Neuro Buzz Flashcards
Le Fort 1
The palate is separated from the maxilla
Lateral nasal aperture
Floating palate
Floating palate
? Which type of Le Fort?
Type 1
Le Fort type 2
The maxilla is separated from the face
Inferior orbital rim and orbital floor
Pyramidal
Pyramidal
What type of Le Fort fracture?
Type 2
Le Fort type 3
The face is separated from the cranium
The zygomatic arch and lateral orbital rim/wall
If …. is not fractured then you don’t have a Le Fort fracture
Pterygoid process
Airless expanded sinuses
Mucocele
Most sensitive MRI sequence for SAH
FLAIR
The classic history for superficial siderosis
Sensorineural hearing loss and ataxia
Watershed infarct in a kid
Moyamoya
What is a pedicle aneurysm?
Artery feeding AVM
This type of aneurism is seen in patients with PAN, Ct disease and syphylis
Fusiform aneurysm
Pulsatile tinnitus is seen in ….
Sigmoid sinus thrombosis
Visual problem is caused by thrombosis in this venous structure
Cavernous sinus
Most common type of AVF’s- gradual onset LE weakness
Spinal AVF
This venous anomaly looks like a large tree with multiple small branches/ caput medusa.
It is also associated with cavernous malformation
DVA
Slow flow lesion with dilated capillary bed without intervening normal brain tissue
Popcorn like with peripheral rim of haemosiderin
Cavernous malformation
Slow flow lesion with normal intervening brain tissue. They have brush like or stippled appearance of enhancement
Capillary telangectasia
This malformation can be seen as a complete location of radiation therapy
Capillary telangectasia
Define colpocephaly
This is asymmetric dilation of the occipital horns
Name two causes of colpocephaly
CC a genesis and pericallosal lipoma
Which type of CNS lipoma usually calcify?
The tubulonodular type
Define anencephaly
Neural tube failing to close on the cranial end leading to reduced or absent cerebrum and cerebellum. The hindbrain will be present
In this condition the AFP will be elevated and there will be polyhydramnios
Frog eye appearance
Anencephaly
What is iniencephaly
This is when the occipital bone is missing and there will be an enlarged foramen magnum
Star gazing fetus
What is rhombencephalosynapsis
Congenital anomaly of the cerebellum where the vermis does not develop and the cerebellum is fused
What is Joubert syndrome associated with?
Retinal dysplasia
Multicystic dusplastic kidney
Molar tooth appearance- small or aplastic vermis and absence of pyramidal decussation
Joubert syndrome
Joubert syndrome and liver fibrosis
Coach syndrome
Absent vermis
Torcular lambdoid inversion
Dandy Walker
Holoprosencephaly- HP
This is a midline cleaving problem with brain failing to cleave into two separate hemisphere
The olfactory bulb is affected in this type of HPE
Semi lobar
HPE association (3)
- single midline monster eye
- solitary median maxillary incisor- MEGA INCISOR
- Nasal process overgrowth leading to pyriform aperture stenosis
What is meckel gruber syndrome
Classic triad of
HPE
Multiple renal cysts
Polydactyly
Hemimegalencephaly
Big brain with big ventricles
Types of lissencephaly pachygyria
Type 1- classic form - smooth brain due to arrest of migration
Type 2- cobblestone brain due to over migration. The cortex is thinner than type 1. No band heterotopia.
This type of lissencephaly is associated with band heterotopia. It’s a figure 8, hour glass configuration with shallow sylvian fissure
Type 1/ classic lissencephaly
What conditions are associated with schizencephaly
Optic nerve hypoplasia 30%
Absent septum pellucidum 70%
Epilepsy 50-80%
What is hydranencephaly?
Destruction of cerebral hemispheres. Bag of CSF. Secondary to vascular insult e.g. Double mca infarct.
Can also be caused by TORCH- HSV
Normal falx but the cortical mantle is gone.
Define type 1 chiari
One cerebellar tonsil more than 5 mm below the foramen magnum. Look for syringohydromyelia
What is chiari 1 associated with?
Klipple feil syndrome
name some of the findings of chiari 2
Hydrocephalus Myelomeningocele Towering cerebellum Tectal plate beaking Long skinny 4th ventricle- normal 4th ventricle ? Shunt malfunction Interdigitated cerebral gyri
Scaphocephaly
Which suture?
Also known as ?
This is premature fusion of Sagittal suture
Also known as dolichocephaly
Brachycephaly
Premature fusion of Coronal and / or lambdoid and is often associated with syndromes
Brachycephaly and fused fingers
Aperts
Brachycephaly and first arch ( maxilla and mandible hypoplasia
Crouzons
Brachycephaly and Wormian bone and absent clavicle
Cleidocranial dysostosis
BESSI vs Subdural collection (1)
BESSI - cortical veins are adjacent to inner table
Subdural- cortical veins are displaced away from the inner table
Diagnosis?
