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[PBR] Radiology oral boards review > Neuro > Flashcards

Neuro Flashcards

1
Q

Ddx intraaxial hemorrhage

A

HTN, tumor (primary or mets), vascular malformation (cavernoma, AVM), trauma, amyloid, venous infarct, transformation of ischemic stroke

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2
Q

gelatinous pseudocysts - who? describe? caused by?

A

HIV pts
perivascular spread of infection from
cryptococcus, toxo, TB, fungal, angiocentric lymphoma

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3
Q

Intraventricular mass in adult

A

glioma (astrocytoma, subependymoma, giant cell astrocytoma), meningioma, ependymoma, choroid plexus papilloma, metastasis, cystercosis, central neurocytoma (young adult)

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4
Q

intraventricular mass in child

A

choroid plexus papilloma, ependymoma, primitive neuroectodermal tumor (PNET), teratoma, and astrocytoma

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5
Q

Posterior dysmyelinating disease

A

Adrenoleukodystrophy (unless it’s a girl - very unlikely in this X-linked disease) - has a leading edge of enhancement
PRES (ask about HTN)

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6
Q

Anterior dysmyelinating disease

A

Alexander
Childhood onset Alexander disease is sporadic and typically presents with macrocephaly, rapid neuorological deterioration, seizures and spasticity, and retarded psychomotor development

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7
Q

Describe pattern of metachromatic leukodystrophy

A

Diffuse, sparing of subcortical U fibers, “tiger striping”

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8
Q

How do you grade an AVM?

A

Spetzler-Martin
Size of nidus (6cm)
location (eloquent?)
draining vein deep or superficial

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9
Q

What is a ganglioglioma

A

low grade, typically temporal lobe.

Solid or partially cystic mass.

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10
Q

Ddx temporal lobe mass with cystic component

A 
Ganglioglioma
PXA: pleomorphic xanthoastrocytoma
hemangioblastoma (can have cystic component)
pilocytic astrocytoma
met (lung, breast, etc.)
oligodendroglioma (look for calcs on CT)
DNET (bubbly on T2)
all cystic - neurocysticercosis
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11
Q

Name the CNS vascular malformations

A

capillary telangiectasia, AVM, cavernous hemangioma, developmental venous anomaly

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12
Q

periventricular cystic spaces in a child

A 
periventricular leukomalacia
from HIE (hypoxic ischemic encephalopathy) in former premie
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13
Q

hypothalamic/suprasellar masses - adult

A

craniopharyhgioma, pituitary adenoma (maybe with hemorrhage), teratoma, aneurysm, rathke cleft cyst, chordoma,
mets

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14
Q

Wernickes Encephalopathy - what is it? findings?

A

Thymine (B1) deficiency

symmetrical increased T2 signal in the thalami, mamillary bodies, tectal plate, and periaqueductal area

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15
Q

Ddx leptomeningeal enhancement

A 
meningitis (bacterial, fungal, TB)
leptomeningeal carcinomatosis (CNS)
lymphoma/leukemia
sarcoidosis
(moya moya)
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16
Q

intracranial hypotension - what? findings?

A

CSF leak (usually in spine)
cerebellar tonsillar herniation
dural venous sinus distention
dural (pachymeningeal) enhancement

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17
Q

Ddx dural/pachymeningeal enhancement

A 
infection: bacterial, fungal, TB
intracranial hypotension
post-op
dural mets (breast and prostate)
sarcoid
lymphoma
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18
Q

What’s the difference between leptomeninges and dura/pachymeninges?

A 
Lepto = pia and arachnoid (gyriform)
Pachymeninges = dura (follows dural reflections)
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19
Q

Enlarged lateral and third ventricles, small 4th ventricle

A

aqueductal stenosis

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20
Q

Multiple hemosiderin deposits in brain (“black dot” differential)

A

DAI, mets, amyloid, cavernomas, neurocystercercosis (calcification internally)

