Neuro Flashcards
What is torcular herophili
Confluence of sinuses
When do fontanelles close
24 months
When is the brain done myelinating
9 years old
Def Dyke-Davidoff-Mason
Hemi-cerebral atrophy/hypoplasia, compensatory IPSI osseous hypertrophy and Contra hemiparesis
Sign of Asterion is what?
Sutural closure of Parietomastoid and occipitomastoid and lamboidal suture
Hyperostosis frontalis interna + Obesity + hirsutism is AKA
Morgagni syndrome
Leptomeningeal cyst is formed how?
Skull Fx with dural tear, prevents union
Anomalies seen with Chiari 1
Klippel-Feil, syrinx, basilar invagination, C0/C1 assimilation
Anomalies seen with Chiari 2
Myelomeningocele, syringohydromyelia, scoliosis, tectal beaking
Def Meckel syndrome
Holoprosencephly/Occipital encephalocele, renal cystic dysplasia, postaxial polydactyly
Morsier syndrome is AKA
Septoopic dysplasia
Def Septo-optic dysplasia
Absent septum pellucidum with optic nerve hypoplasia
Def Kallmann syndrome
Anosmia/hypoosmia, hypogonadism and mental retardation
Def Walker-Warburg syndrome
Ocular malformation, cephaloceles, congenital hypotonia and death within 1 year
What is a porencephalic cyst
CSF space lined by glial white matter
Def Dandy-Walker syndrome
Cystic dilation of 4th ventricle, enlarged posterior fossa and cerebellar hypoplasia
Def Dandy-Walker variant
Mild vermis hypoplasia, cystic space from 4th ventricle widening
L’Hermitte-Duclos dz is what
Cerebellar dysplasia, dysplasia ganglioctyoma. Seen with Cowden disease
MC phakomatosis
NF1 (Von recklinghausen)
What is a Lisch nodule
Pigmented Iris hamartoma seen in NF1 (Not in NF2)
Hallmark tumor of NF1
Plxiform neurofibroma
MR signal of a hamartoma
High T1, very high T2, no enhancement or mass effect
Hallmark of NF2
Acoustic schwannomas
3 common intramedullary lesions of the spine
Astrocytoma, Ependymoma and hemangioblastoma
3 common intradural, extramedullary lesions of the spine
Meningioma, Schwannoma (MC) and neurofibroma
Classic triad of tuberous sclerosis
Papular facial nevus (adenoma sebaceum), Seizures, mental retardation
Cortical tubers are AKA
cortical hamartomas
MR signal of cortical tubers in kids and adults
Kids (T1 High, T2 Low); Adults (T1 Iso/low, T2 High); only 5% enhance
Tumor ass’d with VHL
hemangioblastoma
Hereditary hemorrhagic telangiectasis is AKA
Rendu-Osler-Weber syndrome
Rendu-Osler-Weber syndrome lesions include
telangiectasia, AVM, fistulas, aneurysms. characterized with nose bleeds (85%)
% of arterial infarcts that are hemorrhagic
25%
Lucid interval is ass’d with what hematoma
Epidural hematoma
3 MC locations of DAI
- Gray-white matter junction in frontotemporal
- posterior body of the splenium of the corpus callosum
- Dorsolateral upper brain stem
2 MC brain herniations
Subfalcine - Cingulate gyrus goes under falx cerebri
Inferior/descending transtentorial uncal herniation
Arterial occlusion seen with subfalcine herniation
Anterior cerebral artery, esp the pericallosal branch
Arterial occlusion seen with descending transtentorial herniation
Posterior cerebral artery, leads to Duret hemorrhage
Def kernohan’s notch phenomenon
Indentation of the contralateral cerebral crus by the tentorium due to mass effect. Seen in a inferior/descending tentorial herniation
Early reliable sign of cerebral edema
Sulcal effacement
MC traumatic AV fistula
Carotid-Cavernous sinus fistula
Pneumocephalus, how does patient position affect in epidural vs subdural location
Epidural - No change with pt movement
Subdural - Changes with pt movement
MC cause of CSF fistula
Skull base fx
Def Wyburn-mason
Multiple retinal, brain AVM with cutaneous nevi
MC parenchymal (pial) AVM
85% supratentorial
