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CORE > Neuro: Brain > Flashcards

Neuro: Brain Flashcards

1
Q

what is massa intermedia?

A

gray + white matter struct –> thru 3rd vent –> connect bilat thalami

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2
Q

brain edema –> 3 types?

A
  • cytotoxic edema
  • vasogenic edema
  • interstitial edema
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3
Q

cytotoxic edema –> MOA?

A

cell death –> damage Na-K ATPase pumps –> water ions trapped inside swollen cells

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4
Q

vasogenic edema –> MOA?

A

inc capillary permeability –> interstitial edema

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5
Q

cytotoxic edema –> MCC?

A

infarct

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6
Q

vasogenic edema –> MCC? (3)

A
  • neoplasm
  • infx
  • infarct
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7
Q

interstitial edema –> MOA? MCC?

A

imbalance in CSF flow

obstructive hydrocephalus

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8
Q

interstitial edema –> imaging appearance?

A

periventricular fluid (transependymal flow of CSF)

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9
Q

subfalcine herniation –> comp? (1)

A

compress ACA

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10
Q

uncal herniation –> comp? (4)

A
  • CN III paresis
  • compress PCA
  • Duret hemorrhage
  • compress contralat cerebral peduncle
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11
Q

tonsillar herniation –> comp? (1)

A

compress medulla

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12
Q

CN III paresis –> clinical presentation? (2)

A
  • pupil dilate

- eye –> down & out

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13
Q

upward transtentorial herniation –> comp? (1)

A

compress aqueduct –> hydrocephalus

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14
Q

what is communicating hydrocephalus?

A

no obstructing lesion –> venticles enlrg

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15
Q

communicating hydrocephalus –> 2 causes?

A
  • subarachnoid hemorrhage

- normal pressure hydrocephalus

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16
Q

subarachnoid hemorrhage –> communicating hydrocephalus –> MOA?

A

impede arachnoid granulation from resorb CSF

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17
Q

what is T1? T2?

A
  • T1: longitudinal recovery/relaxation

- T2: transverse relaxation

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18
Q

T1 shortening vs prolongation –> hypo or hyper-intense?

A
  • T1 short –> hyper

- T1 prolong –> hypo

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19
Q

T2 shortening vs prolongation –> hypo or hyper-intense?

A
  • T2 short –> hypo

- T2 prolong –> hyper

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20
Q

what is optic neuritis?

A

optic N –> inflamm –> non-neoplastic

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21
Q

optic neuritis –> clinical presentation? (3)

A
  • pain
  • subacute vision loss
  • reduce color perception
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22
Q

optic neuritis –> MC etiology? less common etiologies? (4)

A
  • # 1 mult sclerosis
  • viral
  • sarcoid
  • vasculitis
  • toxin
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23
Q

optic neuritis + spinal demyelination –> dx?

A

Devic synd

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24
Q

MRI orbit –> optic neuritis –> next step?

A

MRI brain & spine –> look for intracranial plaques

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25
Q

optic neuritis –> MR appearance? T2 signal? enhance?

A
  • enlrg optic N
  • T2 hyper
  • active dz –> enhance
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26
Q

globe –> MC 1ary malig?

A

retinoblastoma

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27
Q

retinoblastoma –> epidemiology?

A

<5yo

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28
Q

retinoblastoma –> classic CT appearance?

A

normal size globe –> retinal mass –> hyperdense –> enhance –> calc

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29
Q

what is trilateral retinoblastoma?

A
  • bilat retinoblastoma

- pineal gland –> pineoblastoma

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30
Q

what is quadrilateral retinoblastoma?

A
  • bilat retinoblastoma
  • pineal gland –> pineoblastoma
  • suprasellar retinoblastoma
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31
Q

what is Coat dz?

A

retina –> vascular dz –> lipoproteinaceous subretinal exudate –> retina detach

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32
Q

Coat dz –> epidemiology?

A

slightly older than retinoblastoma –> M

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33
Q

Coat dz –> imaging appearance?

A

normal size globe –> subretinal soft tissue –> not enhance

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34
Q

premature infant –> prolong O2 therapy –> comp? (1)

A

retinopathy of prematurity

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35
Q

retinopathy of prematurity –> findings? (4)

A
  • bilat microphthalmia
  • abnormal vascular developmt
  • hemorrhage –> high attenuation & calc
  • retina detach
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36
Q

retinopathy of prematurity –> natural progression?

A

phthisis bulbi

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37
Q

full term infant –> retina detach, hemorrhage –> loss of vision –> dx?

A

persistent hyperplastic primary vitreous (PHPV)

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38
Q

what is persistent hyperplastic primary vitreous (PHPV)?

A

vitreous –> persistent embryonic vasculature –> hemorrhage, cataract, retina detach –> vision loss

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39
Q

persistent hyperplastic primary vitreous (PHPV) –> imaging features? (3)

A
  • microphthalmia
  • vitreous –> hyperdense
  • no calc
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40
Q

most brain lesion –> T1 signal? T2?

A
  • T1 hypo

- T2 hyper

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41
Q

T1 short (hyper) –> cause? (8)

A
  • gad contrast
  • fat
  • protein
  • blood –> paramagnetic stage –> metHb –> intra & extra-cell
  • melanin
  • mineral (copper, iron, mangenese)
  • slow flow blood
  • rare –> calcium
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42
Q

T2 short (hypo) –> cause? (6)

A
  • blood –> most paramag stages –> except hyperacute blood & extracell metHb
  • calc
  • fibrous lesion
  • high cellular tumor: high nucleus:cytoplasm ratio –> low water content –> ie. lymphoma, medulloblastoma
  • vasc flow void
  • mucin –> dessicated
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43
Q

what is fluid attenuation inversion recovery (FLAIR)?

A

T2 –> water suppressed (based on T2 charact)

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44
Q

brain –> white vs gray matter –> T1 signal?

A
  • white matter: bright

- gray: darker

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45
Q

brain –> white vs gray matter –> FLAIR signal?

A
  • white matter: darker

- gray: bright

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46
Q

MRI seq with highest signal to noise ratio?

