Ca2+

DDx astrocytoma, ependhymomas are shorter, transverse myelitis 0 central location and resolves

115
Q

bright T1 and T2

A

fat, blood, melanin, enhancement

116
Q

6 segments of the facial nerve

A

origin: medulla. exit: bulbopontine sulcus
cisternal seg in CPA cistern
meatal/canalicular seg
labyrinthine seg (IAC seg to geniculate ganglion)
tympanic seg (geniculate to foraminal eminence
mastoid segment (foraminal eminence to stylomastoid foramen)
extra-temporal segment

117
Q

meningioma vs schwannoma

A

bone changes/thickening (M>S)
in CP Angle, cystic lesion (S>M)
dural tail (M>S)
calcifications (M>S)
heterogenous enhancement (S>M)

118
Q

base of tongue lesions

A

thyroglossal duct cyst (MC congenital neck lesions)- matches fluid.
lingual thyroid (T1/T2 high SI. avid E+)
epidermoid/dermoid cyst (cystic + DR for epidermoid, fat for dermoid)
hemangioma, venolymphatic malformation
tonsillar hypertrophy

119
Q

facial nerve lesions

A

normal enhancment of the tympanic/mastoid
Bell palsy/infection/postinfection
nerve sheath tumor
hemangioma
perineural tumor spread (parotid, usually adenoid cystic)

120
Q

floor of mouth/submandibular cystic masses

A

SqCC - usually ill defined, enhancing mass
infection/abscess
ranula - mucous retention cyst
venolymphantic malgormation
epidermoid/dermoid

121
Q

congenital cholesteatomas are the same as (except for location)?

A

epidermoid cyst!

122
Q

nasal cavity enhancing mass DDx

A

peds: juvenile nasopharyngeal angiofibroma (local aggressive, origin in NP adj to sphenopalatine foramen and ptgopatn fossa)
esthesioneuroblastoma - malignant, classic T2 bright dumbell shape
rhabdomyosarc
hemangioma
sinonasal lymphoma
inverted papilloma

123
Q

CADASIL means?

A

cerebral AD arteriopathy with subcortical infarcts and leukoencephalopathy

124
Q

ADEM features

A

monophasic DMD folloing vax or virus
variable course
large, b/l WM lesions, high T2/FLAIR.
may have open ring/nodular enhancement

125
Q

NOM (Devic disease)

A

optic and spinal cord (periaqueductal WM)
relative brain sparing

126
Q

DDx confluent WM lesion in peds

A

leukodystrophies (metachromic and adrenoleukodystrophy), sometimes MS, chemo-related change.
ADEM

127
Q

ring-enhancing brain lesions

A

metastasis
abscess
GBM
subacute infarct + infection/inflammatory
contusion
demyelination (incomplete ring)
radiation necrosis

128
Q

confluent periventricular and deepwhite matter lesions in adult

A

chronic microvascular changes
demyelination
HIV related progressive multifocal leukoencephalopathy (reactivation of JC virus) - characteristically involves subcortical U, typically asymmetric)
neoplastic (gliomatosis cerebri)
treatment-related leukoencephalopathy (chemo/rad)

129
Q

dandy walker malformation

A

developmental abnormality of the vermis and 4thC,
- enlarged posterior fossa
- vermis partial or complete agenesis
- hypoplasia of the cerebellar hemispheres
- dilated 4th ventricle in communication with the CSF space

130
Q

DW variant

A

normal posterior fossa size
large 4th V
vermial hypoplasia

131
Q

cerebral cortical calcifications DDx

A

Sturge weber - bulky, dystrophic ‘tram-track’ + atrophy
tuberous sclerosis
post-ischemic
AVM
post operative
torch infections

132
Q

Sturge-Weber syndrome

A

phakomatosis, rare, sporadic, 1/20-50k incidence
facial port wine stain (congenital facial cutaneous capillary malformation), pial angiomas