Multiple venous angiomas are seen in which syndrome
Blue Rubber Bleb nevus syndrome
MC brain vascular malformation
Cavernous angioma
Common structure involved in hypoxia-ischemic encephalopathy
basal ganglia
What artery occlusion would affect the septum pellucidum and anterior 1/3 of the corpus callosum
Pericallosal branch from the ACA
Idiopathic Progressive arteriopathy of childhood is AKA
Moyamoya
Def Menkes’ Kinky hair dz
X-linked neurodegenerative condition with copper metabolism issues
MC bug for bacterial meningitis in kids
H. influenza
Syphillitic arteritis is AKA
Cerebrovascular lues
MC systemic necrotizing arteritis with CNS manifestations
Polyarteritis Nodosa (PAN)
Polyarteritis nodosa affects which vessels
Small/medium arteries leading to microaneurysms
MC loc for venous sinus occlusion in the brain
Superior sagittal sinus
MC loc for veins in the brain
Superior cortical veins
4 categories of glial tumors
Astrocytoma, oligodendroglioma, ependymal tumors and choroid plexus tumors
Brain tumors mets or primary more common in adults
Mets is more common
Tumors ass’d with tuberous sclerosis
Subependymal giant cell astrocytoma (SEGA)
MC loc of ependymal tumors
infratentorial; 4th ventricle
Myxoppillary ependymal tumor location?
Spinal cord; Filum terminale
MC loc of papillomas in kids vs adults
Kids - lateral ventricle
Adult - 4th ventricle
MC primary brain tumor
Astrocytoma
2nd primary MC brain tumor
Meningioma
Top 2 MC sites of a schwannoma
CN8 and CN5
% of brain tumors from mets
~33%
MC location of a medulloblastoma
Cerebellar vermis - 90%
2 MC posterior fossa tumors in kids
Pilocytic astrocytomas and medulloblastoma
2 MC posterior fossa tumors in adults
Hemangioblastoma and brain stem glioma
MC non-neoplastic pineal mass
Pineal cyst
What % of medulloblastoma are midline
90% and can lead to drop mets
Top 2 lesions of the cerebellopontine angle
Schwannoma followed by meningioma
Def Gradenigo syndrome
- Petrous apicitis
- Abducens nerve palsy
- V1/V2 distribution pain
Paraganglioma by the cochlea is known as
Glomus tympanicum
Normal MR signal of pituitary
Ant is iso to brain on T1 and T2
Post is high T1, low T2
MC intrasellar mass
Microadenoma
Def Sheehan syndrome
Postpartum infarct of pituitary leading to empty sella
Size cutoff between micro and macropituitary adenoma
10mm
MC benign nasopharyngeal tumor
Juvenile nasopharyngeal angiofibromas
MC primary CNS tumor
GBM
MC supratentorial mass in kids
astrocytoma
MC location of a pilocytic astrocytoma
Cerebellum
MC location of pleomorphic xanthoastrocytoma
Peripheral temporal lobes - seen with seizures
MC loc of SEGA
Foramen of Monro - ass’d with tuberous sclerosis
Desc a SEGA lesion
Partially cystic and calcified lesion, can lead to noncommunicating hydrocephalus
MCly calcified intracranial tumor
oligodendroglioma
MC loc of an oligodendroglioma
Cortical frontal lobe region
MC loc of a choroid plexus papilloma in kids and adults
Kids - trigone of the lateral ventricle
adults - 4th ventricle
Desc hemangioblastoma
Found in cerebellum of adults, primarly cystic with mural nodule, nodule will +C, lack of hemorrhage, calcification or necrosis
MC germ cell tumor
Germinoma
Age and loc of a germinoma
10-30 yo, pineal gland (engulfs it)
Age and sex of a teratoma
Young, males. 2nd MC germ cell tumor
Syndrome ass’d with medulloblastoma
Gorlin syndrome (Basal Cell nevus syndrome)
Age/loc of neuroblastoma
<5 YOA, loves the adrenals and also seen in cerebrum hemispheres
Third and fourth eyes of the head, seen with retinoblastoma
3rd = pineal gland 4th = suprasellar cistern
Def ‘cats eye’ (Leukokoria)
Whitish mass behind the eye seen in 60% of retinoblastomas
How common is lymphoma Mets
