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Radiology Core > Neuro > Flashcards

Neuro Flashcards

1
Q

What’s the relationship between PCOM and CN3 in fetal PCA variant?

A

PCOM runs superior and and LATERAL to CN3 in fetal PCA, while normally it runs superior and MEDIAL to CN3.

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2
Q

What’s persistent trigeminal artery?

A

connection between cavernous ICA and basilar. gives the tau sign.

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3
Q

What forms the vein of Galen?

A

Two internal cerebral veins.

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4
Q

Where does the vein of Galen drain?

A

Straight sinus.

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5
Q

what’s Kallmann syndrome?

A

Arhinencephaly (can’t smell). Hypogonadism. Mental Retardation.

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6
Q

Meckel-Gruber Syndrome?

A
  • Occipital encephalocele. - Renal cysts. - Polydactyly. - Strong association with holoprosencephaly.
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7
Q

de Morsier Syndrome?

A

Septo-optic dysplasia. - absent septum pellucidum. - hypoplastic chiasm. - Associated with schizencephaly. - Azygos anterior cerebral artery can be seen.

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8
Q

what syndrome is associated with Chiari I?

A

Klipper-Feil syndrome.

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9
Q

Interdigitated cerebral gyri seen in which condition?

A

Chiari II malformation

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10
Q

what location is more common for shunt obstruction?

A

Proximal; mostly from ingrowth of choroid and particulate debris.

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11
Q

Findings in methanol toxicity?

A
  • Optic nerve atrophy. - putaminal hemorrhage. - subcortical WM necrosis.
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12
Q

what’s the most common hereditary stroke disorder?

A

CADASIL. (young pt with migraine and strokes). NOTCH3 mutation in chromosome 19.

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13
Q

which area is first affected by Alzheimer’s?

A

Hippoocamus, gets atrophied first.

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14
Q

what’s 11C PiB (Pittsburg compound B)?

A

Amyloid binding tracer; can be used in diagnosing Alzheimer’s.

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15
Q

what’s singulate island sign?

A

seen in Dementia with Lewy Bodies, in PET there’s sparing of the posterior singulate gyrus.

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16
Q

how can parkisnons be differentiated from MSA by I-123 MIBG?

A

By looking at the cardiac/mediastinal ratio; abnormal in PD and normal in MSA.

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17
Q

What’s the most common parkinson plus disease?

A

Progressive Supra-nuclear Palsy. aka Steele-Richardson-Oleszewski.

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18
Q

What’s signs seen in Progressive Supra-nuclear Palsy?

A

Micky mouse sign: tegmentum atrophy withs paring tectum anf peduncles. Hummingbird sign: midbrain volume loss with concave upper surface and spared pons.

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19
Q

What’s the most common MR findings in Wilson disease?

A

T1 bright BG.

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20
Q

What’s the correct position for deep brain stimulating leads?

A

Sub-thalamic nuclei, 9 mm from midline.

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21
Q

How Krabbe disease looks on CT?

A

Hyperdensities in thalamus, caudat and deep white matter.

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22
Q

What’s the MRS pattern in MELAS?

A

elevated lactate and low NAA.

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23
Q

Low-grade tumors that typically enhance?

A
  • Ganglioglioma. - Pilocytic astrocytoma.
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24
Q

what kind of mets does neuroblastoma give to the brain🧠 ?

A

EXTRA-AXIAL METS (to skull, dura, orbit, …).

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25
Q

What’s genetic association with oligodendroglioma?

A

1p/19q deletion (I was 19 with kevin in Vancouver). pts with this deletion has a better outcome.

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26
Q

zuckerguss seen with which tumor?

A

Medulloblastoma - “sugar icing” drop mets along the CSF pathway.

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27
Q

What’s Gorlin syndrome?

A
  • Medulloblastoma, - Dural calcs. - Bifid rib. - Basal cell cancer after RXT - Odontogenic keratocysts.
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28
Q

Location difference between SEGA and subependymal nodules?

A

SEGA is always near the foramin of Monroe; while SEN are along the wall of the venticle. SEGA grows but SEN don’t.

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29
Q

features of xanthogranuloma in MRI?

A
  • Choroid plexus in origin. - Restricts diffusion. - Seen in adults.
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30
Q

CPA mass invading the IAC?

