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Neuro brain CORE - Sheet1 Flashcards

1
Q

baby brain myelination: which changes first, T1 or T2

A

T1 changes precede the T2 changes (adult T1 pattern seen around age 1 , adult T2 pattern seen around age 2).

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2
Q

last part of the brain to myelinate?

A

subcortical white matter (inf–>sup, central–>peripheral, sensory–>motor)

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3
Q

which way does the corpus callosum form?

A

front to back (then rostrum last)

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4
Q

MRI signal of skull bone marrow in babies

A

T1 hypointense in young kids, fatty in older kids (T1 bright)

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5
Q

order of sinus formation

A

maxillary, ethmoid, sphenoid, frontal

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6
Q

normal change in globus pallidus with age

A

brain iron increases, GP darkens up

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7
Q

imprint of the high heeled shoe

A

oval part = foramen ovale, pointy heel = foramen spinosum

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8
Q

foramen rotundum on the different views

A

axial = point heel of high-heeled shoe, sag = “level” (totally horizontal), coronal = coming straight at you

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9
Q

what CN runs next to the carotid in the cavernous sinus?

A

CN6 (you get lateral rectus palsy earlier with cav sinus pathology)

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10
Q

branches of the external carotid

A

superior thyroid, ascending pharyngeal, lingual, facial, occipital, post auricular, maxillary, superficial temporal (Some Admins Like Fucking Over Poor Medical Students)

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11
Q

number of the carotids

A

C1 (cervical), C2 (petrous), C3 (lacerum), C4 (cavernous), C5 (clinoid), C6 (ophthalmic/supraclinoid), C7 (communication/terminal)

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12
Q

persistent fetal connection between cavernous ICA (C4) and basilar artery?

A

persistent trigeminal artery (increases risk of aneurysm)

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13
Q

what’s it called when the carotid artery courses through the tympanic cavity to join the horizontal carotid canal?

A

aberrant carotid artery - pulsatile! don’t biopsy

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14
Q

3 deep cerebral veins

A

basal vein of rosenthal, vein of galen, inferior petrosal sinus

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15
Q

superior and inferior anastomic veins ( collateral veins for alternate superficial middle cerebral vein) are also called

A

Trolard (top) and Labbe (lower)

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16
Q

If I say “CN 3 palsy”, you say

A

PCOM aneursym

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17
Q

If I say “CN 6 palsy”, you say

A

increased ICP

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18
Q

classic findings in intracranial hypotension

A
  1. dural enhancement 2. distension of dural venous sinuses 3. prominence of intracranial vessels 4. engorgement of pituitary 5. subdural hematoma/hygromas
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19
Q

classic findings in intracranial hypertension (pseudotumor)

A
  1. slit like vents 2. partially empty sella 3. compressed venous sinuses 4. tortuous optic nerves 5. flattening of posterior sclera
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20
Q

most common congenital obstructive hydrocephalus

A

aqueductal stenosis (usually from a web or diaphragm)

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21
Q

pathophys of communicating hydrocephalus

A

obstruction at the level of the villi/granulation, blocking reabsorption (all vents will be dilated)

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22
Q

4 causes of communicating hydrocephalus

A
  1. NPH 2. SAH 3. Meningitis 4. Carcinomatous meningitis
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23
Q

pathophys of non-obstructive hydrocephalus

A

something that produces CSF (choroid plexus papilloma)

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24
Q

don’t be silly, if you see transependymal flow, is the hydrocephalus acute or chronic?

A

acute dummy

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25
Q

another name for subfalcine herniation

A

midline shift (ACA can get compressed)

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26
Q

what kind of vascular injury can you get with descending transtenorial herniation?

A

Duret Hemorrhages - compression of perforating basilar artery branches, seen at midline of pontomesencephalic junction

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27
Q

what CN injury can you get with descending transtenorial herniation?

A

CN3 gets compressed between the PCA and Superior Cerebellar Artery causing ipsilateral pupil dilation and ptosis

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28
Q

when do we see Ascending transtentorial herniation?