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21
Q

ring-enhancing lesions in the CNS

A 
GBM (thick rim)
abscess (restricted diffusion)
CNS lymphoma with immunocompromised host
tumefactive MS (incomplete ring)
sequestered subacute infarct
resolving hematoma
radiation necrosis
Toxoplasmosis
(neurocystercercosis - some enhance, some not)
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22
Q

lesion in 3rd ventricle

A

colloid cyst, aneurysm, neurocystercercosis, subependymoma

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23
Q

NF2 lesions

A

meningioma, schwannoma (esp 8th nerve), ependymoma

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24
Q

what is a phakomatosis? name some

A

neurocutaneous disorder characterised by involvement of structures that arise from the embryonic ectoderm (thus central nervous system, skin and eyes)
neurofibromatosis type 1 (NF1)
neurofribromatosis type 2 (NF2)
tuberous sclerosis
encephalotrigeminal angiomatosis: or Sturge-Weber syndrome
von Hippel-Lindau disease
ataxia telangiectasia (etc…)

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25
Q

lesions in Tuberous Sclerosis

A 
cortical tubers
subependymal nodules
subependymal giant cell astrocytomas (SGCA)
renal angiomyolipomas (AML)
renal cysts
cardiac rhabdomyoma(s)
LAM (lungs)
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26
Q

lesions in NF1

A 
neurofibromas, 
pheochromocytoma
malignant peripheral nerve sheath tumour (MPNST)
previously known as neurofibrosarcoma
overal risk of developing a MPNST is ~10%
*optic nerve glioma*
Wilms tumour
rhabdomyosarcoma
renal angiomyolipoma
glioma
juvenile pilocytic astrocytoma
diffuse brainstem glioma
spinal astrocytoma and spinal pilocytic astrocytoma
carcinoid tumour(s)
ganglioglioma
leukemia
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27
Q

Sturge-Weber syndrome in the brain: features?

A

leptomeningeal hemangioma results in a vascular steal affecting the subjacent cortex and white matter producing localised ischemia. The majority of cases (~ 80%) have unihemispherical involvement
Look for port wine stain on face
later get calcification starting subcortically

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28
Q

Hemangioblastoma - where? who gets them?

A

posterior fossa, spine. ~young adults. Consider vHL (25% are vHL, so always raise this possibility).

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29
Q

posterior fossa mass in child

A

medulloblastoma, JPA, ependymoma

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30
Q

posterior fossa mass in adult

A

mets, hemangioblastoma, meningioma, astrocytoma, epidermoid

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31
Q

Findings in ADEM? what does it mean?

A

Acute Disseminated Encephalomyelitis
monophasic acute inflammation and demyelination of white matter typically following a recent (1 - 2 weeks prior) viral infection or vaccination. Grey matter, especially that of the basal ganglia, is also often involved, albeit to a lesser extent, as is the spinal cord

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32
Q

PML - what does it stand for? Look like?

A

Progressive multifocal leukoencephalopathy
Demyelinating disease which results from the JC virus. strongly associated with immunosuppressed states, esp AIDS but also transplant patients and leukemia.
Asymmetric focal zones of low attenuation involving the peri-ventricular and sub-cortical white matter (including U fibers). This is in distinction to the more symmetrical hypo-attenuation seen in HIV encephalopathy.

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33
Q

What’s subacute sclerosing panencephalitis? Who gets it? Caused by?

A

Sub acute sclerosing panencephalitis (SSPE) (also known as Dawson disease)

  • rare chronic, progressive and fatal encephalitis
  • children and young adults
  • caused by persistent infection of immune resistant measles virus
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34
Q

Appearance of HIV encephalitis

A

diffuse, symmetric cerebral atrophy, out of keeping with age
symmetric periventricular and deep white matter hypoattenuation and T2 hyperintensity
confluent or patchy
no mass effect
no enhancement

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35
Q

infant with large cyst and nodule - Ddx

A

DIG - desmoplastic infantile ganglioglioma

Ddx - supratentorial ependymoma, PNET, pilocytic astrocytoma

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36
Q

PNET - stands for? Includes what tumors?

A

Primative neuroectodermal tumor
aggressive brain tumor in child
medulloblastoma : by far the most common
supratentorial PNET : 15% of all CNS PNET
pineoblastoma : most common supratentorial PNET
spinal PNET : rare

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37
Q

hemangiopericytoma - what is it? where does it occur?

A

Think aggressive variant of meningioma that metastasizes
Helpful features include :
lobulated contour
absence of calcification and hyperostosis
invasion of the skull (common)
multiple flow voids on MRI (need to distinguish from spoke-wheel appearance of meningioma)
corkscrew arteries
may have a narrow base of dural attachment

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38
Q

Ddx of skull-base extra-axial masses

A 
Hemangiopericytoma
meningioma
lymphoma
dural mets
plasmacytoma
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39
Q

Leigh disease - what? who? looks like?