A

Schwannoma - “following the schwann in the nerve”.

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31
Q

what lab association seen with hemangioblastoma?

A

Polycythemia

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32
Q

Alanine in MRS?

A

is associated with Meningioma.

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33
Q

HIV pt with soap and bubbles appearance in MRI?

A

cryptococcal meningitis. Also from dilated perivascular spaces.

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34
Q

Watershed infarcts in a kid?

A

Moyamoya

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35
Q

Artery of Percheron

A

Single trunk from one the PCAs to feed both thalami and rostral midbrain.

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36
Q

What’s the most common systemic vasculitis to involve the CNS?

A

PAN

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37
Q

What’s the first segment of the ossicles to be eroded by cholesteatoma?

A

Long process of the incus.

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38
Q

Air in the semicircular canal?

A

Perilymphatic fistula. Look for cholesteatoma!

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39
Q

Noise-induced vertigo is seen in what condition?

A

Superior semicircular canal dehiscence. from long standing high ICP.

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40
Q

Large vestibular aqueduct syndrome

A
  • MC cause of congenital SNHL. - Bilateral. - Associated with absence of bony modiolus of choclea.
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41
Q

most common presenting symptom in glomus jugulare?

A

Hoarseness!

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42
Q

Gardenigo Syndrome

A

A complication of apical petrositis; - Otomastoiditis - Face pain (CN V neuropathy) - Lateral rectus palsy (CN VI)

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43
Q

Most common location for mucocele?

A

Frontal sinus.

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44
Q

What’s the relationship between the vein and the nerve inside the parotid gland?

A

Retromandibular vein runs MEDIAL to the facial nerve.

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45
Q

Which parotid tumor takes up pertechnetate?

A

Warthins!

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46
Q

Which nerve sheath tumor has target sign on T2?

A

Neurofibroma (bright rim with decreased central signal).

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47
Q

Grisel’s Syndrome

A

Torticollis with atlanto-axial joint inflammation or infection.

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48
Q

What’s the most common intra-ocular mass in an adult?

A

Melanoma. - Can have “collar button shape” - Related to Bruch’s membrane. Can mets to LIVER –> nect to liver imaging.

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49
Q

What’s the most common benign congenital orbital mass in a child?

A

Dermoid. Classically, superior and lateral from the frontozygomatico suture.

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50
Q

Raccoon eyes

A
  • Metastatic neuroblastoma - Skull base fracture.
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51
Q

Enlarged pituitary gland with T2 dark rim?

A

Lymphocytic Hypophysitis.

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52
Q

Orbital mass with fluid-fluid levels?

A

Lymphangioma

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53
Q

“Owl’s eyes” sign in spine MRI

A

anterior spinal cord infarct.

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54
Q

What’s the imaging findings seen in Guillain Barre Syndrome?

A

Enhancement of the nerve roots of the Cauda Equina.

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55
Q

Other locations for Pilocytic astrocytoma other than posterior fossa?

A
  • Hypothalamus - Optic chiasm. Association with NF 1 -Cerebellum They are usually solid.
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56
Q

What’s the classic location for ATRT?

A

pontomesencephalic junction and partly occupies the interpeduncular cistern.

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57
Q

Cortically-based temporal lobe lesion DDx?

A

P-DOG - Pleomorphic xanthoastrocytoma (PXA). - DNET - Oligodrndtoglioma (might not be temporal). - Ganglioglioma.

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58
Q

What’s the most common neoplasm associated with chronic intractable epilepsy.

A

Ganglioglioma

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59
Q

Which antibodies have been implicated as a cause for nonneoplastic autoimmune limbic encephalitis?

A

Anti–glutamic acid decarboxylase (GAD) antibodies

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60
Q

MRI findings in Immune reconstitution inflammatory syndrome (IRIS)?

A

Presence of enhancement in the PML lesions with worsening of FLAIR hyperintensity upon immune reconstitution is most compatible with IRIS.

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61
Q

Normally enhancing facial nerve segments?

A

TMG - Tympanic - Mastoid - Geniculate ganglion.

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62
Q

Susac syndrome

A

microangiopathy consisting of a triad of encephalopathy, branch retinal artery occlusions, and hearing loss. The corpus callosum involvement is characteristically central compared to peripheral, callososeptal involvement seen with MS. - Ophthalmologic evaluation with retinal fluorescein angiography is necessary to demonstrate the peripheral retinal arteriolar branch occlusion.