2nd MC mets (breast is MC and lung), found in the supratentorial region liking the frontal lobe and basal ganglia
MC location of trigeminal nerve schwannoma
Trigeminal ganglion or Grasserian ganglion in Meckle’s cave
MC cranial nerve affected by neurofibroma
Trigeminal CNV (V1 in particular)
Loc of cranial epidermoid and dermoid tumors
Epidermoid - off midline, CP angle
Dermoid - Midline, parasellar, vermis, 4th ventricle
Loc of an intracranial lipoma
Midline, usually around corpus callosum
MC location of an arachnoid cyst
Middle cranial fossa
MC loc of a colloid cyst
anterior to 3rd ventricle
MC site of neuroglial cyst
Choroid plexus
Def the Elster rule
Pituitary gland height being 6,8,10,12 mm
Kids, men/postmeno women, childbearing women, and postpartum
MC malignant pituitary lesion
Mets
MC type of pituitary adenoma (What is it secreting)
Prolactin-secreting
def nelsons syndrome
Pituitary adenoma in patients with adrenectomy for Cushing
Enhancement pattern of microadenoma on CT
Slow +C enhancement
MC nonglial brain tumor in kids
Craniopharyngoma
Congenital infections
TORCH (TOxoplasmosis, Rubella, CMV, HSV/HIV)
MC congenital infectious agents
CMV
What is affected with congenital CMV infection
CNS (70%), cardiac anomalies and hepatosplenomegaly
Congenital CMV presentation
Neuronal migration disorder, periventricular calcification, delayed myelination, ventricular enlargement
Triad of Toxoplasmosis infection
Hydrocephalus, Bi chorioretinitis and intracranial calcifications. NO NEURONAL MIGRATION DISORDER
Severe changes from Varicella infection in fetus
necrotizing encephalomyelitis
MC form of CNS infecion
Meningitis
3 categories of meningitis
Acute pyogenic, lymphocytic and chronic
MC agents causing meningitis in neonate, <7YOA, adolescent and adults
Neonate - group B strep
<7 - H influenza
adolescent - N. meningitidis
adult - Strep pneumonia
% of ventriculitis in neonatal meningitis
90%
MC loc of TB (Chronic) meningitis
Basal cisterns
MC cause of brain abscess
Pyogenic bacteria (strep, staph or gram negative)
4 stages of abscess formation
- Early cerebritis
- Late cerebritis
- Early capsule formation
- late capsule formation
MC viral encephalitis
HSV
2 - in neonates and 1 in kids/adults
MC opportunistic CNS infection in AIDS pts
Toxoplasmosis
MC CNS pathogen in AIDS pts
HIV
Cause of progressive multifocal leukoenchalopathy
Group B human papovavirus
MC fungal infection in non-IC patients
Histoplasmosis
MC fungal infection in IC patient
Aspergillosis, candida
MC CNS parasitic infection and MC loc
Neurocysticercosis; Corticomedullary junction followed by ventricles
General myelination pattern
caudad–> Cranial; Dorsal –>ventral; central–> peripheral
T/F is gray-white matter signal reversed in neonates
True
MC hereditary leukodystrophy
Metachromatic leukodystrophy
Metachromatic leukodystrophy demylination site
Sym, deep periventricular white matter; primarily anterior lobes
Globoid cell leukodystrophy is AKA
Krabbe dystrophy
MC site affected by Krabbe dys
Centrum semiovale
Lorenzo oil is AKA
Adrenoleukodystrophy
Desc Alexander disease
Dysmyelination d/t Rosenthal fiber deposition, likes the frontal lobe
Only Dysmylinating disorder to affect the subcortical U-fibers
Canavan Dz
Def Phenylketonuria
Increased phenylalanine; autism, retardation, seizures, , greates changes to optic radiations, osseous metaphyseal cupping, osteoporosis, delayed maturation
Batwing dilation of sylvian fissure is seen in
Glutaric aciduria type 1
pattern of nonketoic hyperglycinuria
Decrease myelination of white matter
Oculocerebral renal syndrome is AKA and Desc
Lowe syndrome; Cataracts, retardation, renal-tubular dz, rickets, supratentorial WM lesions