A

proton density (PD)

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47
Q

proton density (PD) –> useful for eval of what condition?

A

mult sclerosis

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48
Q

diffusion MRI –> DWI & ADC –> based on what characteristic?

A

water proton –> Brownian motion

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49
Q

diffusion MRI –> DWI & ADC –> CSF vs pathologic process –> signal attenuation?

A
  • CSF –> most signal attenuation –> most signal loss

- path process –> less Brownian motion –> less diffusivity –> less signal loss –> DWI hyperintense

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50
Q

what is T2 shinethru?

A

DWI is T2 weighted –> T2 hyper lesion –> hyper on DWI, even if not restricted diffusion

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51
Q

restricted diffusion –> ddx? (6)

A
  • acute stroke
  • bacterial abscess
  • cellular tumor –> ie lymphoma, medulloblastoma
  • epidermoid cyst
  • herpes encephalitis
  • Creutzfeldt-Jakob dz
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52
Q

gradient recall echo (GRE) –> what creates blooming artifact? (2)

A
  • hemosiderin

- Ca

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53
Q

GRE –> mult dark spots –> ddx? (5)

A
  • HTN microbleed
  • cerebral amyloid angiopathy
  • familial cerebral cavernous malformation
  • axonal shear injury
  • mult hemorrhagic mets
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54
Q

cerebral amyloid angiopathy –> GRE –> mult dark spots –> location?

A

subcortical white matter –> usu parietal & occipital lobes

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55
Q

glioblastoma vs mets –> how differentiate on MR spectroscopy?

A
  • glioblastoma –> infiltrative –> gradual transition from abnormal to normal spectroscopy
  • mets –> more abrupt transition
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56
Q

what is N-acetylaspartate (NAA)?

A

normal marker of neuronal viability –> dec in most abnormalities

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57
Q

most tumor –> N-acetylaspartate (NAA) inc/dec? choline (cho)?

A
  • NAA dec

- choline inc

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58
Q

NAA elevated –> ddx? (1)

A

Canavan dz –> dysmyelinating disorder

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59
Q

lactate “doublet” –> ddx? (1)

A

high grade tumor –> anaerobic metabolism

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60
Q

MRI brain –> parenchymal enhance –> MOA? cause? (5)

A

blood brain barrier disrupt:

  • infx
  • inflamm
  • neoplasm
  • trauma
  • vascular
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61
Q

MRI brain –> regions w no BBB –> normally enhance? (5)

A
  • choroid plexus
  • pituitary gland
  • pineal gland
  • tuber cinereum –> inf hypothalamus
  • area postrema –> inf 4th ventricle
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62
Q

MRI brain –> periventricular enhance –> ddx? (4)

A
  • primary CNS lymphoma
  • infx ependymitis
  • primary glial tumor
  • mult sclerosis
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63
Q

primary CNS vs systemic lymphoma –> leptomeningeal involvemt?

A
  • primary CNS –> rarely involve meninges

- systemic lymphoma –> brain mets –> commonly involve leptomeninges

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64
Q

infx ependymitis –> MC org?

A

CMV

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65
Q

infx ependymitis –> imaging appearance?

A

ventricle margins –> thin linear enhance

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66
Q

gyrus enhance –> ddx? (5)

A
  • herpes encephalitis
  • meningitis
  • subacute infarct
  • post reversible encephalopathy synd (PRES)
  • SMART synd
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67
Q

herpes encephalitis –> which locations affected 1st? (2)

A
  • medial temporal lobe

- cingulate gyrus

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68
Q

what is SMART synd?

A

stroke like migraine attacks after rtx

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69
Q

ring enhance –> ddx? (7)

A

MAGIC DR:

  • mets
  • abscess
  • glioma
  • infarct –> subacute basal ganglia
  • contusion –> subacute-chronic
  • demyelination
  • radiation
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70
Q

dura enhance –> ddx? (5)

A
  • intracranial hypotension
  • postop
  • post lumbar puncture
  • meningeal neoplasm
  • hypertrophic pachymeningitis
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71
Q

hypertrophic pachymeningitis –> etiology? (4)

A
  • infx –> TB/fungal, syphilis
  • inflamm –> RA, granulomatosis w polyangiitis
  • sarcoid
  • idiopathic
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72
Q

what is pachymeninges? leptomeninges?

A
  • pachy –> dura

- lepto –> pia & arachnoid

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73
Q

leptomeningeal enhance –> ddx? (4)

A
  • meningitis
  • viral encephalitis
  • leptomeningeal mets
  • inflamm amyloid
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74
Q

subarachnoid space –> FLAIR hyper –> ddx? (7)

A
  • meningitis
  • leptomeningeal mets
  • subarachnoid hemorrhage
  • slow vascular flow
  • O2 tx
  • propofol tx
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75
Q

internal carotid A –> segments? (4)

A
  • cervical
  • petrous
  • cavernous
  • supraclinoid
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76
Q

A1 segmt –> br?

A

recurrent A of Heubner

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77
Q

what is A of Percheron?

A

variant: P1 PCA –> dominant thalamic perforator –> supply b/l ventromedial thalami

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78
Q

what is fetal PCA?

A

normal variant: ICA –> enlrged P-comm –> no PCA

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79
Q

what is azygos ACA?

A

normal variant: –> b/l ACA converge into 1

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80
Q

azygos ACA –> assoc anomaly? (3)

A
  • holoprosencephaly
  • neuronal migration anomaly
  • aneurysm formation
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81
Q

recurrent A of Heubner –> supplies what struct? (2)

A
  • caudate head

- internal capsule –> ant limb

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82
Q

MC persistent carotid-basilar connection?

A

persistent trigeminal A

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83
Q

persistent trigeminal A –> assoc comp? (1)

A

aneurysm

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84
Q

persistent trigeminal A –> sign?

A

angio –> lat view –> “tau” sign

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85
Q

acute stroke –> perfusion imaging –> what is cerebral blood vol (CBV)?

A

blood vol per unit brain tissue

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86
Q

acute stroke –> perfusion imaging –> what is cerebral blood flow (CBF)?