A

posterior fossa mass - causes severe obstructive hydro

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29
Q

fulminant form of ADEM with massive brain swelling and death

A

acute hemorrhagic leukoencephalitis (Hurst)

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30
Q

neuromyelitis optica aka

A

Devics (transverse myelitis + optic neuritis)

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31
Q

MS variant in kids that is horrible

A

Marburg Variant - fulminant, leads to rapid death, may have febrile prodrome

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32
Q

classic findings in Wernicke encephalopathy

A
  1. enhancement of the mammillary bodies 2. T2/FLAIR in bilateral medial thalamus and periaqueductal gray
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33
Q

defiency in Wernicke

A

thiamine

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34
Q

classic findings in CO poisoning

A

CT hypodensity/T2 bright globus pallidus (CO causes “globus warming”

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35
Q

Marchiafava-Bignami: findings

A

Swelling and T2 bright signal affecting the corpus callosum

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36
Q

classic findings in methanol toxicity

A

Optic nerve atrophy, hemorrhagic putamina! and subcortical white matter necrosis

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37
Q

On PET, what is always preserved in dementia?

A

the motor strip

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38
Q

Binswanger disease is a form of what kind of dementia

A

small vessel vascular dementia - seen in older ppl with HTN, spares the subcortical U fibers

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39
Q

dementia classic findings on PET: alzheimer

A

low posterior temporoparietal cortical activity

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40
Q

dementia classic findings on PET: multi-infarct

A

scattered areas of decreased activity

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41
Q

dementia classic findings on PET: Lewy bodies

A

low in lateral occipital cortex (sparing cingular gyrus)

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42
Q

dementia classic findings on PET: Picks/frontotemporal

A

low frontal lobe (depression is a mimic)

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43
Q

dementia classic findings on PET: huntington

A

low activity in caudate and putamen

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44
Q

TORCH findings: CMV

A

Most Common, Periventricular Calcifications, Polymicrogyria

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45
Q

TORCH findings: toxo

A

Hydrocephalus, Basal Ganglia Calcifications

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46
Q

TORCH findings: rubella

A

Vasculopathy/ischemia. High T2 signal- Less Calcifications

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47
Q

TORCH findings: HSV

A

Hemorrhagic Infarct, and lead to bad encephalomalcia (hydranencephaly)

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48
Q

TORCH findings: HIV

A

Brain Atrophy in frontal lobes

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49
Q

HIV infections: AIDS encephalitis

A

symmetric T2 bright, spares U fibers

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50
Q

HIV infections: PML

A

asymmetric T2 bright (out of proportion to mass effect), involved U fibers

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51
Q

HIV infections: CMV

A

periventricular T2 bright, ependymal enhancement, brain atrophy

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52
Q

HIV infections: toxo

A

ring enhancement with LOTS of edema

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53
Q

HIV infections: cryptococcus

A

dilated perivascular spaces filled with mucoid gelatinous crap, basilar meningitis

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54
Q

HSV 1 or 2 in adults vs. babies

A

HSV 1 in adults, HSV 2 in babies

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55
Q

what sequence is most sensitive in HSV encephalitis?

A

diffusion is more sensitive than T2

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56
Q

looks like HSV encephalitis, but HSV titer negative

A

limbic encephalitis - paraneoplastic from small cell lung ca - ask for lung cancer screening

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57
Q

infection that involves the basal ganglia?

A

West Nile - T2 bright basal ganglia and thalamus, with restricted diffusion.

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58
Q

3 ways to show CJD

A
  1. cortical gyriform restricted diffusion 2. restricted diffusion in medial thalamus (hockey stick sign) 3. series of MR/CTs showing rapidly progressive atrophy
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59
Q

4 stages of neurocysticercosis

A
  1. Vesicular- thin walled cyst (iso-iso TI/T2 + no edema) 2. Colloidal - hyperdense cyst (bright-bright T I /T2 + edema) 3. Granular - cyst shrinks, wall thickens (less edema) 4. Nodular -small calcified lesion (no edema)
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60
Q

5 supratentorial peds tumors

A
  1. astrocytoma 2. PXA 3. PNET 4. DNET 5. ganglioglioma
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61
Q