A

also known as sub acute necrotizing encephalomyelopathy). Progressive (mitochondrial) neurodegenerative disorder and invariably leads to death in childhood
High T2 in:
brainstem
periaqueductal gray matter
medulla
midbrain
putamen : characteristic but not always present

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40
Q

Ddx of high T1 in basal ganglia

A

*TPN (hyperalimentation)
hepatic encephalopathy
NF1

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41
Q

Ddx of high T2 in basal ganglia

A 
hypoxic event
CO (globus pallidus)
NF1
CJD (also cortex)
Leigh dz (more generalized)
Wilson's dz (also more generalized)
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42
Q

Finding in CO poisoning:

A

low density / high T2 in globus pallidus

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43
Q

What is Dandy Walker malformation?

A

triad of:
hypoplasia of the vermis and cephalad rotation of the vermian remnant
cystic dilatation of the fourth ventricle extending posteriorly
enlarged posterior fossa with torcular-lambdoid inversion (torcular lying above the level of the lambdoid due to abnormally high tentorium)
It is at the severe end of the spectrum denoted by the term Dandy-Walker continuum.

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44
Q

Holoprosencephaly - describe the types:

A

Incomplete separation of the two hemispheres
Alobar: single midline monoventricle, absent midline structures
Semilobar: fused thalami, absence of septum pellucidum
monoventricle with partially developed occipital and temporal horns
rudimentary falx
Lobar: fusion of the frontal horns of lateral ventricles
wide communication of this fused segment with the third ventricle
fusion of the fornicies
absence of septum pellucidum
agenesis or hypoplasia of the corpus callosum
(Septo-optic dysplasia is in the ddx for lobar)

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45
Q

Schizencephaly - what do you have to have? Two types:

A

grey matter-lined cleft extending from the ependyma to the pia mater
Open lip: CSF seen between
Closed lip: cleft walls touch

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46
Q

rhombencephalosynapsis

A

absent or small cerebellar vermis and fused cerebellar hemispheres
abnormally shaped 4th ventricle

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47
Q

what does herpes encephalitis look like? What do you need to do?

A

T2 hyper, maybe enhancement, of medial temporal lobes, insular cortex and inferolateral frontal lobes (cingulate gyrus). The basal ganglia are typically spared
Call the clinician for immediate treatment!

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48
Q

Vein of Galen malformation: appearance? consequences? Rx?

A

AV fistula of the median prosencephalic vein (MPV) (a precursor of the vein of Galen) occurring at 6-11 weeks gestation. The MPV fails to regress and becomes aneurysmal.
Can cause high-output heart failure, hydrocephalus/aqueductal stenosis, ischemia
Rx: embolization

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49
Q

Signs of carotid-cavernous fistula

A 
proptosis
enlarged superior ophthalmic veins
extra ocular muscles may be enlarged
orbital edema
may show SAH / ICH from ruptured cortical vein
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50
Q

fat going through dorsal spinal defect

A

lipomyelocele (no meningocele in the case shown)

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51
Q

Ddx intramedullary spinal cord lesion

A

astrocytoma (extensive, kids more)
ependymoma (bleeding and cysts, adults more)
hemangioblastoma (often cystic)
lymphoma
sarcoidosis
ADEM (expanding, continuous lesions affecting multiple levels)
MS

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52
Q

transverse myelitis - what is it? appearance

A

Inflammatory condition affecting BOTH HALVES of the spinal cord and associated with rapidly progressive dysfunction
Cause: idiopathic or e.g. MS, ADEM (post viral/vaccine), SLE
Usually thoracic
Usually 3-4 segments of cord, usually 2/3 of cross sectional area of cord

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53
Q

Nonenhancing cyst in conus

A

Ventriculus terminalis (normal structure)

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54
Q

CSF lesion displacing spinal cord

A

arachnoid cyst (rx fenestration)

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55
Q

What is a snake-eye or owl-eye appearance in the spinal cord?

A

compressive myelopathy from compression and venous infarction - means pt won’t totally recover after surgery

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56
Q

Spine: dorsal columns are involved, demonstrating high signal on T2 - what is it? cause?