A

vol of blood flowing per unit of brain tissue

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87
Q

acute stroke –> perfusion imaging –> what is mean transit time (MTT)?

A

avg time for contrast bolus to transverse a voxel

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88
Q

acute stroke –> perfusion imaging –> what is time to maximum (Tmax)/time to peak (TTP)?

A

time from scan start to max contrast bolus in voxel

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89
Q

acute stroke –> perfusion imaging –> how are CBF, CBV, and MTT related?

A

central volume eqn:

CBF = CBV/MTT

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90
Q

acute stroke –> perfusion imaging –> infarct core –> finding?

A

marked dec CBF –> matched dec CBV

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91
Q

acute stroke –> perfusion imaging –> ischemic penumbra –> finding? (2)

A
  • mild dec CBF –> mismatch inc/normal CBV

- inc MTT & Tmax

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92
Q

stroke –> dating?

A
  • DWI bright, ADC dark –> 10days
  • T1 dark –> 16hr
  • T2 bright –> 8hr
  • FLAIR bright –> 6hr
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93
Q

subacute infarct –> what is 2-2-2 rule?

A

enhance:
- begin at 2 days
- peak at 2wk
- resolve by 2mo

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94
Q

subarachnoid hemorrhage –> comp? (3) which is MC?

A
  • # 1 vasospasm –> delayed ischemia
  • hydrocephalus
  • superficial siderosis
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95
Q

aneurysm –> subarachnoid hemorrhage –> hemorrhage location –> indicates aneurysm of what vessel?

  • ant interhemispheric fissure
  • suprasellar cistern
  • Sylvian fissure
  • perimesencephalic cistern
A
  • ant interhemispheric fissure –> A-comm
  • suprasellar cistern –> P-comm
  • Sylvian fissure –> MCA
  • perimesencephalic cistern –> basilar tip
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96
Q

what is perimesencephalic subarachnoid hemorrhage?

A

pattern of nontraumatic SAH –> likely venous origin –> benign prognosis

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97
Q

what is reversible cerebral vasoconstriction synd (RCVS)?

A

nontraumatic, nonaneurysmal –> SAH & ischemia

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98
Q

MC cranial N palsy from giant aneurysm?

A

P-comm aneurysm –> CN III palsy

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99
Q

isolated intraventricular hemorrhage in 4th ventricle –> ddx? (1)

A

PICA aneurysm rupture

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100
Q

mycotic aneurysm –> etiology?

A

septic emboli

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101
Q

what is oncotic aneurysm?

A

aneurysm caused by neoplasm

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102
Q

what is AVM?

A

congenital –> high flow vasc malformation –> directly connecting A & V –> no intervening capillary

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103
Q

what is dural AVF (dAVF)?

A

high flow vasc malformation –> meningeal arterioles & dural venules –> AV shunt

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104
Q

dural AVF (dAVF) –> #1 prognostic factor?

A

presence & degree of cortical venous drainage

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105
Q

dural AVF (dAVF) –> what is a subtype of dAVF?

A

carotid-cavernous fistula (CCF)

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106
Q

what is V of Galen malformation?

A

high flow vasc malformation –> thalmoperf br & deep venous system –> AVF –> enlrg median prosencephalic V

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107
Q

CNS –> vasc malformation –> high flow (2) vs low flow (3) –> ddx?

A

high flow:

  • AVM
  • dural AVF

low flow:

  • cavernous malformation (cavernoma)
  • developmental venous anomaly (venous angioma)
  • capillary telangiectasia
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108
Q

cavernous malformation (cavernoma) –> comp? (2)

A
  • hemorrhage –> small risk

- sz

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109
Q

cavernous malformation (cavernoma) –> assoc anomaly?

A

developmental venous anomaly (venous angioma)

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110
Q

mult cavernous malformation (cavernoma) –> ddx? (1)

A

familial cerebral cavernous malformation synd

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111
Q

what is cavernous malformation (cavernoma)?

A

vasc hamartoma

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112
Q

cavernous malformation (cavernoma) –> assoc RF? (1)

A

brain rtx

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113
Q

cavernous malformation (cavernoma) –> CT appearance?

A

well-circumscribed rounded hyperdense lesion

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114
Q

cavernous malformation (cavernoma) –> usu diagnostic on CTA –> T/F?

A

F

usu occult on vasc imaging

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115
Q

cavernous malformation (cavernoma) –> MRI appearance? T1/T2? enhance?

A
  • T1/T2 mixed “popcorn-like” signal –> blood of varying ages
  • dark rim of hemosiderin
  • no enhance
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116
Q

what is developmental venous anomaly (venous angioma)?

A

abnormal V –> provide functional drainage to normal brain

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117
Q

developmental venous anomaly (venous angioma) –> usu only seen on contrast-enhanced or susceptibility weighted imaging –> T/F?

A

T

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118
Q

developmental venous anomaly (venous angioma) –> imaging appearance?

A

radially oriented V –> caput medusa appearance

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119
Q

cavernous malformation (cavernoma) –> Do Not Touch lesion –> T/F?

A

F

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120
Q

developmental venous anomaly (venous angioma) –> Do Not Touch lesion –> T/F?

A

T

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121
Q

capillary telangiectasia –> Do Not Touch lesion –> T/F?

A

T

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122
Q

what is capillary telangiectasia?

A

low flow vasc malformation –> dilated capillaries w interspersed normal brain –> asx

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123
Q

capillary telangiectasia –> usu diagnostic on CTA –> T/F?

A

F

occult on vasc imaging

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124
Q

developmental venous anomaly (venous angioma) –> usu diagnostic on CTA –> T/F?

A

T

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125
Q

capillary telangiectasia –> MRI appearance? T2? GRE? enhance?

A
  • occult on T2/FLAIR
  • GRE –> blooming artifact
  • contrast –> “brush stroke”-like lesion
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126
Q

capillary telangiectasia –> MC location?

A

brainstem

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127
Q

what is venous angle?

A

intersect of septal V & thalmostriate V –> angio landmark for foramen of Monro

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128
Q

deep venous sinus or cortical V –> thrombosis –> RF? (5)

A
  • preg/OCP
  • thrombophilia
  • malig
  • infx
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129
Q

noncontrast CT –> venous thrombosis –> sign?