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63
Q

In a young patient with bilateral optic nerve enhancement and limb weakness, next step?

A

C-spine MRI, Neuromyelitis optica is strongly suggested.

64
Q

Under which spectrum Subcortical band heterotopia is classified?

A

Subcortical band heterotopia (SBH) is classified with lissencephaly complex (agyria–pachygyria) and not with the other heterotopias.

65
Q

Venous epidural hematomas are commonly associated with injury to what structure?

A

Dural venous sinus

66
Q

Telecanthus is seen in which facial fracture?

A

NOE, due to disruption of the medial canthal ligaments

67
Q

Which of the following types of mandible fracture poses the greatest risk of inferior alveolar nerve injury?

A

Angle. Inferior alveolar nerve enters the mandibular canal at the lingula and exits through the mental foramen, which is at the level of second premolar.

68
Q

Infections and lymphoma in AIDS patients tend to prefer which area?

A

Basal Ganglia (Crypto, toxo and lymphoma)

69
Q

protein 14-3-3 in CSF?

A

CJD

70
Q

What treatment can be given to MELAS patients who have stroke-like episode?

A

Urgent administration of nitric oxide precursors (e.g., arginine) in patients with MELAS ameliorates the clinical symptoms associated with stroke-like episodes.

71
Q

MRI findings in PKAN?

A

T2-weighted images demonstrate hypointense signal in the globus pallidus with an anteromedial hyperintensity (“eye of the tiger” sign) and in the substantia nigra.

72
Q

What’s the other name of PKAN?

A

Hallervorden-Spatz syndrome- disorder of iron accumulation in brain. (eye of the tiger)

73
Q

Thunderclap headache in a young female?

A

RCVS. May show Complete resolution of symptoms and imaging findings within 3 months.

74
Q

What’s the Spetzler-Martin grading system?

A

Grading AVMs; considers size of the nidus, venous drainage (superficial vs deep) and eloquence of adjacent brain.

75
Q

What’s “Ivy sign” in moyamoya?

A

FLAIR and postcontrast T1w sequences can show pial vascular congestion–related hyperintensity, Along subarachnoid spaces

76
Q

What’s the artery seen coursing in the middl ear in cases of aberrant ICA?

A

The inferior tympanic artery arising from the ascending pharyngeal artery is consequently hypertrophied and serves as a collateral pathway to supply the horizontal petrous ICA.

77
Q

Methanol toxicity findings?

A

PUTAMEN is mainly involved.

78
Q

What’s (rule of Spence) in neck trauma?

A

On open mouth view radiographs or coronal CT, sum of lateral displacement of lateral masses of C1 over C2 exceeding 7 mm is considered as a sign of transverse ligament injury

79
Q

Spinal lesion with hemosiderin cap (T1 bright rim)?

A

Ependymoma.

80
Q

Severe hypotension can result in which type of cord infarction?

A

Central cord infarction

81
Q

What’s Type 2 caudal regression syndrome.

A

Low-lying tethered cord with less severe sacral agenesis, typically below S2.

82
Q

What’s Type 1 caudal regression syndrome.

A

Abnormal high termination (above L1) of the conus, which is blunted or wedge shaped typically associated with sacral anomalies above S1.

83
Q

how do metastatic LN from Papillary thyroid cancer usually look like?

A

Cystic LN with thin walls.

84
Q

the most common neoplasm of pre-styloid parapharyngeal space.

A

Pleomorphic adenoma

85
Q

Where The sphenoid and posterior ethmoid sinuses drain into?

A

Superior meatus.

86
Q

Where does the nasolacrimal duct drain?

A

Inferior meatus

87
Q

Which bone juvenile nasal angiofibroma can commonly erode?

A

Medial pterygoid plate

88
Q

Pregnant or post partum lady with diffusely enlarged pituitary gland?

A
  • Lymphocyitc hypophysitis. - Hemorrhage (sheehan)
89
Q

The most common pathogen cultured in typical skull base osteomyelitis

A

Pseudomonas

90
Q

How chondrosarcoma is different from chordoma?

A

Off-center location and relatively higher ADC measurements.

91
Q

Glomus jugulare is supplied by which artery?