A

Subacute combined degeneration (B12 deficiency)

or Tabes Dorsalis from tertiary Syphilis

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57
Q

name for enhancing lesion in or around conus

A

myxopapillary ependymoma

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58
Q

Name for spinal defect containing CSF? Containing neural elements as well?

A

Meningocele contains meninges
myelomeningocele contains neural elements
named for direction (dorsal, ventral, lateral) and location (thoracic, sacral, etc.)

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59
Q

widened neural foramen

A

Peripheral nerve sheath tumor (schwannoma), neurofibromas (NF1), synovial cyst, arachnoid cyst

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60
Q

Ddx ivory vertebral body - child

A

lymphoma
osteosarcoma
osteoblastoma
metastatic disease (eg neuroblastoma)

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61
Q

Ddx ivory vertebra - adult

A

osteoblastic mets (prostate, breast)
lymphoma
Paget disease of bone

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62
Q

What’s the Currarino triad?

A 
Hereditary:
anorectal malfomation or congenital anorectal stenosis
sacrococcygeal osseous defect 
pre sacral mass
e.g anterior sacral meningocoele
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63
Q

describe a hangman’s fracture. is it stable?

A

involves both pars interarticularis of C2, and is as a result of hyperextension and distraction
unstable

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64
Q

what’s os odontoideum

A

tip of dens is separate, not an acute fracture

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65
Q

Fracture in pt with ankylosing spondylitis

A

Anderson fracture

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66
Q

Defect and scelrosis at anterio-superior corner of a vertebral body

A

Limbus vertebra
Caused by herniation of a portion of the nucleus pulposus underneath the ring apophysis before its fusion to the body
More central is a Schmorl’s node

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67
Q

epidural spinal mass

A 
epidural metastasis
lymphoma
epidural abscess
herniated disk
epidural hematoma
meningioma
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68
Q

retrobulbar mass that changes in size with valsalva

A

orbital varix

69
Q

Brain lesion with an outer ring of restricted diffusion

A

CNS lymphoma

70
Q

Lesion: intraaxial cyst with enhancing nodule in adult

A

hemangioblastoma (often associated with vHL, so look for other lesions)

71
Q

What’s the pattern of areas involved in DAI?

A

Diffuse axonal injury
can be deceptive/absent on CT
grey white matter junction, in the corpus callosum or the brain stem/pons

72
Q

extra-axial lesion with restricted diffusion

A

epidermoid

73
Q

Mass in middle ear - two most likely lesions, how do you tell the difference? What are some things to check for?

A 
Acquired cholesteatoma (pearly white), glomus tympanicum (red)
Check for ossicular erosion, bony covering of lateral semicircular canal, covering of carotid and jugular
74
Q

Parotid lesions: cystic and bilateral. Ddx:

A

lymphoepithelial cysts in HIV, Sjogren’s, warthin’s tumors, (sialocele)

75
Q

“kissing spinous process(es)”

A

Baastrup disease - pain from friction

76
Q

What does a “dense cerebellum” imply

A

Anoxic injury, the supratentorial brain is edematous and low attenuation

77
Q

describe mesial temporal sclerosis

A

Decreased volume of one or both medial temporal lobes/hipocampi, usually related to intractable seizures. Rx surgery.

78
Q

Thickened cerebellar folds/folia in a tiger-striped pattern

A

Lhermitte-Duclos - (probably) hamartoma of cerebellum (is benign)
Can be seen in Cowden syndrome:
-multiple hamartomas
-breast cancer

79
Q

hypothalamic/ suprasellar masses - child

A 
craniopharyngioma
gliomas: chiasmatic/hypothalamic low-grade, optic chiasm glioma
pituitary adenoma
LCH
Ewing sarcoma
rathke cleft cyst
hypothalamic hamartoma
mets (neuroblastoma)
80
Q

Abnormal signal in putamen

A

Methanol

81
Q

Name the small round blue cell tumors

A 
Ewing sarcoma
neuroblastoma
embryonal rhabdomyosarcoma
pineoblastoma
Wilms tumour
retinoblastoma
hepatoblastoma
CNS primitive neuroectodermal tumour (CNS-PNET)
(more)
82
Q

Ddx for lesion in quadrigeminal plate cistern

A 
aka tectal plate
glioma
dermoid
teratoma
lipoma
(pineal region lesions)
83
Q

Pineal region ddx

A 
pineal parenchymal tumours (pineocytoma, pineoblastoma (aka PNET))
germ cell tumours (pineal germinoma (most common; ~ 50% of all tumours), others
pineal teratoma
astrocytoma of pineal gland
pineal metastasis
pineal cyst
meningioma near pineal region
other rare entities
cavernoma in pineal region
aneurysm in pineal region
84
Q

PRES: what is it? appearance? causes?