A

“cord” sign –> inc density of thrombosed sinus/cortical V

130
Q

venous thrombosis –> comp?

A

venous HTN –> infarct, hemorrhage

131
Q

venous thrombosis –> pattern of venous infarction?

  • sup sagittal sinus
  • deep venous system
  • transverse sinus
A
  • sup sagittal sinus –> parasagittal high convexity cortex
  • deep venous system –> b/l thalamus
  • transverse sinus –> post temporal lobe
132
Q

CTA brain –> what is spot sign?

A

small enhancing focus w/in hemorrhage –> not seen on noncontrast –> sep from adj vessels –> reflect active hemorrhage

133
Q

evolution of blood product –> phases? how relate to acuity of hematoma? (5)

A

1) intracell oxyHb –> hyperacute (0-6hr)
2) intracell deoxyHb –> acute (6-72hr)
3) intracell metHb –> early subacute (3day-1wk)
4) extracell metHb –> late subacute (1wk-months)
5) hemosiderin & ferritin –> chronic

134
Q

blood product –> dating –> used for intra vs extra-axial vs both?

A

intra-axial only

135
Q

parenchymal hematoma –> dating –> T1/T2 signal?

A

IdDy BiDy BaBy DaDy:

  • acute –> T1 iso, T2 dark
  • early subacute –> T1 bright, T2 dark
  • late subacute –> T1 bright, T2 bright
  • chronic –> T1 dark, T2 dark
136
Q

what is cerebral amyloid angiopathy? comp?

A

small & med A –> amyloid accum in wall –> weak wall –> inc risk of hemorrhage

137
Q

cerebral amyloid angiopathy –> main clinical clue?

A

elder –> normotensive

138
Q

cerebral amyloid angiopathy –> microhemorrhages –> location?

A

lobar, cortical, subcortical

139
Q

CNS vasculitis –> most sens imaging modality? finding?

A

conventional angiography –> multifocal stenosis/dilation

140
Q

CNS vasculitis –> MC presentation?

A

cerebral ischemia

141
Q

CNS vasculitis –> standard MR finding?

A

basal ganglia & subcortical white matter –> multifocal T2 bright

142
Q

MC hemorrhagic neoplasm?

A

glioblastoma

143
Q

hemorrhagic brain mets –> primary CA ddx? (6)

A
  • melanoma
  • RCC
  • chorioCA
  • thyroid
  • breast
  • lung
144
Q

what is moyamoya dz?

A

non-atherosclerotic vasculopathy –> intracrnial ICA & prox br –> progressive stenosis –> comp prolif of collateral vessels –> esp lenticulostriate & other perforating vessels of basal ganglia –> fragile

145
Q

what is moyamoya synd?

A

2ary cause –> ie. sickle cell, NF1, rtx, Down synd –> moyamoya vasc findings

146
Q

moyamoya dz –> classic angio finding?

A

enlrg lenticulostriate perforating collaterals –> “puff of smoke” appearance

147
Q

moyamoya dz –> classic FLAIR finding?

A

sulci –> cortical A br –> slow flow –> bright tubular branching –> “ivy” sign

148
Q

moyamoya dz –> comp? MC location?

A

post circ –> aneurysm formation

149
Q

severe moyamoya dz –> tx?

A

ECA to MCA bypass

150
Q

intracranial hemorrhage –> what is swirl sign?

A

hematoma –> mixed high & low density –> active bleeding

151
Q

diffuse axonal injury (traumatic axonal injury) –> characteristic locations –> least to worst in prognosis?

A
  • grade 1: cerebral hemisphere –> gray-white jx
  • grade 2: corpus callosum
  • grade 3: dorsolat, rostral midbrain
152
Q

diffuse axonal injury (traumatic axonal injury) –> FLAIR? SWI/GRE? DWI?

A
  • restricted diffusion
  • FLAIR bright
  • SWI/GRE blooming if hemorrhagic axonal injury
153
Q

extra-axial mass –> clues that extra-axial? (3)

A
  • CSF cleft
  • gray matter bw mass
  • dural tail
154
Q

cerebellopontine angle –> mass –> ddx? (3)

A
  • vestibular schwannoma
  • meningioma
  • epidermoid cyst
155
Q

pineal region –> mass –> ddx? (2)

A
  • germ cell tumor –> ie. germinoma

- pineal tumor –> ie. pineoblastoma

156
Q

transcallosal (butterfly) mass? (3)

A
  • glioblastoma
  • 1ary CNS lymphoma
  • demyelinating dz
157
Q

MC cortical brain tumor? (4)

A
  • pleomorphic xanthoastrocytoma
  • dysembryoplastic neuroepithelial tumor
  • oligodendroglioma
  • ganglioglioma
158
Q

MC 1ary central skull base tumor? (2)

A
  • chordoma

- chondrosarcoma

159
Q

MC suprasellar tumor in adult? child?

A
  • adult –> pit adenoma

- child –> craniopharyngioma

160
Q

MC post fossa tumor in adult? (2) child? (4)

A

adult:
- hemangioblastoma
- mets

child (BEAM):

  • brainstem glioma (diffuse) - ependymoma
  • astrocytoma (pilocytic)
  • medulloblastoma
161
Q

lat ventricle atrium –> MC purely intraventricular tumor in adult? (2) child? (1)

A

adult:
- meningioma
- degen choroid plexus cyst/xanthogranuloma

child:
- choroid plexus papilloma

162
Q

MC mass of foramen of Monro in adult? child?

A
  • adult: colloid cyst

- child: subependymal giant cell astrocytoma

163
Q

types of glial cells? (4)

A
  • astrocyte
  • oligodendrocyte
  • ependymal cell
  • choroid plexus cell
164
Q

what is drop mets?

A

intracranial tumor –> disseminate to spine –> intradural extramedullary cmpt

165
Q

what is gliomatosis cerebri?

A

diffuse glioma –> involve at least 3 lobes of brain

166
Q

what is T2-FLAIR mismatch sign?

