Neuro Flashcards
CP angle mass ddx
AMEN: acoustic schwannoma (75%) meningioma (10%) epidermoid cyst (5%) nonacoustic schwannoma: V, VII
rare:
- arachnoid cyst, lipoma, dermoid, teraroma
- ependymoma, medulloblastoma, pilocytic astrocytoma
- aneurysm (PICA > VA > AICA)
thoracic spinal cord displaced anteriorly ddx
dorsal thoracic arachnoid WEB
- scalpel sign d/t focal compression from behind
dorsal spinal arachnoid CYST
- myelography can demonstrate cyst
ventral cord HERNIATION
- cord pulled rather than pushed forward
intradural intramedullary spinal lesion ddx
all planes: cord appears widened, CSF space thinned
ependymoma (MC adult; if at conus: myxopapillary) astrocytoma (MC peds) hemangioblastoma (VHL) medulloblastoma lipoma/(epi)dermoid syringohydromyelia intramedullary AVM rare site: met (lung, breast), lymphoma, abscess
intradural extramedullary spinal lesion ddx
(CSF forms acute angles with mass, +/- dural attachment/”marble on the carpet” → “meniscus” around mass w widened CSF on one side & effacement on other)
- meningioma (dural tail, +/- Ca2+)
- schwannoma (MC; NF2, Carney complex, necrosis/hemorrhage)
- neurofibroma (solitary, plexiform [NF1], target sign)
- drop met (medulloblastoma; breast>lung>melanoma)
- hemangioblastoma
- lipoma/(epi)dermoid
- arachnoid cyst/adhesion
- veins (extramedullary AVM)
extradural spinal lesion ddx
dura & sac displaced together, away from mass; obtuse angle of CSF around mass/”marble under carpet”
degenerative:
- disc hernation, extrusion, sequestration
- synovial cyst (facet jt arthrosis)
- osteophyte
- rheumatoid pannus
nondegenerative:
- mets, myeloma, lymphoma
- epidural abscess
- hematoma
- perineural cyst
- 1/1 tumor invasion or expansion: chordoma, myeloma, ABC, GCT
- epidural lipomatosis (steroids, obesity)
hemorrhagic intracranial mets ddx
MR CT BB melanoma renal cell carcinoma choriocarcinoma thyroid carcinoma bronchogenic breast
pituitary region mass ddx
SATCHMOE
- sarcoid
- aneurysm, pituitary adenoma, pituitary apoplexy
- teratoma
- craniopharyngioma, Rathke cleft cyst, chordoma
- hypothalamic hamartoma, hamartoma of tuber cinereum
- meningioma
- optic nerve glioma
- eosinophilic granuloma, epidermoid/dermoid
- mets
- osteosarc
- hypothalamic/chiasmatic astrocytoma
leptomeningeal enhancement ddx
pia-arachnoid
- meningitis (bacterial, viral, TB, fungal, Lyme)
- tumor (mets-breast, lung, melanoma; lymphoma, ependymoma)
- granulomatous (TB, sarcoid, Wegener, rheumatoid)
- vascular (collateral flow [ischemia], increased flow [post-ictal])
pachymeningeal enhancement ddx
dura-arachnoid
- intracranial hypotension
- postop (greatest at craniotomy site)
- infection
- neoplastic (meningioma, mets, 2/2 CNS lymphoma, solitary fibrous tumor of dura)
- granulomatous (TB [basal], sarcoid, Wegener, rheumatoid, Sjogren, Behcet, Erdheim-Chester)
- extramedullary hematopoiesis
moyamoya-like vascular collaterals ddx
moyamoya disease radiation tx NF1 trisomy 21 sickle cell dz slowly progressive atherosclerosis
ivy sign ddx
in moyamoya: tubular branching FLAIR hyperintensities within sulci
leptomeningeal metastases
SAH
meningitis
high oxygen tension or hyperbaric O2
cyst with enhancing nodule
- hemangioblastoma
- pilocytic astrocytoma
- pleomorphic xanthoastrocytoma
- ganglioglioma
- neurocysticercosis
- mets
- glioblastoma
- abscess
- toxo
- supratentorial ependymoma
- intraparenchymal schwannoma
perineural tumour spread
- squamous cell ca (mucosal > cutaneous), SNUC
- salivary gland ca (adenoid cystic > mucoepidermoid)
- basal cell ca (mucosal, cutaneous)
- melanoma
- lymphoma
(rare: sarcoma, meningioma)
trigeminal neuralgia causes
- vascular loop (MC SCA pressing on CN V at CPA)
- multiple sclerosis
- CP angle mass