A

Ascending pharyngeal.

92
Q

What’s Bezold abscess?

A

is a complication of otitis media with extension of the infection deep to the sternocleidomastoid muscle and throughout the fascial planes of the neck.

93
Q

Pulsatile red retrotympanic masses ddx.

A

Glomus tympanic paraganglioma and aberrant ICAs

94
Q

blue retrotympanic masses ddx

A

Cholesterol granulomas and dehiscent jugular bulbs

95
Q

What other vascular anomaly is most commonly associated with an aberrant ICA?

A

Persistent stapedial artery

96
Q

Which corresponding bony foramen is absent in persistent stapedial artery?

A

Foramen spinosum.

97
Q

Which organ does hereditary hemorrhagic telangiectasia most commonly involve?

A

Nasal mucosa

98
Q

Thinning of pars combacta in substantia nigra

A

Seen in Parkinsons

99
Q

MRI in vasculitis

A

MRI is almost 100% sensitive in diagnosing vasculitis, if negative can exclude the diagnosis.

100
Q

Contraindications for partial laryngectomy, should go straight to total laryngectomy:

A
  • Inter-arytenoid involvement - Cartilage invasion - Sub-glottic extension - Extra-laryngeal invasion.
101
Q

Salivary gland stones most commonly occur in ?

A

submandibular gland as the secretions are thicker and viscous.

102
Q

“mirror-image” type of recurrent intracranial bleeding.

A

Amyloid angiopathy. Could be lobar, cortical, or sub-cortical bleeding

103
Q

MS plaques in the spine

A

usually short segments within the posterior cord.

104
Q

What causes diffusion restriction in epidermoid?

A

parallel-layered keratin filaments and flakes

105
Q

(notch sign) just above the carotid bifurcation

A

Extension of the branchial cleft cyst between the ICA and ECA is pathognomonic.

106
Q

Nerve exiting anteriorly from midbrain

A

oculomotor (III) nerve

the trochlear nerve (IV) comes from the posterior side of the midbrain. It has the longest intracranial length of all the cranial nerves.

107
Q

Nerves exiting anteriorly from pons

A

abducent nerves.

108
Q

What’s the MCC of cerebral vascular malformation?

A

Developmental venous anomalies. Usually solitary. Associated with cavernomas!.

109
Q

What’s the most likely cause of a noninfectious masticator space mass.

A

malignancy, particularly sarcoma.

110
Q

post-styloid parapharyngeal space

A

Carotid space

111
Q

DDX for pulsatile tinnitus?

A

Aberrant Carotid Artery, Persistent Stapedial Artery, Dehiscent Jugular Bulb, Dural AVF, Paragangliomas, Caroticocavemous “ CC” Fistula.

112
Q

Möbius syndrome

A

also known as congenital facial diplegia syndrome, is a rare congenital condition characterized by the absence or underdevelopment of the abducens nerve (CN VI) and facial nerve (CN VII) nuclei.

113
Q

Difference b/w anencephaly and acrania

A

the skull is present in anencephaly and absent in acrania. (anencephaly is an insult to the brain after its formed).

114
Q

Which muscle opens the Eustachian tube?

A

Tensor veli palitini

115
Q

What’s s the ONLY muscle that opens the mouth?

A

Lateral pterygoid. Medial pterygoid and temporalis closes the mouth.

116
Q

Lateral meningoceles is associated with which disease?

A

NF-1.

117
Q

What core volume indicates a poor prognosis in infarcts?

A

> 70 cc. Named malignant infarct, WON’T do revascuralization.

118
Q

Meningioma growth starts from

A

the ARACHNOID space!

119
Q

Pneumosinus dilatans

A

Sinuses tend to ENLARGE TOWARDS the meningioma

120
Q

Meningiomas are primarily supplied by

A

branches of EXTERNAL CAROTID artery.

121
Q

Pathologies SPARING the U-fibers

A
  • Post-radiation - Subcortical atherosclerotic encephalopathy (SAE) - metachromatic leukodystrophy - Krabbe - HIV Encephalitis - CADASIL.
122
Q

Pulsatile exophthalmous

A

Carotid-cavernous fistula or sphenoid wing dysplasia.

123
Q

Infundibulum thickening

A

seen in Langherhans histiocytosis and neurosarcoid.