A

T2 hyper –> FLAIR central hypo –> highly specific for 1p19q non-co-deleted IDH-mutant astrocytoma

167
Q

expansile cortical mass –> gyriform calcs –> dx?

A

1p19q-co-deleted IDH-mutant oligodendroglioma

168
Q

supratentorial cortical tumors –> ddx? (6)

A

P-DOG MD:

  • pleomorphic xanthoastrocytoma (PXA)
  • dysembryoplastic neuroepithelial tumor (DNET)
  • oligodendroglioma
  • ganglioglioma
  • multinodular and vacuolating neuronal tumor (MVNT)
  • desmoplastic infantile astrocytoma and ganglioglioma (DIA/DIG)
169
Q

pleomorphic xanthoastrocytoma (PXA) –> epidemiology? (2)

A
  • child

- YA

170
Q

pleomorphic xanthoastrocytoma (PXA) –> MRI appearace? (3)

A
  • mass –> avid enhance
  • cyst formation
  • dural tail
171
Q

brain cortex –> solid & cystic lesion –> ddx? (2)

A
  • pleomorphic xanthoastrocytoma (PXA)

- ganglioglioma

172
Q

dysembryoplastic neuroepithelial tumor (DNET) –> MRI appearance? T2? FLAIR? enhance?

A
  • circumscribed bubbly appearance
  • T2 bright
  • FLAIR bright rim sign
  • enhance
173
Q

ganglioglioma –> freq assoc anomaly?

A

focal cortical dysplasia

174
Q

hemangioblastoma –> assoc synd?

A

25% –> von Hippel-Lindau (VHL)

175
Q

hemangioblastoma –> classic appearance?

A

cystic mass –> avid enhance mural nodule

176
Q

diffuse midline glioma –> MRI appearance?

A

brainstem/diencephalon –> expansile solid or infiltrative mass –> FLAIR hyper

177
Q

MC CNS embryonal tumor?

A

medulloblastoma

178
Q

MC brain malig of child?

A

medulloblastoma

179
Q

medulloblastoma –> CT density? T2? ADC? why?

A

hypercellular:
- CT slight hyperdense
- T2 hypo
- ADC dark

180
Q

child –> MCC drop mets to spine?

A

medulloblastoma

181
Q

<3yo –> lrg brain mass –> look like medulloblastoma –> ddx? (1)

A

atypical teratoid/rhabdoid tumor (AT/RT)

182
Q

dysplastic cerebellar gangliocytoma (Lhermitte-Duclos) –> charact imaging finding?

A

cerebellar hemisphere –> thick folia –> “corduroy” or “tiger-stripe” appearance

183
Q

dysplastic cerebellar gangliocytoma (Lhermitte-Duclos) –> adult onset –> assoc synd?

A

Cowden synd

184
Q

Cowden synd –> synd?

A
  • multiple hamartoma syndrome associated with benign mucocutaneous lesions like facial trichilemmomas
  • breast CA
  • thyroid cancer
185
Q

child –> post fossa mass –> hyperattenuating on CT, low ADC on MR –> ddx? (1)

A

medulloblastoma

186
Q

child –> post fossa mass –> cystic mass w enhancing mural nodule –> ddx? (1)

A

juvenile pilocytic astrocytoma

187
Q

child –> post fossa mass –> intraventricular mass –> ddx? (1)

A

ependymoma

188
Q

child –> post fossa mass –> cystic mass w enhancing mural nodule & flow voids –> ddx? (1)

A

hemangioblastoma

189
Q

child –> post fossa mass –> h/o von Hippel-Lindau –> ddx? (1)

A

hemangioblastoma

190
Q

child –> post fossa mass –> renal mass present –> ddx? (1)

A

atypical teratoid/rhabdoid tumor

191
Q

adult –> post fossa mass –> h/o 1ary malig –> ddx? (1)

192
Q

adult –> post fossa mass –> h/o von Hippel-Lindau –> ddx? (1)

A

hemangioblastoma

193
Q

adult –> post fossa mass –> minimal enhance –> ddx? (1)

A

astrocytoma

194
Q

YA –> post fossa mass –> lateral location –> ddx? (1)

A

medulloblastoma

195
Q

infant –> cystic mass w enhancing mural nodule –> supratentorial & cortical –> ddx? (1)

A

desmoplastic infantile astrocytoma/ganglioglioma

196
Q

child-adol –> cystic mass w enhancing mural nodule –> cerebellar –> ddx? (1)

A

pilocytic astrocytoma

197
Q

adol-YA –> cystic mass w enhancing mural nodule –> supratentorial & cortical –> ddx? (1)

A

pleomorphic xanthoastrocytoma, ganglioglioma

198
Q

YA-middle age –> cystic mass w enhancing mural nodule –> cerebellar –> ddx? (1)

A

hemangioblastoma

199
Q

intraventricular mass –> ddx? (4)

A
  • ependymoma
  • subependymoma
  • medulloblastoma
  • developmental/degen cyst
200
Q

central neurocytoma –> typical imaging findings –> appearance? location? enhance? calcs?

A
  • lobulated heterogenous, multicystic –> “bubbly”, “Swiss cheese”
  • lat ventricle –> attached to septum pellucidum
  • mod enhance
  • calcs common
201
Q

intraventricular meningioma –> how differentiate from other intraventricular neoplasms? (2)

A
  • hypercell

- homogeneous enhance

202
Q

adult –> MC choroid plexus mass?

A

choroid plexus xanthogranuloma (degen choroid plexus cyst)

203
Q

what is choroid plexus xanthogranuloma (degen choroid plexus cyst)?

A

collection of cholesterol & lipid-laden histiocytes

204
Q

types of choroid plexus tumors? (3)

A
  • choroid plexus papilloma
  • atypical choroid plexus papilloma
  • choroid plexus CA
205
Q

choroid plexus tumor –> charact MRI appearance?

A

intraventricular mass –> “cauliflower-like” –> avid enhance

206
Q

choroid glioma –> cell origin?

A

lamina terminalis –> ependymal cells

207
Q

choroid glioma –> tumor location?

A

ant 3rd ventricle –> assoc w hypothalamus

208
Q

choroid glioma –> imaging appearance? CT density? T2? enhance?