What is Tay-sachs dz
Axonal death-demylination
Mega neurites is ass’d with what disease (MPS)
MPS1-H - Hurlers
Cortical atrophy is seen in which MPS
MPS 3(San Filippo) and MPS2 (Hunter)
Brain changes in Wilsons disease
Calcificaions in Basal ganglia
MC location of MS in kids
Infratentorial
Def marchiatava-bignami
Alcoholics, demyelination of corpus callosum
What dz contains Lewy bodies
Alzheimers and Parkinson with frontal lobe atrophy
What is Picks dz
Frontotemporal lobe degeneration/atrophy with pick bodies
Def neural placode
Neuronal tissue surface open to the air (NO DURA)
MC cause of meningocele
Acquired –> Laminectomy
MC cause of tethered cord
Spinal lipoma
Anterior sacral meningocele is ass’d with what conditions
NF1 and Marfans
% of spinal hemangioblastomas in pts with VHL
30%
MC cause of pyogenic spondylitis
Staph aureus (2nd is enterobacter)
1st and 2nd MC cause of granulomatous spondylitis
TB and brucella
What type of cord matter do virus vs bacteria like
virus is gray
bacteria is white
MC plaques in the cord are found where (in terms of axial slice)
Dorsolateral
What is Devic dz
Spinal MS and optic nerve only
MC spinal vascular anomaly
AVM/AVF type 1
spinal AVM MC location
TL junction
MC spinal location for osteochondroma
C2 usually SP or TP
MC loc of epidural lipomatosis
T/s> L/s, never C/s
Sinus seen on Caldwell projection
Frontal and ethmoid
Sinus seen on Waters
Maxilla
Sinus seen on Rheese projection
Post ethmoid with superimposition
MC sinus with sinusitis
Maxillary
Potts puffy tumor is
ST swelling over frontal sinus from OM
What is Coalescent mastoiditis and Bezold
Mastoiditis that speads to bone and Bezold when it breaks through the cortex to create a subperiosteal abscess
MC fx to skull base bone
Temporal bone
MC primary tumor of temporal bone
Glomus
MC salivary gland tumor
Pleomorphic adenoma
Def Warton tumor
benign parotid gland tumor
What is ass’d with spinal ependymoma
NF2
Meningiomas in kids is ass’d with what
NF2
Loc in the spinal cord (cross-section) for a hemangioblastoma
Posterior cord
Age and loc of a PNET brain
Children; sellar/suprasellar
Compression of the tectal plate can cause what syndrome
Perinaud syndrome - inability to gaze upward
DDx for a butterfly lesion of the corpus callosum
GBM, primary CNS lymphoma and mets
Loc of Rathke cleft cyst
Intra and suprasellar mixed - 70%
% of a solitary enhancing brain tumor is mets
50%
Imaging differences in parkinson plus syndromes (Multisystem atrophy vs Progressive supranuclear palsy)
MSA - Spares the midbrain
PSP - Spares the Pons (hummingbird sign)
MC cause of basal ganglia calcification
Idiopathic/physiologic aging
Familial idiopathic striopallidodentate calcification is known as
Fahr dz
Rad of basilar meningitis
Intense enhancement with pituitary and parasellar involvement, Ca seen in late dz
MC loc and cause of empyema
Subdural space and sinusitis
DDx for lyme dz is
MS and ADEM
Ring enhancing lesions brain
DR MAGICAL
Demylinating (incomplete ring on the central portion), Radiation, Mets, Abscess, GBM, Infarct, Contusion, AIDS and Lymphoma
At what measurement is tonsilar herniation called
> 5mm
Chiari 1 vs 2 is seen in what age
Chiari 1 = Adult, Chiari 2 = newborn
MC loc for a cephalocele
Occipital
What conditions typically affect corpus callosum development
Dandy-walker, lipoma, Chiari 2, encephalocele, migration anomalies
What chromosomal syndrome is ass’d with holoproscencephaly
Pateau (13)
Mild form holoproscencephaly
Septo-optic dysplasia
2 congenital syndrome with spinal stenosi
Achondroplasia and Morquio
Cap sign is suggestive of what spinal tumor
Ependymoma, can also be seen in hemangioblastoma and paragangliomas