124
Q

Metronidazole toxicity typically involves

A

cerebellar DENTATE NUCLEI bilaterally.

125
Q

Changes in hypoglycemia SPARE THE THALAMUS.

A

Changes in hypoglycemia SPARE THE THALAMUS.

126
Q

Elevated CBV can be seen with aggressive brain tumors.

A

Elevated CBV can be seen with aggressive brain tumors.

127
Q

Thick pachymeningeal enhancement ddx

A

Intracranial hypotension, TB, neurosarcoid, IG-g4 related, Wegners.

128
Q

acute hyperammonimic encephalopathy.

A

Diffuse cortical DWI restriction

129
Q

Fusiform enlargement of nerve roots W/O enhancement

A

Charcot-Marie-Tooth, if there’s enhancement –> plexiform NF-1.

130
Q

Post-op perineural fibrosis of the SPINE is a contraindication of doing another spine surgery

A

because it will create more fibrosis.

131
Q

Onodi cell

A

posterior ethmoid cell extends into sphenoid sinus and forms medial wall of the OPTIC CANAL.

132
Q

Posterior limb of internal capsule is supplied by

A

Anterior choroidal artery.

133
Q

where the intradural ICA starts.

A

Supra-clinoid carotid

134
Q

most commonly affected nerve in vestibular schannoma.

A

Superior vestibular nerve

135
Q

Which sequence is perfusion MRI?

A

Echo-planar T2*

136
Q

Subarachnoid FLAIR signal is artifactually increased when

A

patient is on oxygen or propofol therapy, without abnormal enhancement.

137
Q

The two primary differential considerations for a ring-enhancing basal ganglial mass in an immunocompromised patient

A

Lymphoma and toxoplasmosis. CNS lymphoma is thallium avid and toxoplasmosis does not take up thallium.

138
Q

The pituitary gland is formed from

A

Rathke’s pouch, which is a superior invagination from the primitive oral cavity.

139
Q

What’s the second most common suprasellar mass in children?

A

astrocytoma involving the visual pathway (optic nerve, optic chiasm, and optic tract)

140
Q

The pineal gland does not have a blood brain barrier.

A

The pineal gland does not have a blood brain barrier.

141
Q

The relationship of any pineal region mass to which vein is key for surgical planning and approach.

A

the internal cerebral veins

142
Q

Factors that increase AVM bleeding risk

A

intra-nidal aneurysm, venous ectasia, venous stenosis, deep venous drainage, and posterior fossa location.

143
Q

The key imaging finding of a hyperacute hematom

A

peripheral rim of hypointensity on T2-weighted images due to deoxygenation of the most peripheral red cells

144
Q

Uveoparotid fever

A

bilateral uveitis, parotid enlargement, and facial nerve palsy, is considered pathognomonic for sarcoidosis.

145
Q

The contents of the pterygopalatine fossa

A

pterygopalatine ganglion and branches of the internal maxillary artery.

146
Q

Bilateral parotid lymphoepithelial cysts

A

are CLASSIC in HIV.

147
Q

POSTERIOR Belly of digastric separates which spaces?

A

Parotic space and Carotid space

148
Q

Which vein may drape over a colloid cyst make resection more challenging?

A

Internal cerebral vein

149
Q

What’s the gender distribution for pineal gland tumors?

A
  • Germ cell tumors: MALES. - Pineoblastoma and pineocytoma: EQUAL in both sexes.
150
Q

Posterior limb of internal capsule is supplied by what artery?

A

Anterior choroidal artery.

151
Q

What’s Supra-tentorial medulloblastoma?

A

PNET

152
Q

Recurrent laryngeal nerve supplies ALL laryngeal muscles EXCEPT?

A

Cricothyroid muscle. Supplied by Superior Laryngeal nerve.

153
Q

What’s Pelizaeus-Merzbacher disease?

A
  • X-linked leukodystrophy
  • Can have tigroid patten when patchy.
  • X-linked leukodystrophy
154
Q

What connects the middle cranial fossa with PPF?

A

Foramen rotundum

155
Q

What connects the PPF to the orbital cavity?

A

Inferior orbital fissure

156
Q

What’s the continuation of the ACA?

A

Pericallosal artery; runs along the superior aspect of CC.

Radiology Core (9 decks)

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