Failure to get ass an NGT in a child or respiratory distress while feeding
Choanal atresia
Name 5 syndromes associated with choanal atresia
- CHARGE
- Crouzons
- DiGeorge
- Treacher Colins
- Fetal alcohol syndrome
The piriform aperture stenosis is highly associated with …
Hypothalamic pituitary adrenal axis dysfunction
Diagnosis?
Mitochondrial disorder with lactic acidosis and stroke like episodes
MELAS
What are the spect findings in MELAS
Increased lactate and decreased NAA
Name the leukodystrophies:
Shown with SPECT WITH ELEVATED NAA
Canavans
Name the leukodystrophies:
big head with frontal lobe white matter involvement
Alexanders
Big head like Alexander the Great
Name the leukodystrophies:
Tigroid- dark spots or stripes within the T2 bright demyelinated periventricular wm
Deficiency of enzyme arylsulfatase A
Metachromatic
Name the leukodystrophies:
Normal head with symmetric occipital and splenium of cc white matter involvement
It is sex linked and only occurs in boys
Adreno leukodystrophy
Name the leukodystrophies:
Normal head
Focal areas of subcortical wm. BG and the periaquaductal GM have involvement
Leigh disease
Also called subacute necrotising encephalomyelopathy
Mitochondrial enzyme defect
The NAA and s super high in this disease
Canavans
Name three reasons for raised choline
Increased choline in increased cell turn over:
Malignancy
Infarct
Inflammation
There is usually no peak for lactate. If there is then it means …… and ….
Necrotic tumour
And
Infection - abscess
What is raised in hepatic encephalopathy
Glutamine
What is raised in meningioma
Alanin
NAA is not raised
Myoinositol is raised in which 2 conditions?
Alzheimer’s and low grade glioma
MRS pattern in
High grade tumour
Choline raised
Lactate and lipid raised
NAA reduced
MRS pattern in
Low grade tumour
Choline and NAA reduced
Inositol raised
MRS pattern in
Radiation necrosis
Choline and NAA reduced
Lactate increased
This lesion is the primary petrous apex lesion. It’s T1 and T2 bright with T2 dark hemosiderin rim
Cholesterol granuloma
Lesion in petrous apex
T1 dark
T2 bright
With restricted diffusion
Cholesteatoma
Difference between cholesteatoma and cholesterol granuloma
Granuloma: T1 and T2 bright. Does not restrict. Smooth expansile bone changes.
Cholesteatoma: T1 dark, T2 bright with restricted diffusion. Smooth expansile bone changes.
Classic triad for grandenigo syndrome
Otomastoiditis
Face pain- trigeminal neuropathy
Lateral rectus palsy
Endolymphatic sac tumour is associated with
VHL
Appearances of endolymphatic sac tumour
They grow into CPA
Internal amorphous ca++ on CT
T2 bright with intense enhancement
Very vascular with flow void and tumour blush on angio
Patient presents with hoarseness
MRI: hypervascula lesion, salt and pepper on post contrast MRI with flow void
FDG avid
Paraganglioma
Imaging findings in labyrinthitis
The cochlea and semicircular canals will be enhancing on T1 post contrast images.
Conductive hearing loss in adult female
Otosclerosis
Types of otosclerosis (2)
Fenestral
Retro fenestral
Cholesteatoma order of destruction predictable
Scutum is eroded early
The ossicles- long process of incus
The lateral segment of the semi circular canal
Fistula to the semi circular canal most commonly involves the lateral segment
In labyrinthine fistula, which part is most commonly affected?
The lateral semicircular canal is most often involved
Noise induced vertigo
Superior semicircular canal dehiscence
Necrotising external otitis
Predisposing disease
Causative agent
95% have diabetes and the causative agent is 98% pseudomonas
Which part of the facial nerve does not enhance?
The cisternal , canalicular and labyrinthine segments should not enhance
The normal enhancement is due to perineural venous plexus
What causes abnormal enhancement of the facial nerve? (4)
Bell’s palsy
Lymes
Ramsay Hunt
Cancer
Ground glass lesion in a young patient
Fibrous dysplasia
It usually spares the optic capsule
Multi focal fibrous dysplasia, cafe au lair spots and precocious puberty
Mc Cune Albright syndrome
Mouth mass lesion in the midline. It’s fluid sack with globules of fat- sack of marbles.
Floor of mouth dermoid/ epidermoid
What is a ranula?