- superficial siderosis
- infarcts in pons/medulla
intractable epilepsy - causes
- mesial temporal sclerosis
- developmental: focal cortical dysplasia, heterotopia, polymicrogyria, hemimegalencephaly, schizencephaly
- epileptogenic tumors: DNET, ganglioglioma, pleomorphic xanthoastrocytoma, hypothalamic hamartoma (gelastic)
- gliosis
- cavernous hemangioma
- Rasmussen/chronic focal encephalitis
- Sturge Weber, tuberous sclerosis
nasal septal perforation
- trauma: surgical, cautery, digital trauma
- malignant: tumors (non-Hodgkin lymphoma), malignant granuloma
- chronic inflammatory conditions: GPA, syphilis, TB, sarcoidosis
- poisons: industrial, chronic (>3 mo) cocaine, topical corticosteroids, topical decongestants
- idiopathic
brainstem atrophy - diffuse
radiotherapy
inflammatory
- MS: midbrain/pons > medulla
- NMO: medulla > midbrain/pons
- Behcet’s: edematous lesions + perivascular enhancement
Wallerian degeneration (diffuse or focal): atrophy & signal change downstream of a supratentorial lesion (eg. infarct, hemorrhage, demyelination)
chronic infectious rhomboencephalitis (Listeria, enterovirus)
infarction
spinocerebellar ataxia
inherited leukoencephalopathies (rare, child/young adult onset)
brainstem atrophy - regional
midbrain: progressive supranuclear palsy, Wilson’s
pons: multiple system atrophy, cerebellar type (MSA-C)
medulla: hypertrophic olivary degeneration (late), adult onset Alexander’s disease
Wallerian degeneration (diffuse or focal): atrophy & signal change downstream of a supratentorial lesion (eg. infarct, hemorrhage, demyelination)
thickened pituitary stalk
mets (breast, lung) germinoma lymphoma Langerhans cell histiocytosis lymphocytic hypophysitis sarcoidosis TB (+ basal pachymeningeal enhancement)
epilepsy associated tumors
- ganglioglioma
- DNET
- pleomorphic xanthoastrocytoma
- diffuse low grade astrocytoma
- oligodendroglioma
- hypothalamic hamartomas
lytic skull lesions
Langerhans cell histiocytosis metastases myeloma Paget disease Brown tumor hemangioma
midline sacrococcygeal lesions
chordoma chondrosarcoma teratoma lymphoma plasmacytoma metastases
conductive hearing loss
(ossicular motion impeded) cholesteatoma hemangioma glomus tympanicum trauma: disruption congenital otosclerosis
T1 hyperintense basal ganglia
calcium: physiologic, Ca2+/PO4 abN, Fahr dz
hepatic: hepatic encephalopathy, Wilson dz
toxins: carbon monoxide, manganese (prolonged TPN), non-ketotic hyperglycemic hemichorea, previous linear Gad
global hypoxia
blood: hemorrhagic infarct
hamartoma in NF1
lacrimal gland lesion
benign mixed tumour lymphoma idiopathic orbital inflammatory disease (pseudotumour) adenoid cystic carcinoma sarcoidosis Sjogren’s dermoid, epidermoid
cyst with mural nodule
pilocytic astrocytoma hemangioblastoma pleomorphic xanthoastrocytoma ganglioglioma desmoplastic infantile ganglioglioma
enlarged superior ophthalmic vein
carotid-cavernous fistula cavernous sinus or SOV thrombosis ophthalmic vein varix Graves disease orbital pseudotumour raised ICP
leukocoria
retinoblastoma persistent hyperplastic primary vitreous (PHPV) Coats disease retinopathy of prematurity toxocaral endophthalmitis retinal astrocytoma
bilateral parotid masses
nodes: sarcoid, lymphoma
Warthin’s
HIV: benign lymphoepithelial aggregates and cysts
Sjogren’s
Meckel’s cave lesion
trigeminal schwannoma meningioma metastasis neurosarcoid neurofibroma intracranial pseudotumor
multiple T2* hypointensities
cerebral amyloid angiopathy hypertensive microhemorrhages multiple cavernous malformations diffuse axonal injury hemorrhagic mets less common: septicemia, fat emboli, vasculitis, fungal, sickle cell, coagulopathy, metallic microemboli from mechanical heart valves