A

circumscribed ovoid homogenous enhance mass:

  • CT hyper
  • T2 slight hyper
209
Q

machine oil-like contents –> dx?

A

colloid cyst

210
Q

1ary CNS lymphoma –> key imaging features? –> location? CT density? T2? diffusion? enhance?

A
  • periventricular
  • CT hyper (hypercell)
  • T2 hypo
  • restricted diffusion
  • enhance
211
Q

1ary CNS lymphoma –> hemorrhage or no hemorrhage?

A

no hemorrhage

212
Q

1ary CNS lymphoma –> immunocompetent vs immunocomp –> mass apeparance?

A
  • immunocompetent: homo enhance mass

- immunocomp: ring enhance

213
Q

1ary CNS lymphoma –> immunocomp –> assoc org?

214
Q

HIV/AIDS –> ring enhance mass –> MCC? (2)

A
  • lymphoma

- toxo

215
Q

HIV/AIDS –> ring enhance mass –> lymphoma vs toxo –> how to differentiate? (6)

A
  • empirical toxo tx –> fu imaging
  • MR DWI –> lymphoma more restricted diffusion
  • MR perfusion –> lymphoma higher rCBV
  • MR spectroscopy –> lymphoma elevated choline
  • FDG PET –> lymphoma higher glucose metabolism
  • thallium SPECT –> lymphoma more thallium uptake
216
Q

2ary CNS lymhoma –> MC location?

A

extra-axial:

  • leptomeninges
  • dura
  • skull
217
Q

MC intracranial mets? (3)

A
  • lung
  • breast
  • melanoma
218
Q

solitary hemorrhagic brain neoplasm –> ddx? (2)

A
  • mets

- glioblastoma

219
Q

mult dural masses –> ddx? (2)

A
  • mult meningiomas

- mets

220
Q

leptomeningeal enhance & sulcal FLAIR hyper –> ddx? (2)

A
  • meningitis –> infx/inflamm

- leptomeningeal mets (carcinomatosis meningitis)

221
Q

what is “mother in law” sign? dx?

A

mother in law –> come early, stay late

meningioma:
- early arterial enhance
- venous contrast retention

222
Q

pineal region –> mass –> comp? (2)

A
  • compress cerebral aqueduct –> noncomm hydrocephalus

- compress tectum (quadrigeminal plate) –> Parinaud synd –> vertical gaze palsy

223
Q

MC pineal region mass? (4)

A
  • # 1 benign cyst
  • germ cell tumor
  • pineal parenchymal tumor
  • glioma
224
Q

intracranial germ cell tumor –> MC location? 2nd MC?

A
  • # 1 pineal gland

- #2 suprasellar region

225
Q

pineal region –> germ cell tumor –> MC type? 2nd MC?

A
  • # 1 germinoma

- #2 teratoma

226
Q

what is germinoma?

A

extra-gonadal seminoma

227
Q

pineal parenchymal tumor spectrum –> includes what tumor types?

A
  • pineocytoma
  • pineal parenchymal tumor or interm differentiation
  • papillary tumor of the pineal
  • pineoblastoma
228
Q

pineal parenchymal tumor spectrum –> epidemiology?

  • pineocytoma
  • pineal parenchymal tumor or interm differentiation
  • papillary tumor of the pineal
  • pineoblastoma
A
  • pineocytoma: adult
  • pineal parenchymal tumor or interm differentiation: adult
  • papillary tumor of the pineal: adult
  • pineoblastoma: young child
229
Q

pineal region mass –> how can differentiate germ cell tumor vs pineal parenchymal tumor on imaging?

A
  • germ cell tumor: “engulf” pineal gland –> central calc

- pineal parenchymal tumor –> “explode” –> peripherally displace physiologic calcs

230
Q

demyelinating dz –> key imaging finding to differentiate from mass?

A

minimal mass effect relative to lesion size

231
Q

mult sclerosis –> how differentiate active vs chronic lesion?

A
  • active demyelination –> enhance

- chronic lesion –> not enhance

232
Q

mult sclerosis lesions –> common locations? (7)

A
  • periventricular
  • corpus callosum
  • subcortical white matter
  • temporal white matter
  • brainstem
  • cerebellum
  • cervical spinal cord
233
Q

what is central V sign? dx?

A

mult sclerosis –> white matter lesion –> FLAIR hyper –> central V is FLAIR hypo

234
Q

mult sclerosis –> what is “black hole”?

A

T1 dark lesion –> assoc w more severe demyelination & axonal loss

235
Q

what is concentric (Balo) sclerosis? pathogonomic finding?

A

very rare variant of MS –> alternating concentric bands of normal & abnormal myelin

236
Q

what is NMO spectrum disease (NMOSD)?

A

demyelinating dz –> involve optic N & spinal cord

237
Q

NMO spectrum disease (NMOSD) –> highly specific lab finding?

238
Q

acute disseminated encephalomyelitis (ADEM) –> epidemiology? RF?

A

children –> after viral infx or vaccine

239
Q

acute disseminated encephalomyelitis (ADEM) –> imaging findings can look like what other condition?

A

can look identical to MS

240
Q

posterior reversible encephalopathy synd (PRES) –> MOA?

A

post circulation –> failed autoregulation –> resultant hyperperfusion –> vasogenic edema

241
Q

recurrent episodes of stroke/TIA –> imaging –> always basal ganglia or subcortical white matter –> dx?

A

cerebral autosomal dominant arteriopathy w subcortical infarcts & leukoencephalopathy (CADASIL)

242
Q

cerebral autosomal dominant arteriopathy w subcortical infarcts & leukoencephalopathy (CADASIL) –> synd? (4) MOA?

A

small vessel arteriopathy:

  • recurrent stroke
  • migraine
  • subcortical dementia
  • pseudobulbar palsy
243
Q

cerebral autosomal dominant arteriopathy w subcortical infarcts & leukoencephalopathy (CADASIL) –> highly sens & spec imaging finding?

