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RRC DDx > Neuro > Flashcards

Neuro Flashcards

1
Q

CP angle mass ddx

A 
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)

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2
Q

thoracic spinal cord displaced anteriorly ddx

A

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

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3
Q

intradural intramedullary spinal lesion ddx

all planes: cord appears widened, CSF space thinned

A 
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
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4
Q

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)

A
  • 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)
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5
Q

extradural spinal lesion ddx

dura & sac displaced together, away from mass; obtuse angle of CSF around mass/”marble under carpet”

A

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)
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6
Q

hemorrhagic intracranial mets ddx

A 
MR CT BB
melanoma
renal cell carcinoma
choriocarcinoma
thyroid carcinoma
bronchogenic
breast
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7
Q

pituitary region mass ddx

A

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
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8
Q

leptomeningeal enhancement ddx

pia-arachnoid

A
  • 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])
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9
Q

pachymeningeal enhancement ddx

dura-arachnoid

A
  • 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
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10
Q

moyamoya-like vascular collaterals ddx

A 
moyamoya disease
radiation tx
NF1
trisomy 21
sickle cell dz
slowly progressive atherosclerosis
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11
Q

ivy sign ddx

in moyamoya: tubular branching FLAIR hyperintensities within sulci

A

leptomeningeal metastases
SAH
meningitis
high oxygen tension or hyperbaric O2

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12
Q

cyst with enhancing nodule

A
  • hemangioblastoma
  • pilocytic astrocytoma
  • pleomorphic xanthoastrocytoma
  • ganglioglioma
  • neurocysticercosis
  • mets
  • glioblastoma
  • abscess
  • toxo
  • supratentorial ependymoma
  • intraparenchymal schwannoma
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13
Q

perineural tumour spread

A
  • squamous cell ca (mucosal > cutaneous), SNUC
  • salivary gland ca (adenoid cystic > mucoepidermoid)
  • basal cell ca (mucosal, cutaneous)
  • melanoma
  • lymphoma
    (rare: sarcoma, meningioma)
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14
Q

trigeminal neuralgia causes

A
  • vascular loop (MC SCA pressing on CN V at CPA)
  • multiple sclerosis
  • CP angle mass
  • superficial siderosis
  • infarcts in pons/medulla
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15
Q

intractable epilepsy - causes

A
  • 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
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16
Q

nasal septal perforation

A
  • 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
17
Q

brainstem atrophy - diffuse

A

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)

18
Q

brainstem atrophy - regional

A

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)

19
Q

thickened pituitary stalk

A 
mets (breast, lung)
germinoma
lymphoma
Langerhans cell histiocytosis
lymphocytic hypophysitis
sarcoidosis
TB (+ basal pachymeningeal enhancement)
20
Q

epilepsy associated tumors

A
  • ganglioglioma
  • DNET
  • pleomorphic xanthoastrocytoma
  • diffuse low grade astrocytoma
  • oligodendroglioma
  • hypothalamic hamartomas
21
Q

lytic skull lesions

A 
Langerhans cell histiocytosis 
metastases
myeloma
Paget disease
Brown tumor
hemangioma
22
Q

midline sacrococcygeal lesions

A 
chordoma
chondrosarcoma
teratoma
lymphoma
plasmacytoma
metastases
23
Q

conductive hearing loss

A 
(ossicular motion impeded)
cholesteatoma 
hemangioma
glomus tympanicum
trauma: disruption
congenital
otosclerosis
24
Q

T1 hyperintense basal ganglia

A

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

25
Q

lacrimal gland lesion

A 
benign mixed tumour
lymphoma 
idiopathic orbital inflammatory disease (pseudotumour)
adenoid cystic carcinoma 
sarcoidosis
Sjogren’s
dermoid, epidermoid
26
Q

cyst with mural nodule

A 
pilocytic astrocytoma
hemangioblastoma
pleomorphic xanthoastrocytoma
ganglioglioma
desmoplastic infantile ganglioglioma
27
Q

enlarged superior ophthalmic vein

A 
carotid-cavernous fistula
cavernous sinus or SOV thrombosis
ophthalmic vein varix
Graves disease
orbital pseudotumour
raised ICP
28
Q

leukocoria

A 
retinoblastoma 
persistent hyperplastic primary vitreous (PHPV)
Coats disease
retinopathy of prematurity 
toxocaral endophthalmitis 
retinal astrocytoma
29
Q

bilateral parotid masses

A

nodes: sarcoid, lymphoma
Warthin’s
HIV: benign lymphoepithelial aggregates and cysts
Sjogren’s

30
Q

Meckel’s cave lesion

A 
trigeminal schwannoma
meningioma
metastasis
neurosarcoid
neurofibroma
intracranial pseudotumor
31
Q

multiple T2* hypointensities

A 
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

RRC DDx (12 decks)

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