A

2/2 inability of posterior circulation to auto-regulate in response to acute changes in BP. Hyperperfusion with resultant disruption of the BBB results in
appearance: vasogenic edema, but no infarction in the parieto-occipital regions.
causes: severe hypertension (post partum, eclampsia)
haemolytic uraemic syndrome (HUS)
thrombocytopaenic thromboic purpura (TTP)
systemic lupus erythromatosis (SLE)
drug toxicity

85
Q

Pontine myelinolysis - how does it look different from ADEM?

A

Myelinolysis cortical spinal tracts of brainstem are spared

86
Q

Risk factors for venous infarct:

A

dehydration, cancer, sickle cell, hypercoag. states (Prot. S), mastoiditis

87
Q

What does DNET stand for? Where is found?

A

Dysembrioplastic Neuroepithelial tumor
benign (WHO I) lesion arising in cortical or deep grey matter, young patients. Does not enhance.
80% are associated with cortical dysplasia
60% in temporal lobe and assoc with SEIZURES

88
Q

Oligodendroglioma - who what and where?

A

middle-aged adults presenting with seizure
involve white matter and overlying cortex
usually in frontal lobes (or temporal)
Commonly CALCIFY!!

89
Q

Septo-optic dysplasia - describe
what’s it similar to?
What’s associated?

A

Pts have hypotelorism, severe visual problems, and short stature or other pituitary symptoms. Primary imaging findings include optic nerve hypoplasia and absent septum pellucidum.
Septo-optic dysplasia somewhat resembles lobar holoprosencephaly (septo-optic dysplasia is more common)
Septo-optic is assoc. with schizencephaly
but not assoc with agen of CC

90
Q

Ddx gyriform enhancement

A

encephalitis, stroke

91
Q

What’s a paranasal sinus mucocele?

A

result of obstruction of the ostium of a sinus with resultant accumulation of mucus and eventual expansion (bony remodeling) of the sinus
associated with non-invasive chronic fungal sinusitis

92
Q

small middle ear mass at cochlear promontory

A 
Glomus tympanicum (no bone erosion)
must distinguish from aberrant carotid
93
Q

What space does a JNA expand?

A

Pterygopalatine fossa and pterygomaxillary fissure

94
Q

Ddx petrous apex lesion

A 
Cholesterol granuloma (bright T1 and T2)
mucocele
cholesteotoma/epidermoid
petrous apicitis
bone stuff: chondrosarcoma/osteosarcoma, lymphoma, plasmacytoma, mets
95
Q

Small globe with enhancing cone-shaped posterior density, no calcification

A

PHPV: persistent hyperplastic primary vitreous

96
Q

Calcified mass in the globe: what is it? What should you look for now?

A

Retinoblastoma

Look for contralateral, pineal, and suprasellar retinoblastomas

97
Q

Ddx paranasal sinus mass

A 
mucocele
encephalocele
esthesioneuroblastoma
sinonasal carcinoma
inverted papilloma (middle meatus, looks cerebriform)
antrochoanal polyp (benign, snare it)
(JNA in teenager)
sinonasal polyposis (bilateral, atopia, ciliary)
bone: fibrous dysplasia, osteoma
98
Q

Parotid glands are missing

A

Chronic phase of sjrogen’s disease

99
Q

Ddx optic nerve sheath enlargement

A

Fluid: hematoma, papilledema
Inflammation: optic neuritis, sarcoid, pseudotumor
Tumor: optic nerve glioma, nerve sheet meningioma, leukemia/lymphoma/mets

100
Q

Who’s at risk for optic glioma?

