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Radiology Ddx > Neuro > Flashcards

Neuro Flashcards

1
Q

Demyelination ddx

A
  • acute disseminated encephalomyelitis (ADEM, teen 2wk post viral inf, 5% post vaccination)
  • neuromyelitis optica spectrum disorder (NMOSD, AQP4 IgG)
  • multiple sclerosis
  • osmotic demyelination (rapid Na correction typical round/trident lesion central pons)
  • post traumatic (focal, relevant history)
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2
Q

Intramedullary expansile spinal cord lesion ddx

A

- tumors
– astrocytoma
– ependymoma (hemosiderin cap)
– pilocytic astrocytoma (most common pediatric)

**- demyelination **(open ring of enhancement; T2 high signal does not extend beyond)
– MS (multiple short lesions in time and space, <50% cord transverse area)
– transverse myelitis (longer lesion, variable enhancement)
- infarction

- other
– syrinx

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3
Q

Long spinal cord lesions ddx

A
  • neuromyelitis optica spectrum disorder (NMOSD)
  • myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)
  • acute disseminated encephalomyelitis (ADEM)
  • neurosarcoidosis, Sjögren syndrome, systemic lupus erythematosus (SLE)
  • Behçet disease (vasculitis)
  • paraneoplastic myelitis (e.g. anti-CRMP-5, anti-amphiphysin, anti-Hu)
  • post-infectious/infectious (eg HTLV-1-associated myelopathy, poliomyelitis, tuberculous myelopathy)
    -spinal cord infarction
  • spinal dural arteriovenous fistula (dAVF)
  • transverse myelitis (>2 vertebral levels, >2/3 axial area)
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4
Q

Cortical cystic tumor ddx

A

P-DOG
- pleomorphic xanthoastrocytoma
- DNET
- oligodendroglioma
- ganglioglioma

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5
Q

Low lying conus medullaris ddx

A
  • myxopapillary ependymoma
  • fatty filum terminale
  • diastomyatomyelia with bony bar
  • adhesions eg from surgical repair of open spinal dysraphism, trauma, infection, inflammation)
  • dermoid/epidermoid tumors
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6
Q

Posterior vertebral body scalloping ddx

A

mass
- myxopapillary ependymoma
- astrocytoma
- paraganglioma
- neurofibroma
- schwannoma
- dermoid/epidermoid

Dural ectasia
- NF1
- Marfan syndrome
- Ehler-Danlos
- osteogenesis imperfecta
- Loeys-Dietz

Skeletal
- achondroplasia
- mucopolysaccharidoses (Hurler/Morquio)
- acromegaly

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7
Q

Fat containing intracranial lesion ddx

A
  • dermoid (risk of rupture)
  • teratoma (never rupture)
  • lipoma (may calcify)
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8
Q

cerebellopontine angle mass ddx

A
  • schwannoma (vestibular or jugular foramen, T2 hyperintense, bilobed)
  • meningioma (dural tail, calcifications, may erode bone)
  • cholesterol granuloma (cystic petrous apex, blood products, hx recurrent otitis media)
  • paraganglioma (glomus jugulare, T2 flow voids)
  • dermoid (fat signal/density)
  • endolymphatic sac tumour (von Hippel Lindau)
  • petrous apicitis (infectious presentation, + lateral rectus palsy = Gradenigo syndrome)
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9
Q

Middle ear soft tissue mass ddx

A
  • Glomus tympanicum or Jugulare Paraganglioma
  • Aberrant Internal Carotid Artery
  • Dehiscent Jugular Bulb
  • Middle Ear Congenital or acquired Cholesteatoma
  • Facial Nerve Schwannoma, Tympanic Segment
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10
Q

hemorrhagic brain mets ddx

A
  • melanoma
  • renal cell carcinoma
  • papillary thyroid carcinoma
  • choriocarcinoma
  • lung
  • breast
  • HCC
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11
Q

petrous apex lesion ddx

A
  • petrous apicitis
  • cholesterol granuloma
  • trapped fluid (not a lesion)
  • internal carotid artery aneurysm
  • meningioma
  • schwannoma
  • paraganglioma
  • cholesteatoma
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12
Q

thickened soft tissues around the basion/dens ddx

A
  • hematoma (GRE artefact)
  • rheumatoid arthritis (enhances, doesn’t calcify)
  • CPPD (crowned dens, calcifies)
  • clival chordoma
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13
Q