133
Q

Filum terminale lesion DDx

A

myxopapillary ependymoma
lipoma
lipomyelomeningocele
spinal neuroendocrine tumor
nerve sheath tumor

134
Q

cauda equina neuroendocrine tumors

A

rare WHO I tumors

135
Q

hemangiopericytoma = no longer used. use solitary fibrous tumor of the dura

A

aggressive solitary fibrous tumor of the dura
large, solitary mass, frequently goes through the skull

136
Q

central neorucytoma

A

50% of intravent tumors in 25-50 yo.
usually 4thV, but can be lat vent.
WHO II.
lobular, well circumscribed lesion with intratumoral cysts, near septum pellucidum

DDx subependymoma (no enhancement, older), SEGA, intraventricular met, meningioma, choroid plex papilloma (usually 4th vent/posterior horn)

137
Q

lhermitte duclos

A

dysplastic cerebellar gangliocytoma
relatively well defined, infiltrative, cerebellar tumor, usually above vermis, benign but unclear if neoplasm or hamartomatous

T1 low, T2 high with septations, little to minimal enhancement
MASS effect!

138
Q

EAC masses DDx

A

cerumen impaction
exostoses
keratosis obturans
cholesterol granuloma
cholesteatomas (congenital/epidermoids or acquired)
EAC atresia
fibroangiomas
malignant otitis external
venous malformations/hemangioma
foreign body

139
Q

cholesterol granuloma vs cholesteatoma

A

CG is T1 and T2 hyper, not DWI bright

140
Q

cystic petrous apex lesions

A

cholesterol granuloma
carotid aneurysm
mucocele
cephalocele
congenital cholesteatoma
petrous apex effusion

141
Q

solid petrous apex lesions

A

meningioma
schwannoma
paraganglioma
skull base chordoma/chondrosarc
plasmacytoma
met

142
Q

suprasellar lesions DDx

A

if arising from sella - pituitary macroadenoma
meningioma
saccular aneurysm
astrocytoma
craniopharyngioma (papillary solid in adults, adamantinomatous cystic in peds)
germinoma

143
Q

oligodendroglioma features

A

intraaxial, WHO 2-3 gliomas, 5-25% of gliomas, 30-40yo.
cortical-based therefore often px as seizures
IDH mutation and 1p19q co deleted
cortex or subcortical WM
low T1, high T2, variable enhnacement, blooming common, typically no DR
heterogenous - Ca2+ hemorrhage, cyst.

DDx: astrocytoma, ganglioglioma, PXA

144
Q

ganglioglioma

A

uncommon, low grade, cortical based tumors.
propensity for temporal lobes (70%)
VARIABLE - cystic mass with nodule to solid mass
variable E+ (solid component), ca2+ show blooming

DDx: DNET (bubbly), PXA, oligodendoglioma

145
Q

subependymal giant cell astrocytomas

A

WHO 1, seen in TS patients (5-10%), may be asx or px with obstructive hydroceph
intraventricular mass near F of Munro, multilobulated mass, heterogenous T1 and T2 (high T2), marked E+, may ca2+

Ddx: subependymoma (no E+), central neurocytoma (older), choroid plexus tumors, intraventricular meningioma, met

146
Q

dysembryoplastic neuroepithelial tumor

A

glioneuronal tumors arising from cortical or subcortical GM
associated with cortical dysplasia. cause of intractable focal seizures
common temporal (65%+), frontal lobe (~20%).
low T1, high T2, bubbly appearance, some suppress on FLAIR. E+ variable (20-30%)

147
Q

PXA features

A

cortical tumor, uncommon, peak 20-30s.
usually cortical tumor with cystic component and vivid E+, usually temporal lobe.
may involve overlying meninges
T1 iso/hypo to GM, T2 solid hyper. cystic hyper. E+ in solid component
DDx: ganglioglioma. DNET, oligodendroglioma (Ca2+ common!)