A

NF1

101
Q

Name the paragangliomas in and around the carotid space:

A

Glomus jugulare, vagale (9-12), tympanicum, carotid body tumor (splays)

102
Q

ddx cystic mass in lateral neck

A 
branchial cleft cyst
necrotic lymph node
abscess
thrombosed IJ vein
lymphangioma
cystic nerve sheeth tumor (plexiform neurofibroma)
plunging ranula
103
Q

Difference b/t ranula and plunging/diving ranula:

A

Extension through the myelohyoid m. or posteriorly around it (requires a different surgical approach)

104
Q

Ddx clivus lesion

A 
Mets/myeloma, lymphoma
chordoma (bright on T2)
chondrosarcoma
fibrous dysplasia
osteomyelitis
105
Q

describe presentation of acquired cholesteatoma

A

pars flaccida of TM
Prussak’s space with erosion of scutum
destruction of ossicles

106
Q

Masticator space mass:

A
  • odontogenic abscess
  • osteomyelitis
  • direct spread of squamous cell carcinoma
  • lymphoma
  • minor salivary gland tumours
  • muscle sarcoma
  • bone sarcoma
107
Q

Parotid space lesions:

A
  • salivary gland tumours (pleiomorphic adenoma, warthin, mucoepidermoid, adenoid cystic)
  • metastatic adenopathy
  • lymphoma
  • parotid cysts
108
Q

Describe orbital pseudotumor

A

idiopathic inflammatory condition that usually involves the extraocular muscles although, in some cases there is inflammatory change involving the uvea, sclera, lacrimal gland and retrobulbar soft tissues

  1. lacrimal pseudotumour
  2. anterior pseudotumour: immediately behind the globe
  3. posterior pseudotumour: distinguished from Tolosa-Hunt syndrome in that the cavernous sinus is spared
  4. diffuse pseudotumour
  5. myositic pseudotumour: predominantly involve the EOMs and therefore mimic thyroid associated orbitopathy (TAO)
109
Q

Tolosa Hunt

A

idiopathic inflammatory condition that involves the cavernous sinus and orbital apex

110
Q

Ddx for absent septum pellucidum

A

Septo-optic dysplasia, Lobar holoprosencephaly, isolated

111
Q

Fluid-filled cyst in the sella ddx

A

Epidermoid, rathke cleft cyst, cystic adenoma

112
Q

Increased periaqueductal T2 signal ddx:

A

MS, Wernicke enceph. (B1 deficiency)

113
Q

T1 bright lesion in pituitary stalk

A

Ectopic pituitary, lipoma

114
Q

Ddx cavernous sinus lesion

A

Adenoma (invasive), perineural spread of nasopharyngeal ca, clival lesion, lymphoma, meningioma, CC fistula

115
Q

Which is more common - NF1 or NF2?

A

NF 1 is 9x more common than NF2
remember: NF2 gets “central” tumors
NF1 gets extradural/peripheral lesions

116
Q

What’s the medical Rx for prolactinoma, and what’s the complication?

A

Bromocriptine, hemorrhage (apoplexy)

117
Q

Cystic lesion in the 3rd ventricle

A

colloid cyst, aneurysm, dermoid/epidermoid

118
Q

Ddx etiology of vertebral artery dissection

A

Trauma, connective tissue disease, spontaneous, arteriopathy

119
Q

What’s Chiari III?

A

Colpocephaly, agenesis of CC, tonsilar ectopia, occipital encephalocele

120
Q

What’s associated with agenesis of the corpus callosum?

A

MANY things, among them:

Chiari II, III, trisomy 13 & 18, holoprocencephaly, Dandy-Walker

121
Q

3 most common sites for encephaloceles:

A
  1. Occipital (75%)
  2. fronto-ethmoidal encephalocoele / nasal encephalocoele : ~ 15% of cases
  3. sphenoethmoidal (is this separate?)
122
Q

Ddx lesion of mandible

A 
periapical cyst
dentigerous cyst (around crown of unerrupted tooth)
ameloblastoma (aka adamantinoma)
odontogenic keratocyst (around root)
brown tumor
ABC
bisphosphonates, radiation, mets, infection
Child: LCH (floating teeth)
123
Q

Complications of sinusitis

A

cavernous sinus thrombosis
intracranial spread with subdural empyema, meningitis, encephalitis, brain abscess, mastoiditis
subcutaneous spread
Chronic: mucocele

124
Q

carotid space mass ddx

A 
schwannoma
neurofibroma
paraganglioma (various)
metastatic adenopathy
lymphoma
cellulitis/abscess
meningioma
cystic: 2nd branchial cleft or necrotic lymph node
125
Q

Limbic encephalitis - what is it? Looks like? Caused by?