A

ant temporal lobe or paramedial frontal lobe –> subcortical white matter –> symm T2 hyper foci

244
Q

subcortical & deep white matter –> mult small T2 hyper foci –> how differentiate MS vs vasculitis?

A
  • vasculitis –> may show foci of hemorrhage

- MS –> no hemorrhage

245
Q

what is progressive multifocal leukoencephalopathy (PML)?

A

immunocomp ie AIDS –> JC virus reactivate –> demyelinating dz –> no inflamm response

246
Q

progressive multifocal leukoencephalopathy (PML) –> how dx?

A

CSF –> PCR –> JC virus DNA

247
Q

progressive multifocal leukoencephalopathy (PML) –> MR appearance? mass effect? enhance?

A
  • asymm multifocal white matter lesions –> usu subcortical U-fibers
  • no enhance
  • no mass effect
248
Q

AIDS –> white matter lesions on MRI –> ddx? (2)

A
  • PML

- HIV encephalitis

249
Q

AIDS –> white matter lesions on MRI –> PML
vs HIV encephalitis –> how to differentiate?

  • location
  • cerebral atrophy
A

HIV encephalitis:

  • diffuse/symm bilat
  • spare subcortical white matter
  • cerebral atrophy

PML:

  • asymm bilat
  • involve subcortical white matter
  • no cerebral atrophy in acute dz
250
Q

subacute sclerosing panencephalitis (SSPE) –> org?

A

measles virus –> reactivate

251
Q

whole brain rtx –> radiation injury –> what are the 3 phases? occur how long after rtx?

A
  • acute phase: during or immed after rtx
  • early delayed: wks - up to 6mo
  • late delayed: 6mo to years
252
Q

whole brain rtx –> radiation injury –> acute phase –> MOA? MRI findings?

A

endothelial injury –> edema –> white matter –> diffuse T2 hyper

253
Q

whole brain rtx –> radiation injury –> early delayed phase –> MOA? MRI findings?

A

demyelination –> field of radiation –> white matter:

  • inc T2 hyper
  • inc size contrast-enhance lesions
254
Q

whole brain rtx –> radiation injury –> late delayed phase –> MOA? MRI findings?

A

vascular changes:

  • white matter change
  • radionecrosis
  • vasc lesions –> ie capillary telangiectasis, cavernous malformation
255
Q

whole brain rtx –> radiation injury –> late delayed phase –> radiation necrosis –> imaging appearance? tx?

A

peripheral enhance, central necrotic lesion

corticosteroid

256
Q

ctx & rtx –> pseudoprogression –> peaks when?

A

3-6mo after tx

257
Q

ctx & rtx –> pseudoprogression vs progressive dz –> relative cerebral blood vol?

A

progressive dz –> higher relative cerebral blood vol

258
Q

Wernicke encephalopathy –> synd? (3)

A
  • ataxia
  • confuse
  • oculomotor dysfx
259
Q

Wernicke encephalopathy –> etiology?

A

thiamine (vitB1) def

260
Q

Wernicke encephalopathy –> MRI appearance?

  • FLAIR?
  • DWI?
  • contrast?
A

symm bilat:

  • FLAIR hyper
  • restrict diffusion
  • enhance
261
Q

Wernicke encephalopathy –> MC locations? (5)

A
  • medial thalami
  • mamillary bodies
  • hypothalamus
  • tectal plate
  • periaqueductal gray matter
262
Q

hyperPTH –> CNS –> main imaging finding?

A

basal ganglia –> coarse Ca deposition

263
Q

basal ganglia –> coarse Ca deposition –> ddx? (2)

A
  • hyperPTH

- Fahr dz

264
Q

chronic hepatic encephalopathy –> charact imaging finding?

A

globus pallidus & substantia nigrae –> symm T1 hyper

265
Q

acute hepatic encephalopathy (hyperammonemic encephalopathy) –> charact imaging finding?

A

symm & bilat –> insula & cingulate gyrus:

  • FLAIR hyper
  • restricted diff
266
Q

uremic encephalopathy –> MC location?

A

bilat symm basal ganglia

267
Q

what is lentiform fork sign? dx?

A

uremic encephalopathy + concurrent metabolic acidosis –> white matter surrounding lentiform nuclei –> FLAIR hyper

268
Q

hypoglyemic encephalopathy –> MC imaging pattern? MC location?

A

parieto-occipital & temporal –> gray matter:

  • FLAIR hyper
  • restricted diff
269
Q

diabetic striatopathy (hyperglycemic-induced hemichorea-hemiballismus) –> pathognomonic imaging findings?

A

striatum –> unilat:

  • CT hyper
  • T1 hyper
270
Q

circulatory or resp fail –> global hypoxia/anoxia –> type of encephalopathy?

A

hypoxic ischemic encephalopathy (HIE)

271
Q

hypoxic ischemic encephalopathy (HIE) –> common locations? (3)

A

gray matter:

  • cerebral cortex
  • hippocampus
  • basal ganglia
272
Q

hypoxic ischemic encephalopathy (HIE) –> CT findings? (3)

A
  • loss of gray-white differentiation
  • diffuse cerebral hypo
  • sulcal efface
273
Q

what is white cerebellum sign? dx?

A

hypoxic ischemic encephalopathy (HIE) –> cerebellum spared –> appear hyper compared to supratentorial brain

274
Q

hypoxic ischemic encephalopathy (HIE) –> MRI findings?

  • FLAIR
  • DWI
A
  • FLAIR hyper

- DWI hyper

275
Q

methanol poisoning –> charact imaging finding?

A
  • putamen –> hemorrhagic necrosis

- sparing of globus pallidus

276
Q

carbon monoxide poisoning –> MRI appearance? hallmark imaging finding?

  • FLAIR
  • DWI
  • SWI
A

bilat symm –> globus pallidus –> necrosis:

  • FLAIR hyper w hypo rim
  • restrict diff
  • SWI hypo
277
Q

osmotic demyelination –> predisposing conditions? (3)

A

poor nutritional status:

  • alcoholic
  • chronic lung dz
  • liver tx recipient
278
Q

Marchiafava-Bignami dz (MBD) –> predisposing conditions? (2)

A
  • chronic alcohol

- vit B complex def

279
Q

Marchiafava-Bignami dz (MBD) –> charact finding?

