Neuro 2A Flashcards
Brown Tumour (osteitis fibrosa cystica or osteoclastoma)
Adults cohort with 1ry or 2ry hyperparathyroidism, chronic renal disease, or focal areas with rapid bone loss
Depression, constipation, bone pain, muscle weakness, bone pain
Plain film: Purely lytic lesion with thinned bone expansion. No periosteal reaction or soft tissue mass.
CT: Attenuation in the range of blood and fibrous tissue
MRI: Varies from solid, cystic, to mixed. Solid component and septa enhance. Fluid-fluid levels.
DSA: Hypervascular
NM: Bone scan often shows intense uptake.
Next step would be check the parathyroid levels
Coloboma
Collective term encompassing any focal discontinuity in the structure of the eye including iris, chorioretinal (posterior globe), and optic nerve coloboma. Congenital incomplete choroidal fissure closure.
Associated with encephalocele, agenesis of the corpus callosum or CHARGE syndrome
They are typically cone or notched shaped and
commonly affect the inferomedial portion of the globe. They are bilateral in 50%.
Pineoblastoma
WHO grade 4 tumour found in children peaks 18 months
Presents with obstructive hydrocephalus, Parinaud syndrome (upward gaze palsy), or leukocoria.
CT: Large (> 3 cm), lobulated, hyperdense, and enhancing mass with peripherally “exploded” calcification (unlike pineal germinoma which has “engulfed” calcification. Poorly defined (unlike other pineal lesions) invading adjacent brain.
MRI: Cyst and necrosis signal with heterogenous enhancement. Restricted diffusion.
Well-established association with retinoblastoma. Sporadic form; 30% are bilateral. Hereditary form; 70% are bilateral. When bilateral retinoblastoma are associated with pineoblastomas; they are called trilateral retinoblastomas. NORMAL size globes.
Neuroblastoma
Children - peak 2 years. Not older than 10 years.
Abdominal pain and palpable mass.
Most common extracranial mass (adrenal gland, retro peritoneal, and posterior mediastinum) and most common cause of paediatric CNS metastasis
Plain film: Bone metastasis are lytic
US: heterogeneous mass with internal vascularity
CT: Heterogeneous with 90% calcification and necrosis
Poorly defined, crosses midline, elevates aorta, encases vascular structures but does not invade them, spine and chest extension, retro peritoneal lymph nodes common, bone metastasis (Hutchinson syndrome), liver, dura and orbit metastasis are common
Diagnosis and staging: MIBG
Recurrence: Tc99 MDP to assess bone metastasis
Stage 1, 2, and 4S have better prognosis
Medulloblastoma
Gorlin’s Syndrome (Basal Cell Naevus Syndrome)
Autosomal dominant affecting 19 year old mostly but can affect up to 49 years old.
At risk are those who received prior radiation treatment
Odontogenic keratocysts (unilocular or multilocular) at body or ramus of mandible at the unerupted molars, thick dural calcification, and medulloblastoma
Keratocysts occurs at unerupted molars as lucent expansible well defined cysts. Contents vary but include keratin. Peripheral enhancement on MRI contrast unlike ameloblastoma
Schwannoma
Adults in 5- 6th decade but maybe 3rd decade in NF2
Symptoms depends on location it arises from
Benign tumour. Can affect any intracranial nerve EXCEPT 1 and 2 (no Schwann cells). Usually solitary except in NF-2, bilateral. You can get peripheral spinal nerve schwannoma.
CT: Not very sensitive. Well defined with adjacent displacement but not invasion. Adjacent bone remodelling with smooth corticated edges
MRI: Best modality. Cystic and fatty degeneration signal. No calcification. Small tumours homogeneous enhancement but large tumour have heterogeneous enhancement
split-fat sign: thin peripheral rim of fat best seen on planes along the long axis in non-fat-suppressed sequences
target sign: peripheral high T2 signal
central low signal - rarely seen intracranially
fascicular sign: multiple small ring-like structures
Wilm’s Tumour
Children - 3/4 years old (older than neuroblastoma)
HHT
Chordoma
Chonrosarcoma
Inverted papilloma
Ameloblastoma (Adamantinoma of the
jaw)
30 - 50 year olds
Hard painless jaw mass
Locally aggressive with a variable appearance is variable - multi-cystic with solid components
Multiple “soap bubbles”, extensive tooth root absorption, mandibular expansion, solid component (shown on MR or CT) favours Ameloblastoma
Vivd heterogeneous enhancement unlike OTK which only maybe enhance peripherally
Cavernous-carotid fistula
Caused by commonly trauma or periorbital abscess can cause thrombosis of the ophthalmic veins or cavernous sinus (in extreme examples infection — usually aspergillosis)
Affects C4 (cavernous) segment of ICA.
Present with painful eye swelling and a third nerve palsy
Cholesteatoma