A

paraneoplastic syndrome caused by non-CNS primary tumors resulting in functional and imaging changes in the limbic system
High T2 medial temporal lobe(s) - looks like herpes
*small cell carcinoma of the lung (classic cause)
also testicular, thymic, breast, ovarian carcinoma

126
Q

Ddx lesion in pituitary stalk/infundibulum:

A

*hypothalamic glioma, *lymphoma, *LCH (in child), *sarcoid, TB, lymphocytic hypophysitis (related to pseudotumor), teratoma / germinoma,

127
Q

Sclerosis of cochlea is probably what? What causes it?

A

Labyrinthitis ossificans, mostly meningitis (could be tumor or trauma)

128
Q

Ddx high T2 signal in corpus callosum

A

Tumor: GBM, lymphoma
Demyelination: MS, ADEM
Infarct, incl. venous (check thalami)
Trauma: DAI

129
Q

What’s the normal myelination pattern in a young child?

A

Bottom to top
back to front
central to peripheral
@9 months, the splenium of the CC is myelinated

130
Q

Ddx diffuse low T1 signal in bones (esp spine)

A

Marrow infiltrating process:
lymphoma/leukemia
prostate mets, myeloma
myelofibrosis

131
Q

One side of brain is larger than the other - no significant flow voids. What’s it called? Causes?

A

Hemimegalencephaly (rare congenital disorder of cortical formation with hamartomatous overgrowth of part of all of a cerebral hemisphere)
Klippel-Trenaunay Syndrome
McCune-Albright syndrome
Proteus syndrome
(Ddx is Sturge-Weber, should be pial angioma)

132
Q

What’s the hockey stick sign?

A

hyperintense signal involving the pulvinar and dorsomedial thalamic nuclei bilaterally on FLAIR, in cases of variant Creutzfeldt-Jakob disease (vCJD), which has the shape of a hockey stick.

133
Q

Ddx for high T2 signal in the pons

A

Tumor (pontine glioma - may not enhance)

ADEM or osmotic demyelination

134
Q

Midline lipoma can be normal but is associated with:

A

agenesis of the corpus callosum

135
Q

ddx white matter disease in a young to middle aged woman

A

MS, CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), Susac syndrome (vasculitis), MELAS (mitochondrial encephalopathy with lactic acidosis and stroke-like episodes)

136
Q

Ddx high T2 signal in thalamus / thalami

A

HIE, ADEM, myelinolysis, venous infarct (artery of Percheron), (bilateral) thalamic glioma, wernicke encephalopathy (B1 defic), Fabry dz, Fahr dz, Wilson dz, Leigh dz

137
Q

DDx for dislocated lens

A

trauma, Marfan’s, Ehlers-Danlos

138
Q

What CNS tumor has a predilection for the periventricular area?

A

Lymphoma

139
Q

Ddx diffusely irregular/indented inner table of skull

A
  1. Infant/very young child: Luckenschadel skull: dysplasia of the membranous skull vault and is associated with Chiari II malformations - NOT from hydrocephalus
  2. Older child - Copper beaten skull from increased intracranial pressure
140
Q

Ddx for moya moya appearance

A 
RAINS
Radiation
arteritis/atherosclerosis
Idiopathic (actual dz)
NF1
Sickle Cell
141
Q

Ddx enlarged, enhancing cauda equina nerve roots

A

arachnoiditis
lymphoma, mets
Guillan-Barre

142
Q

What is an esthesioneuroblastoma? Who gets it?

A

olfactory neuroblastoma - ethmoids and invading into the anterior cranial fossa and/or orbit
bimodal age distribution~ 2nd decade) and another peak in the 5th to 6th decades

143
Q

Why are dural AV fistulas treated?

A

Cause cord ischemia (often symptoms are LE weakness)

144
Q

Lytic skull lesions

A

LCH, mets (neuroblastoma in child), leptomeningeal cyst (aka growing fracture), myeloma, lymphoma, hemangioma, epidermoid, Paget’s

145
Q

Name the hemorrhagic brain mets

A

renal, thyroid, choreocarcinoma, breast, lung

146
Q

What do you look for with mastoid air cell opacification?

