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FRCR 2A > Neuro > Flashcards

Neuro Flashcards

1
Q
  1. Appearance of myelin on T1?
  2. Appearance of myelin on T2?
  3. Best sequence for evaluating myelination in the first 12 months of an infant’s life?
  4. Structures that are T1 bright in term neonate?
  5. Causes of delayed myelination (i.e. abnormal brain development)?
A
  1. Bright - fat content
  2. Dark - hydrophobic
  3. T1 - myelination appears complete on T1 by 12 months of age (but on T2 by 24 months of age)
  4. Dorsal brainstem, posterior limb of the internal capsule, perirolandic cortex
  5. Hypoxic ischaemic injury, intra-uterine or postnatal infection, chromosomal abnormalities
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2
Q
  1. What is the FLAIR sequence?
  2. Location of MS demyelinating lesions?
  3. Active demyelination?
  4. Differential for MS appearance on MR?
  5. What is tumefactive MS?
  6. How to differentiate MS from ADEM?
  7. How to differentiate MS from NMO?
A
  1. Heavy T2 weighting but signal removed from CSF - especially good for highlighting periventricular white matter abnormalities
  2. Juxtacortical, periventricular/periependymal and posterior fossa
  3. Enhancement or restricted diffusion
  4. Lupus, vasculitis
  5. Mimics a brain tumour - large deep white matter mass with peripheral horseshoe shaped ring enhancement
  6. ADEM affects children, has a monophasic course and responds well to steroids
  7. NMO spinal cord lesions are longer than MS, often spares the brain
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3
Q

Posterior reversible encephalopathy syndrome
1. Characteristic imaging findings?
2. Aetiology?

A
  1. Parieto-occipital cortical and subcortical oedema. No contrast enhancement or diffusion restriction.
  2. Cyclosporin/tacrolimus, chemotherapy, ARF, TTP, eclampsia, hypertension - latter may or may not be present
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4
Q

Drugs & toxins CNS findings:
1. Carbon monoxide?
2. Methanol?
3. Alcohol?

A
  1. Global pallidus abnormality
  2. Putamen, optic nerve atrophy
  3. Atrophy of cerebellar vermis
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5
Q

Differential for ring enhancing brain lesion?

A

MAGIC DR

Metastasis
Abscess
Glioblastoma
Infarct/Infection -TB, neurocystercicosis, toxo
Contusion/haematoma

Demyelinating lesion - tumefactive MS
Radiation necrosis

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6
Q

HIV-related infection
1. HIV encephalitis on MRI?
2. Progressive multifocal leukoencephalopathy on CT and MRI?
3. Most common fungal infection in AIDS?
4. Imaging appearances of this fungal infection?

A
  1. Normal T1, T2 hyperintense but sparing the subcortical u-fibres. Symmetric.
  2. CT -hypodense areas, MR - T1 low signal, T2 hyperintense involving the subcortical u-fibres. Asymmetric.
  3. Cryptococcus
  4. Leptomeningeal enhancement, gelatinous pseudocysts - do not enhance, cryptococcomas - do enhance
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7
Q

Haemorrhagic metastases?

A

MR CT BB

Melanoma
Renal cell ca

Choriocarcinoma
Thyroid ca

Breast ca
Bronchogenic ca (lung)

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8
Q

Multifocal primary brain tumours?

A

Mets
Multifocal GBM
Lymphoma
Gliomatosis cerebri

Medulloblastoma
Ependymoma
Oligodendroglioma
Syndromes

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9
Q

Cortically based brain tumours?

A

P-DOG

Pleomorphic xanthoastrocytoma
DNET
Oligodendroglioma
Ganglioglioma

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10
Q

Medulloblastoma vs ependymoma
1. which is more common?
2. which calcifies more frequently?
3. location?
4. imaging appearance of ependymoma?
5. imaging appearance of medulloblastoma?

A
  1. Medulloblastoma
  2. Ependymoma
  3. Medulloblastoma arises from roof of 4th ventricle - MR, ependymoma from floor, also a subset of supratentorial ependymomas
  4. Heterogenous enhancing, may be calcification, may be haemorrhage
  5. Enhancing, high attenuation on CT/low T2 due to hypercellularity, restrict
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11
Q

What causes restricted diffusion?

A

Acute stroke
Active demyelination
Abscess
Highly cellular tumours - medulloblastoma, lymphoma
Epidermoid cyst
HSV encephalitis

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12
Q

Cystic mass with nodule
- in child?
- in adult?

A
  • juvenile pilocytic astrocytoma
  • haemangioblastoma
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13
Q

Calcified intracranial masses?
Most commonly calcified?

A

CA COME

Craniopharyngioma
Astrocytoma, aneurysm

Choroid plexus papilloma
Oligodendroglioma
Meningioma
Ependymoma

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14
Q

Intracranial lesions that cross the midline?

A

Neoplastic
- GBM
- Lymphoma
- Gliomatosis cerebri
- Meningioma of the falx
- Metastasis
Demyelination
- MS plaque
- NMO, ADEM
- Marchiafava Bignami
Vascular
- corpus callosum infarct
Radiation necrosis
Trauma

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15
Q
  1. NF1 brain tumours?
  2. NF2 brain tumours?
  3. VHL?
  4. TS?
A
  1. Circumscribed glioma in the optic tract - a pilocytic astrocytoma
  2. MSME - multiple schwannomas, meningiomas, ependymomas
  3. Haemangioblastomas
  4. Subependymal giant cell astrocytomas
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16
Q

Normal pituitary on MR?