This is a mucous retention cyst- typically lateral
Where would ranula arise from?
Arise from sublingual gland/ space
Once it’s under the mylohyoid muscle it’s plunging
Diagnosis?
Grandmothers dentures won’t stay in
Torus palatinus- bony exostosis that comes off the hard palate in the midline
Re sialolithiasis , which gland is most commonly affected?
Submandibular gland duct- whartons
Diagnosis?
Young patient with new level II neck mass
HPV related SCC
Aetiology of osteonecrosis of the mandible (2)
Prior radiation
Bisphosphonate treatment
Microcalcification is seen in thyroid mass. Diagnosis?
Papillary thyroid cancer
Come tail in thyroid nodule means…. nodule.
Colloid nodules
This condition increased your risk of primary thyroid lymphoma
Hashimotos
Hashimotos is associated with which auto antibodies
Thyroid peroxidase TPO and anti thyroidglobulin
Name two findings associated with hashimotos on uss
White knight- uniform hyperechoic nodules
Giraffe skin- heterogenous appearances
A sick looking level 6 node or delphian node is a sign of ….
Laryngeal cancer met
What are the causes of hyper PTH? (3)
- Hyper functioning adenoma
- Multi gland hyperplasia
- Cancer
What factors does sestamibi parathyroid imaging depend on?
Mitochondrial density and blood flow
This type of thyroid cancer is asso with MEN 2 They produce calcitonin
Medullary type
This type of thyroid cancer is seen in elderly patients with prior radiation treatment
Anaplastic type
What is the best way to monitor the Hurthle cell follicular cancer?
FDG PET
What’s contained in the parotid space (3)
- parotid gland
- Facial nerve
- Retro- mandibular vein
This is the only salivary gland containing lymph nodes
Parotid gland
can get lymphoma therefore.
Diagnosis?
male smoker presenting with bilateral cystic mass in parotid gland
Warthins
How do you diagnose warthins?
it takes up pertechnetate
the only super rare tumour to take this up is parotid oncocytoma
this salivary gland tumour likes perineurial spreads
adenoid cystic carcinoma
This group of patients have high risk of getting bilateral lymphoma in parotid gland
Sjogren
Diagnosis?
HIV patient with painless bilateral mixed solid and cystic lesions with enlarged parotid glands
Benign lymphoepithelial disease.
Diagnosis?
female in their 60’s present with dry eyes and mouth. The parotid gland has honeycomb appearance
Sjogrens
Which type of lymphoma would patients with Sjogren’s get?
non hodgkins MALT type lymphoma.
What is contained in the carotid space? (4)
- Carotid artery
- Jugular vein
- Cranial nerves 9, 10 and 11
- internal jugular chain lymph nodes
Name the different types of tumours arising from the carotid space (3)
- Schwannoma
- Paraganglioma
- Neurofibroma
compare the schwannomas and paraganglioma (4)
Paraganglioma: Flow void Hypervascular In 111 octreotide avid Salt and pepper look on MRI
Schwannomas Not all are hyper vascular No flow void - target sign NOT IN111 Octreotide avid No salt or pepper
What is Lemierre disease?
Thrombophlebitis (thrombosis) of the jugular vein with distant metastatic sepsis- usu septic emboli in lung. It is usually found in the setting of oropharyngeal infection or recent ENT surgery
BUZZ: Fusobacterium Necrophorum
When i say perineurial spread, you should think: (2)
- adenoid cystic salivary tumour
2. melanoma
This tumour causes neural foramina expansion
Schwannoma
What is Grisel’s syndrome?
Torticollis with atlantoaxial joint inflammation seen in H&N surgery or retropharyngeal abscess
what is contained within the parapharyngeal space?
trigeminal nerves and the pterygoid veins
Bilateral optic nerve glioma is seen in this condition:
NF1
Diagnosis?
doughnut appearance with circumferential enhancement around optic nerve. Tram track calcification.
Optic nerve sheath meningioma
Most common location for orbital dermoid
superior and lateral. From frontozygomatic suture
DDx for raccoon’s eyes: (2)
Met neuroblastoma and skull fracture
Orbital lymphoma is associated with these 2 conditions
chlamydia Psittaci and MALT lymphoma
Diagnosis?
Ca in globe of a child <3 years
Retinoblastoma
Diagnosis?
Bilateral coloboma is associated with …..
CHARGE syndrome Coloboma Heart defect Atresia choanal Retardation Genital hypoplasia Ear abnormality- Deaf
Small size eyes ddx (3)
PHPV
Coats
Retinopathy of prematurity
What is type 2 lissencephaly is associated with?
Cerebellar and ocular malformation and muscular dystrophy - walker warburg syndrome