A

could be from eustachian tube obstruction from nasopharyngeal mass - carcinoma or lymphoma
Also: otitis media, temporal bone lesion

147
Q

Low T2 signal along the brain surfaces

A

Superficial hemosiderosis
Look for a source - angiography (CT, MR, etc.)
Ask about Sx deafness (8th nerve is sensitive to hemorrhage)

148
Q

What’s the significance of air in one laryngeal ventricle?

A

Laryngeal ventricle is just above the true cord
Means unilateral vocal cord paralysis (look for medial deviation of the arytenoid cartilage)
This means lesion somewhere along the vagus/recurrent laryngeal nerve.

149
Q

Top locations for intracranial aneurysms:

What happens a week after subarachnoid hemorrhage?

A

Anterior communicating a.
Posterior communicating a.
MCA
~7 days out: vasospasm

150
Q

jugular foramen “smudged” or obviously eroded:

A

Glomus jugulare

151
Q

Describe the three bones of the inner ear

A

Malleus (hammer) ice cream, incus between malleus and stapes, stapes has two foot platse (could be a staple) on the oval window

152
Q

tumor near aqueduct, mastoid, IAC:

What sydrome might the patient have?

A

Endolymphatic sac tumor

VHL

153
Q

Ddx tumor involving lacrimal gland:

A

sarcoid, Sjogren’s, lymphoma, pseudotumor (if fat stranding & pain)

154
Q

Ddx for calcified neck lymph nodes

A

Papillary thyroid ca (also characteristic are cystic changes of the lymph nodes), TB, treated lymphoma

155
Q

Lesions of VHL

A 
CNS: cerebellar, spinal, and retinal hemangioblastomas
Pheochromocytomas
endolymphatic sac tumors
Renal: RCC, cysts, (AMLs)
Pancreas: cysts, islet cell tumors
Liver cysts
156
Q

Intradural, extramedullary spine lesions:

A

schwannoma, meningioma, neurofibroma, myxopapillary ependymoma, mets, lipoma, cysts (dermoid, epidermoid, arachnoid)

157
Q

Origin and territory of the PICA

What happens when it’s occluded?

A

Posterior inferior cerebellar artery - arises directly from ipsilateral vertebral artery, supplies the inferior cerebellum
Occlusion = Wallenberg (lateral medullary) syndrome of deficit in ipsi cranial nerves and face, contra trunk

158
Q

MR spect peaks & basic significance:

Choline, Lactate, NAA

A

Choline - CHO - cell membrane and turnover marker
Lactate - necrosis
NAA - brain tissue

159
Q

Intraaxial masses with restricted diffusion:

A 
(abscess - cystic)
lymphoma
medulloblastoma
CJD (basal ganglia and cortex)
meningioma
160
Q

Sphenoid wing is absent on one side

A

Sphenoid wing dysplasia - make sure edges are smooth, no evidence of mass
50% are NF1 (rest sporadic)

161
Q

Ddx midline spinal (sacral) mass:

A

chordoma, teratoma, GCT, chondroblastoma

then regular bone stuff - Ewings, myeloma, etc.

162
Q

Corpus callosum demyelination and atrophy

A

Machiafava-Bignami (chronic alcoholics, other malnutrition)

163
Q

Ddx basal ganglia calcification

A 
aging
Fahr dz (also cerebellum and cerebrum)
toxic (CO, Pb, rad, chemo)
infxn (TORCH, TB, neurocyster)
metabolic (hyperpara)
164
Q

Ddx for enopthalmos (orbit retraction)

A

scirrous breast cancer, radiation

165
Q

Ddx neck lymphadenopathy

A 
Infection (Mono, cat scratch)
Lymphoma
mets (esp H&N, thyroid)
Castleman's
TB
166
Q

Ddx hyperdense CNS lesion on CT

A

aneurysm/hematoma, meningioma, lymphoma, melanoma

167
Q

Temporal lobe atrophy, more than just mesial temporal sclerosis:

A

Rasmussen’s encephalitis (uncertain etiology)

usually children under 10y

168
Q

Order of extraocular muscle involvement with thyroid orbitopathy

A

IMSLO

169
Q

ddx for extraorbital muscle enlargement

A

thyroid orbitopathy, pseudotumor (painful), CC fistula, lymphoma, cellulitis or myositis (sinusitis), mets, hematoma

[PBR] Radiology oral boards review (10 decks)

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