A

Anterior gland (adenohypophysis) is isointense on T1 and T2

Posterior gland (neurohypophysis) is bright on T1, dark on T2

Contrast enhancement from the stalk gradually spreads to the periphery

17
Q

HSV encephalitis

A
18
Q

What is a Jefferson fracture?
What is the mechanism?

A

Burst fracture of C1
Axial loading

19
Q

What is a Hangman fracture?
Mechanism?

A

Fracture of bilateral pars interarticularis of C2
Hyperextension

20
Q

What is a clay-shoveler’s fracture?

A

Avulsion fracture of lower cervical/upper thoracic spinous process - usually C7.

21
Q

Maximum distance between anterior arch and dens on flexion in adult and child?
Associations?

A

<3 mm adult and <5 mm in child

Congenital
os odontoideum, Down’s Syndrome, Morquio,

Connective tissue/arthritis
RA, AS, psoriatic arthropathy, Marfan’s

Trauma

22
Q
  1. Chiari I malformation?
  2. Chiari II malformation?
A
  1. Cerebellar tonsils protrude beyond foramen magnum, lying >5mm below a line connecting the basion and opisthion. Look for syrinx! Bony abnormalities - basilar impression, occipitilisation of the atlas, Klippel-Feil
  2. Constellation of intracranial findings (3 examples - displacement of medulla, fourth ventricle and cerebellum through foramen magnum, corpus callosum dysgenesis, tectal beaking) plus open spinal dysraphism - myelomeningocele/myelocele
23
Q

Features of tuberculous discitis?

A

Calcification
Posterior element involvement
Less loss of disc height
Gibbus deformity
Multilevel involvement

24
Q

Causes of posterior vertebral body scalloping?

A

SALMON

Spinal cord tumours (astrocytoma, ependymoma, schwannoma, dermoid, lipoma)
Achondroplasia, acromegaly
Loeys-Dietz syndrome & other connective tissue disorders
Marfan’s, mucopolysaccharidoses (Morquio, Hurler)
Osteogenesis imperfecta
NF1

Dural ectasia

25
Q

On craniopharyngioma:

  • demographics?
  • clinical features?
  • location?
  • key CT finding?
  • key MR?
  • differentiate from macroadenoma?
A

Bimodal - 75% in children/teenagers, rest in 50-60s

“most common suprasellar tumour of childhood”

Headache, visual disturbance, endocrine disturbance, hydrocephalus

Usually suprasellar, may be supra and intrasellar, just intrasellar rare

Cystic lesion with Calcification! Calcs more common in kids.

May be cystic or solid or mixed. Cyst characteristics - slightly T1 hyperintense compared to CSF due to protein, very T2 bright. MR spectroscopy - high lipid peak.

Pituitary macroadenoma is rare in children and expands the pituitary fossa.

26
Q

On Behcet’s:

  • most common parenchymal abnormality?
  • most common vascular abnormalities?
A

Scattered foci of high SI on T2w seen in brainstem, cerebellar peduncles, thalamus, basal ganglia

Dural venous sinus thrombosis Arterial aneurysms - may be multiple

27
Q

Classic MR finding of a preganglionic brachial plexus injury?

Clinical features?

A

Pseudomeningiocele

Rhomboid/paraspinal/serratus anterior paralysis
Horner’s syndrome

28
Q

Pineal germinoma

A

Most common
M»F
Homogenous, hyperdense on CT, engulfed calcs
MR: iso on T1/2, avid contrast enhancement, may restrict!

29
Q

Pineocytoma

A

Benign, slow-growing
M=F
Well-circumscribed, may be hyperdense, <3cm
Calcifications dispersed peripherally
Commonly cystic areas!
T1 low to iso, T2 high, avid and homogenous enhancement

30
Q

Pineoblastoma

A

Aggressive, large
Young patients/children
May form a 3 with bilateral retinoblastoma
May be haemorrhage
Exploded calcs
Avid enhancement

31
Q

8 Cs of Sturge-Weber?

A

Congested veins in pial angiomatosis
Cutaneous port wine stain
Cerebral atrophy
Calvarial thickening
Cortical tram-track calcification
Choroidal angioma
Choroid plexus enlargement
Cavernous sinus dilatation

32
Q

MS in the spine:

  1. Which part of the cord is most commonly affected?
  2. How long are lesions?
  3. MR features?
  4. Best sequence?
A
  1. Cervical cord, dorsolateral peripherally located
  2. Less than two segments in length
  3. High T2, enhancement of active lesions
  4. STIR better than FLAIR
33
Q

Imaging features of cerebral manifestations of AIDS - what condition is alluded to?

  1. Basal meningitis
  2. Cerebral infarcts
  3. Ventriculoencephalitis
  4. Non-enhancing low attenuation basal ganglia lesions
A
  1. Neurotuberculosis
  2. Neurosyphilis
  3. CMV
  4. Cryptococcal pseudocysts

FRCR 2A (10 decks)

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