4 infratentorial peds tumors

A
  1. JPA 2. medulloblastoma 3. ependymoma 4. brainstem astrocytoma
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62
Q

3 supratentorial adult tumors

A
  1. mets ++ 2. astrocytoma 3. oligodendroglioma
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63
Q

2 infratentotial adult tumors

A
  1. JPA 2. hemangioblastoma
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64
Q

4 CP angle tumors

A
  1. schwannoma 2. meningioma 3. epidermoid 4. arachnoic cyst
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65
Q

3 cortically based tumors

A

DOG - 1. DNET 2. oligodendroglioma 3. ganglioglioma

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66
Q

3 tumors that like to be multifocal

A
  1. lymphoma 2. multicentric GBM 3. gliomatosis cerebri
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67
Q

4 tumors that are multifocal from seeding

A
  1. medulloblastoma 2. ependymoma 3. GBM 4. oligodendroglioma
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68
Q

“tumors” that restrict diffusion

A
  1. abscess 2. lymphoma 3. maybe GBM 4. epidermoid at CP angle 4. herpes in temporal horns 5. xanthrogranuloma in choroid plexus
69
Q

tumors that calcify

A
  1. oligodendroglioma (90% have Ca) 2. astrocytoma (only 20% have Ca, but >>> more common than oligo)
70
Q

hemorrhagic mets (MR/CT)

A

melanoma, renal, carcinoid/choriocarcinoma, thyroid

71
Q

T1 bright tumors

A

Fat: Dermoid, Lipoma Melanin: Melanoma Blood: Bleeding Met or Tumor Cholesterol: Colloid Cyst

72
Q

syndrome with GI polyps + GBMs

73
Q

chromosome deletion with better outcome in oligodendroglioma

74
Q

most common brain mets

A

lung or breast

75
Q

foramen of Monro/4th ventricle tumor in adults

A

subependymoma

76
Q

most common IV mass 20-40yo

A

central neurocytoma (swiss cheese, calcify)

77
Q

intraventricular mass that restricts diffusion

A

xanthogranuloma - benign choroid plexus mass

78
Q

round well circumscribed mass in the anterior 3rd ventricle

A

colloid cyst - can cause sudden death via acute hydro

79
Q

most common intraventricular location for meningioma

A

trigone of the lateral ventricles

80
Q

most common functional pituitary adenoma

A

prolactinoma

81
Q

craniopharyngioma subtypes in kids vs. adults

A
  1. Papillary - adults 2. Adamantinomatous - kids
82
Q

very bright T2 suprasellar lesion

A

rathke cleft cyst

83
Q

3 adult meningeal tumors

A
  1. meningioma 2. hemangiopericytoma (soft tissue sarcoma that mimics aggressive meningioma) 3. mets
84
Q

4 tumors in the first year of life

A
  1. atypical teratoma/rhabdoid 2. Desmoplastic infantile Ganglioglioma/Astrocytoma 3. choroid plexus papilloma/carcinoma 3. mets (neuroblastoma)
85
Q

when I say “rapidly increasing head circumferance + baby + tumor”

A

Desmoplastic infantile Ganglioglioma/Astrocytoma

86
Q

13 year old with seizures, and a temporal lobe mass that is cystic and solid with focal calcifications

A

ganglioglioma

87
Q

Kid with drug resistant seizures.

A

DNET (temporal lobe, high T2 “bubbly lesion”)

88
Q

cyst with a nodule in the temporal lobe

89
Q

histologically the same as medulloblastoma, but supratentorial

A

PNET (deep white matter)

90
Q

when I say “gelastic seizures”, you say

A

hypothalamic hamartoma (of the tuber cinereum), also can have precocious puberty

91
Q

3 main pineal region tumors

A
  1. germinoma (fat + “engulfed” Ca) 2. pineocytoma (not in kids, non-invasive) 3. pineoblastoma (kids, retinoblastoma, highly invasive)
92
Q

most common location of chordoid glioma

A

anterior wall of 3rd ventricle

93
Q

Parinaud syndrome location

A

lesion of the pineal gland (upward-gaze deficiency, pupillary light-near dissociation, convergence-retraction nystagmus)

94
Q

cell of origin: meningioma

A

arachnoid cap cell

95
Q

most common 4th ventricle mass in an adult

A

subependymoma

96
Q

the basal ganglia in chronic liver disease can exhibit what MR abnormality

A

increased T1 signal intensity (manganese accumulation - can also been seen in TPN patients)

97
Q

epidermoids or dermoids can rarely transform into

A

squamous cell cancer

98
Q

most common location of central neurocytoma

A

lateral ventricle attached to septum pellucidum

99
Q

what subtype of medulloblastoma occurs in adults?