Optic neuritis ddx

A
  • multiple sclerosis (unilateral)
  • neuromyelitis optica (bilateral)
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14
Q

Cauda equina enhancement ddx

A
  • Guillaine Barré (smooth)
  • meningitis (smooth or nodular)
  • carcinomatous/lymphomatous meningitis (nodules)
  • sarcoidosis (nodular)
  • chronic polyneuropathies
  • Dejerine-Sottas (minimal enhancement, thickened nerves)

  • chemical/surgical arachnoiditis (clumps and thickens, but does not typically enhance)
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15
Q

Cystic nodule at neck lymph node level 2

A
  • lymphadenopathy from SCC/thyroid malignancy
  • branchial cleft cyst
  • scrofula (TB, confluent infected looking nodes)
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16
Q

Moyamoya syndrome ddx

A
  • sickle cell anemia
  • neurofibromatosis type 1
  • post radiation
  • TB meningitis
  • trisomy 21
  • Algaille syndrome
  • inherited idiopathic

- In children, moyamoya typically presents with a history of multiple ischemic strokes.
- In adults, onset is more often heralded by intracranial hemorrhage

17
Q

Calcific density material within the spinal canal ddx

A
  • retropulsed fracture fragments
  • calcified meningioma
  • calcified disc extrusion
  • cement extrusion
  • posterior longitudinal ligament calcification
18
Q

4th ventricular mass ddx

A
  • ATRT (<3yrs)
  • medulloblastoma (kids and young adults)
  • Ependymoma (toothpaste through foramen of Magendie/Luschka)
  • subependymoma (older adults)
  • choroid plexus papilloma/carcinoma
  • epidermoid cyst
19
Q

leptomeningeal enhancement ddx

A

Combined dural, arachnoid, and pial enhancement
- meningeal carcinomatosis (mets)
- TB (usually basal)
- secondary CNS lymphoma (primary is intra-axial)
- neurosarcoidosis (often involves infundibulum)
- meningitis
- IgG4-related hypertrophic pachymeningitis
- granulomatosis with polyangiitis

Note when describing meningeal enhancement, there is dural/arachnoid, pial/arachnoid, and involvement of all three layers. The arachnoid is inseparable from dura and pia so doesn’t get it’s own mention.

20
Q

Intraventricular mass (brain) ddx

A

primary
- ependymoma (child) / subependymoma (adult)
- choroid plexus papilloma/carcinoma
- subependymal nodule/SEGA (TS patients)
- epidermoid cyst

metastasis
- renal cell carcinoma (most typical)
- melanoma
- breast
- lung carcinoma (most common due to lung Ca frequency)
- SCC cervix, colorectal carcinoma, papillary thyroid carcinoma

21
Q

retropharyngeal space fluid collection ddx

A
  • abscess
  • hematoma
  • acute longus colli tendonitis
  • previous neck dissection
  • IJV thrombus
22
Q

brain lesion with dural tail

A
  • meningioma (middle aged women, calcification)
  • solitary fibrous tumor of dura (haemangiopericytomas)
  • pleomorphic xanthroastrocytoma (cortically based, seizures)
  • metastases
  • glioblastoma
23
Q

trachesophageal groove mass ddx

A
  • parathyroid adenoma
  • nodal metastases (usually differentiated thyroid carcinoma)
  • schwannoma of the recurrent laryngeal nerve

or invasion of masses arising from adjacent structures…

24
Q

Dural ectasia ddx

A
  • NF1
  • Marfan syndrome (75%)
  • Ehler-Danlos
  • osteogenesis imperfecta
  • Loeys-Dietz
  • ankylosing spondylitis
  • trauma
  • post-surgical
25
Q

hyperattenuating brain lesions on CT ddx

A
  • lymphoma (homogenous)
  • central neurocytoma (attached to septum pellucidum)
  • colloid cyst
  • pineal germinoma
  • medulloblastoma
  • AVM
  • mets
  • bleed
  • pituitary apoplexy
26
Q

T1 hyper/isointense CSF ddx

A
  • MR artifacts (flow and susceptibility related)
  • subarachnoid Hemorrhage
  • meningitis, ventriculitis
  • dermoid cyst rupture
  • intrathecal contrast

Radiology Ddx (9 decks)

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