148
Q

calcified intraaxial cortical mass

A

oligodendroglioma, sometimes ganglioglioma., DNET, cavernoma, ATRT, CAPNON (mostly extraaxial)

149
Q

calcified extraaxial

A

meningioma, skull base chondrosarc, chordoma, intracranial dermoid , adamantinomatous craniopharyngioma

150
Q

clival chordoma features

A

chordoma - uncommon malignant tumors originating from primitive notochord remnants, locally aggressive
30-35% of chordomas
posterior midline, indentation of pons
CT: central, circumscribed, destructive lytic lesion with expansile ST mass.
T1 inter/low. T2 very high. hetero E+

151
Q

clival mass DDx

A

chondrosarc SB
chordoma
meningioma SB
pit macroadenoma
plasmacytoma

152
Q

PRES causes and associations

A

severe HTN/eclampsia, HUS, SLE, TTP, drug tox (chemo, interferon, immunosuppr.) transplants, sepsis, SCD

153
Q

PRES features

A

bilateral vasogenic edemia inparietooccipital regions (70-90%) butcan be non-posterior.
cortical/subcortical.
T1 low. T2 high. DWI usually normal. 10-50% hemorrhage. E+ patchy
may have vessel irregularity (constrict/dilation/string of beads)

154
Q

PRES DDx (cortical/subcortial high T2 signal)

A

inflammatory amyloid
PML (but spares cortex)
post circ infarct (DR+)
gliomatosis cerebri

155
Q

gliomatosis cerebri

A

uncommon growth pattern of diffuse gliomas

156
Q

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS)

A

uncommon disorder characterized by infiltration of the brain by inflammatory cells.
predilection for pons, fairly characteristic curvilinear regions of enhancement

multiple punctate, patchy and linear regions of E+ relatively confined to the pon

157
Q

RCVS features

A

thunderclap HA and reversible vasoconstriction
F>M, 20-50 yo.
T2/FLAIR high signal - cortical or sulcal from SAH. MRA _ vascular narrowings sometimes, DWI - infarcts/
DDx: SAH with vasospasm, primary angiitis, arterial dissection

158
Q

DDX (broad) for high T2 signal in spinal cord

A

neoplasm (astro/ependy/HMB/mets/lymphoma(
demyelination (MS, TM, NMO, ADEM)
Vascula: ischemia, AVM, DAVF
Inflam: vasculitis, sarcoid
Infection

159
Q

short segment demyelination

A

MS, TM

160
Q

long segment demyelination

A

TM, NMO, ischemia

161
Q

differential for SAH withoutt aneurysm

A

non-aneurysmal SAH
pseudo-SAH
trauma

162
Q

causes of non-aneurysmal SAH

A

perimesencephalic, traumatic, vascular malformation, RCVS, rare inflammatory causes (vasculitis), drug use (cocaine)

163
Q

aneurysm frequency - ant vs posterior?

A

90% anterior
(Acom, Pcom, MCA bif, carotid terminus)
10% posterior circ (basilar tip, cerebellar arteries)

164
Q

densely calcificed parenchymal CNS lesion DDx

A

oligodendroglioma
ganglioglioma
DNET
ATRT
cavernous hemangioma

165
Q

typical location for ganglioglioma?

A

temporal lobe

166
Q

primary CNS lymphoma

A

1-2% intracranial tumors. most NHL. prediliection for meninges/ependyma/deep BG/periventricular region/CC.
solid E+, low T1 and T2 signal, surrounding edema

167
Q

classic appearance of Sjogren’s on US

A

multiple small cystic spaces throughout the gland, gland atrophy

168
Q

Salivary gland tumor DDx

A

Pleomorphic adenoma)
Warthin tumor (2nd MC, b/l in 10%)
Adenoid cystic (MC in SMG)
mucoepidermoid (50% in MSG, 40% parotid)
Acinar cell CA
undifferentiated
mets
hemangiomas

169
Q

Systemic dz affecting salivary glands

A

HIV - lymphoepithelial cysts
sarcoid (gland calcs)
Sjogren’s disease
Lymphoma
inflammatory/infectious

Case review (8 decks)

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