A

desmoplastic/nodular (more peripheral than classic)

100
Q

iatrogenic fake out for SAH on FLAIR?

A

supplemental O2

101
Q

“blood anterior to brainstem”

A

Benign Non-Aneurysm Perimesencephalic hemorrhage:

102
Q

classic clinical history in superficial siderosis (following repeated SAH)

A

sensorineural hearing loss and ataxia.

103
Q

“numerous small foci of restricted diffusion”

A

septic emboli

104
Q

watershed infarcts in a kid

105
Q

the big list of things that restrict diffusion besides strokes

A

Bacterial Abscess, CJD (cortical), Herpes, Epidermoids, Hypercellular Brain Tumors (Classic is lymphoma), Acute MS lesions, Oxyhemoglobin, and Post Ictal States. + artifacts

106
Q

how long before strokes are bright on FLAIR?

A

about 6 hours

107
Q

what % of infarcts demonstrate hemorrhagic conversion

A

50% (6hrs-4 days), 90% petechial, 10% full on hematoma

108
Q

mnemonic for MRI signal of bleeds

A

I Bleed, I Die, Bleed Die, Bleed Bleed, Die Die. (I-iso, B-hyper, D-Hypo) I Bleed (hyperacute), I Die (acute), Bleed Die (early subacute), Bleed Bleed (late subacute), Die Die (chronic)

109
Q

why do babies get venous infarcts?

A

dehydration

110
Q

why do big kids get venous infarcts?

A

mastoiditis

111
Q

why do adults get venous infarcts?

A

coagulopathies or birth control

112
Q

Stigmata of chronic venous thrombosis

A

development of a a dura l AVF, or increased CSF pressure from impaired drainage.

113
Q

3 things associated with Fusiform aneurysms

A

PAN, Connective Tissue Disorders, or Syphilis (most common in the posterior circulation)

114
Q

2 things associated with pseudoaneurysms

A

trauma, mycotic (often distal MCA)

115
Q

Pedicle Aneurysm

A

Artery feeding the AVM

116
Q

4 things that increase risk of bleeding in AVMs

A
  1. small size 2. single draining vein 3. intranidal aneursym 4. BG/thalamic/periventricular location
117
Q

classic symptom of dural AVF

A

pulsatile tinnitus (when it involves the sigmoid sinus) or vision problems (cavernous sinus)

118
Q

increased risk of bleeding in dural AVF

A

direct cortical venous drainage

119
Q

when I say “caput medusa”, you say

120
Q

“popcorn-like” with “peripheral rim of hemosiderin”

A

Cavernous Malfonnation aka “cavernomas” aka “cavernous angiomas”

121
Q

which vascular malformation can develop as a complication of radiation therapy

A

Capillary Telangiectasia (don’t bleed, totally incidental)

122
Q

classic timing for vasospasm

A

4-14 days after SAH (NOT immediately).

123
Q

Are there Non-SAH causes of vasospasm?

A

Yep. Meningitis, PRES, and Migraine Headache.

124
Q

most common systemic vasculitis to involve the CNS

125
Q

most common collagen vascular disease causing CNS vasculitis

126
Q

“puff of smoke”

127
Q

4 association of moya moya

A
  1. sickle cell 2. NF 3. prior radiation 4. down syndrome
128
Q

40yo presenting with migraine headaches and then dementia

A

CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical inarcts and Leukoencephalopathy).