A

corpus callosum –> demylination –> necrosis

280
Q

metronidazole-induced brain toxicity –> charact imaging findings? MC locations? (5)

A

symm FLAIR hyper:

  • cerebellar dentate nuclei
  • corpus callosum splenium
  • tegmentum
  • dorsal pons
  • dorsal medulla
281
Q

methotrexate-induced brain toxicity –> charact imaging findings?

A

lesion –> bilat asymm –> white matter –> centrum semiovale –> cross vasc territory, spare subcortical U fibers:

  • FLAIR hyper
  • restrict diff
282
Q

autoimmune encephalitis (autoimmune limbic encephalitis) –> categories? (2)

A
  • paraneoplastic vs non-paraneoplastic

- grp I (intracell antigen) vs II (cell surface Ag)

283
Q

autoimmune encephalitis (autoimmune limbic encephalitis) –> grp I vs II –> which is more assoc w paraneoplastic synd?

284
Q

autoimmune encephalitis (autoimmune limbic encephalitis) –> grp I vs II –> which has worse clinical outcome?

285
Q

what is tuberculoma?

A

localized TB granuloma

286
Q

tuberculoma –> MR appearance?

  • T2
  • DWI
A
  • T2 central hypo

- restrict diff

287
Q

lyme dz –> imaging appearance?

A

nonspec –> frontal –> subcortical white matter –> T2 hyper

288
Q

neonate –> TORCH infx –> CMV –> imaging findings? (4)

A
  • brain atrophy
  • encephalomalacia
  • ventricle enlrg
  • periventricular calcs
289
Q

CMV infx –> MC CNS manifestation? (2)

A
  • ventriculitis

- meningoencephalitis

290
Q

CMV ventriculitis –> charact imaging findings?

A
  • subependymal FLAIR hyper

- ventricular system enhance

291
Q

intracranial abscess –> how to differentiate fungal vs bact abscess?

A

fungal abscess:

  • crenated/lobulated border
  • intracavitary projections –> nonenhance –> restrict diff
  • core –> not restrict diff
292
Q

CNS fungal infx –> cryptococcus –> MC clinical presentation?

A

chronic basilar meningitis

293
Q

CNS cryptococcus –> charact imaging findings? (2)

A
  • basal ganglia perivascular spaces –> gelatinous pseudocysts
  • choroid plexus –> ring-enhancing granulomas (cryptococcomas)
294
Q

neurocysticerosis –> 4 stages?

A
  • viable/vesicular
  • colloidal
  • nodular/granular
  • calcified
295
Q

neurocysticerosis –> viable/vesicular stage –> imaging finding?

A

CSF-intensity cysts –> some may demonstrate eccentric “dot” (scolex)

296
Q

neurocysticerosis –> colloidal stage –> imaging finding?

A

ring enhancing lesion –> inc diffusion

297
Q

neurocysticerosis –> nodular/granular stage –> imaging finding?

A

cyst involute:

  • cyst wall thicker
  • dec edema
298
Q

neurocysticerosis –> calcified stage –> imaging finding?

A
  • small parenchymal calc

- small foci of susceptibility

299
Q

toxoplasmosis –> typical appearance? MC location?

A

basal ganglia –> ring enhancing lesion(s)

300
Q

toxoplasmosis –> what is a not very sens, but relatively specific sign?

A

“asymm target” sign –> toxo lesion –> mural nodular enhance

301
Q

immunocomp –> basal ganglia –> mass –> ddx? (2)

A
  • toxo

- CNS lymphoma

302
Q

Creutzfeldt-Jakob dz (CJD) –> typical MRI appearance? 3 signs?

A

“cortical ribboning” –> cerebral cortex:

  • FLAIR hyper
  • restrict diff

“pulvinar” sign –> thalamus –> pulvinar nucleus –> bright FLAIR & DWI

“hockey stick” sign –> dorsomedial thalamus –> bright FLAIR & DWI

303
Q

brain myelination –> which part of brain is last to myelinate?

A

subcortical white matter

304
Q

brain myelination –> which part of brain is already myelinated at birth? (2)

A
  • brainstem

- internal capsule –> post limb

305
Q

1 cerebral hemisphere –> enlrged –> enlrged ventricle –> dx?

A

hemimegalencephaly

306
Q

chiari 1 –> occur ONLY in pt w neural tube defect –> T/F?

A

F –> not assoc w NTD

307
Q

chiari 2 –> occur ONLY in pt w neural tube defect –> T/F?

308
Q

chiari 3 –> occur ONLY in pt w neural tube defect –> T/F?

309
Q

hot cross bun sign –> dx?

A

mult system atrophy - cerebellar subtype (MSA-C)

310
Q

brain mass –> cortically-based –> ddx? (4)

A

P-DOG:

  • pleomorphic xanthoastrocytoma (PXA)
  • dysembryoplastic neuroepithelial tumor (DNET)
  • oligodendroglioma
  • ganglioglioma
311
Q

1p/19q deletion –> brain tumor –> dx?

A

oligodendroglioma

312
Q

CPA –> mass –> ddx? (3) in order

A
  • # 1 vestibular schwannoma
  • # 2 meningioma
  • # 3 epidermoid
313
Q

dermoid vs epidermoid –> main difference?

A
  • dermoid: behave like fat

- epidermoid: behave like CSF

314
Q

ped –> infratentorial –> cyst w nodule –> dx?

A

pilocytic astrocytoma

315
Q

adult –> infratentorial –> cyst w nodule –> dx?

A

hemangioblastoma

316
Q

mult hemangioblastoma –> dx?

317
Q

gelastic sz –> dx?

A

hypothalamic hamartoma

318
Q

bilat hippocampi –> symmetric –> T2/FLAIR hyper, restricted diffusion –> dx?

A

hypoxic-ischemic encephalopathy

319
Q

deep venous system –> thrombosis –> infarct what area?

A

bilat thalamus

320
Q

acute isolated bilateral thalamic infarcts –> which artery?

A

Artery of Percheron

CORE (33 decks)

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