129
Q

typical findings in CADASIL

A

Diffuse White Matter Disease, Hitting the Temporals, Sparing Occipitals

130
Q

NASCET criteria formula

A

[1- A/B] x 100% (A=at lesion and B=normal distal segment)

131
Q

definition: colpocephaly

A

disproportionate prominence of the occipital horns (seen in agenesis of the CC)

132
Q

“neoplasm” associated with agenesis of the CC

A

intracranial lipoma (most commonly in the interhemispheric fissure)

133
Q

definition: iniencephaly

A

deficit of occipital bones -> enlarged foramen magnum; “star gazing fetus”

134
Q

definition: arhinencephaly

A

no olfactory bulb or tracts (seen with Kallman syndrome - hypogonadism + MR)

135
Q

definition: rhomboencephalosynapsis

A

no vermis/fused cerebellum (aunt minnie)

136
Q

“molar tooth” appearance of the superior cerebellar peduncles

A

Joubert syndome - strong association with retinal dysplasia

137
Q

Dandy Walker =

A

absent vermis

138
Q

“torcular-lamboid inversion”

A

Dandy Walker

139
Q

midline defects associated with holoprosencephaly

A
  1. single midline monster eye 2. solitary/mega-incisor 3. pyriform aperture stenosis
140
Q

classic triad of Meckel-Gruber

A
  1. holoprosencephaly 2. multiple renal cysts 3. polydactyly
141
Q

major finding in semi-lobar HPE

A

fused at thalami, posterior brain normal, olfactory tracts gone

142
Q

major finding in alobar HPE

A

single large ventricle, fusion of thalami + BG, no falx or CC

143
Q

when I say “big side + big ventricle”, you say

A

hemimegalencephaly

144
Q

3 associations of schizencephaly

A
  1. optic nerve hypoplasia (30%) 2. absent septum pellucidum (70%) 3. epilepsy (50-80%)
145
Q

“in utero double MCA infarct”

A

hydrancephaly - destruction of cerebral hemispheres, can also be caused by TORCH

146
Q

Chiari 1

A

one cerebellar tonsil > 5mm below foramen magnum + syringohydromelia (50%)

147
Q

Chiari 2 associations (5)

A
  1. Myelomeingocele (L-spine) 2. towering cerebellum 3. tectal beaking 4. long skinny 4th vent 5. interdigitated cerebral gyri (on axial CT)
148
Q

Chiari 3

A

Chiari 2 + encephalocele (high cervical or low occipital)

149
Q

most common craniosynostosis

A

Scaphocephaly (Sagittal suture), aka dolichocephaly

150
Q

fused sutures: brachycephaly

A

bicoronal +/- bilambdoid (long side-side)

151
Q

fused sutures: scaphocephaly

A

sagittal (long front-back)

152
Q

fused sutures: plagiocephaly

A

unilateral coronal

153
Q

fused sutures: trigonocephaly

A

metropic (forehead suture)

154
Q

“harlequin eye”

A

unilateral coronal suture craniosynostosis

155
Q

“failure to pass NG tube”

A

choanal atresia

156
Q

“respiratory distress while feeding”

A

choanal atresia

157
Q

piriform aperature stenosis is associated with dysfunction of

A

hypothalamic-pituitary-adrenal axis

158
Q

SPECT abnormality with MELAS

A

increased lactate, decreased NAA (mitochondrial disorder with lactic acidosis and stroke-like episodes)

159
Q

highest normal SPECT peak

160
Q

NAA peak will be super high with

A

Canavans (one of the leukodystophies)

161
Q

SPECT abnormality with high cell turnover

A

Choline elevation (tumor, infarct, inflammation)

162
Q

lactate can be normally elevated when?

A

first hours of life (who is getting a SPECT that early??)

163
Q

Myoinositol is elevated in these 2

A

Alzheimer and low grade glioma

164
Q

SPECT abnormality specific for meningiomas

A

Alanine elevation

165
Q

SPECT abnormality with hepatic encephalopathy

A

glutamine elevation

166
Q

SPECT peaks are in what order?

A

alphabetical (choline, creatine, and NAA), but lactate comes last if it’s present

167
Q

Cranial fossas and their contents?

CORE Neuro (4 decks)

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