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Neuro Imaging > Neuro (Core Qs & Others) > Flashcards

Neuro (Core Qs & Others) Flashcards

1
Q

At which intervertebral disc level does the conus medullaris typically terminate?

A

L1-L2

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2
Q

What is the upper limit of the diameter of a normal filum terminale?

A

2mm

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3
Q

The filum terminale extends from the conus medullar is to the _____

A

Periosteum of the coccyx

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4
Q

CN I (sensory)

A

Olfactory: smell

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5
Q

CN II (sympathetic)

A

Optic: sight

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6
Q

CN III (motor)

A

Oculomotor: eyeball movement, pupillary light reflex

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7
Q

CN IV (parasympathetic)

A

Trochlear: eyeball movement

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8
Q

CN V (sensory, sympathetic, motor)

A

V1: ophthalmic
V2: maxillary
V3: mandibular

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9
Q

CN VI (motor)

A

Abducens: eyeball movement

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10
Q

CN VII (sympathetic)

A

Facial: taste (anterior 2/3 of tongue), facial expressions, salivary and lacrimal glands

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11
Q

CN VIII (sensory)

A

Vestibulocochlear: hearing and baalnce

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12
Q

CN IX (sensory, motor, parasympathetic)

A

Glossopharyngeal: sensation of posterior 1/3 tongue, parotid salivary gland

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13
Q

CN X (motor, parasympathetic, sympathetic)

A

Vagus: swallowing, heart rate, GI peristalsis, sweating

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14
Q

CN XI (motor)

A

Accessory: sternocleidomastoid (head turning), trapezius (shoulder shrugging)

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15
Q

CN XII (motor)

A

Hypoglossal: most muscles of the tongue

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16
Q

Which CN exists through the cribiform plate?

A

CN I Olfactory

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17
Q

Which CN exists through the optic canal?

A

CN II Optic

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18
Q

Which CN exists through the superior orbital fissure?

A

CN III Oculomotor
CN IV Trochlear
CN V(v1) Ophthalmic
CN VI Abducens

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19
Q

Which CN exists through foramen rotundum?

A

CN V(v2) Trigeminal (maxillary)

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20
Q

Which CN exists through foramen ovale

A

CN V(v3) Trigeminal (mandibular)

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21
Q

Which CN exists through the internal acoustic meatus?

A

CN VII Facial

CN VIII Vestibulocochlear

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22
Q

Which CN exists through the jugular foramen?

A

CN IX Glossopharyngeal
CN X Vagus
CN XI Accessory

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23
Q

Which CN exists through the hypoglossal canal?

A

CN XII Hypoglossal

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24
Q

With spinal cord contusion and/or edema, what are the different types?

A

From best prognosis to the worst:
Cord edema only
Cord edema and contusion
Cord contusion only

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25
Q

Spinal cord compression requires what kind of referral?

A

A neuro-surgical emergency, requires decompression

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26
Q

Cauda equina syndrome is the compression of _____

A

Spinal nerve roots, past the conus medullaris

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27
Q

There are many causes of spinal cord compression, what are some common ones?

A

Intervertebral disc
Spondylophytes
Trauma
Tumors

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28
Q

What is the most common cerebellarpontine angle mass in adults?

A

Acoustic schwannoma (CN VIII vestibulocochlear nerve) accounts for approximately 80%

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29
Q

Aside from acoustic schwannoma, what are some other common masses of the cerebellarpontine angle?

A

Meningioma
Trigeminal schwannoma
Facial nerve schwannoma
Ependymoma

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30
Q

What is intraspinal hemorrhage? (Aka hematomyelia)

A

Hematoma within the spinal cord, can occur during trauma

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31
Q

If a hematomyelia is present without trauma, what should be considered?

A

Underlying lesion of the spinal cord

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32
Q

What are some causes of intraspinal hemorrhage (hematomyelia)?

A 
Vascular malformation
Intramedullary tumor
Cavernous hemangioma 
Spinal cord metastasis
Coagulopathies
Radiation therapy
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33
Q

Where is the foramen spinosum located?

A

Posterior-lateral to the foramen ovale

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34
Q

What exists out of the foramen spinosum?

A

Middle meningeal artery
Middle meningeal vein
Nervus spinosus (usually)

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35
Q

What is the most common cause of neurogenic arthropathy (aka Charcots joints) in the shoulder and/or upper extremity?

A

Syringomyelia

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36
Q

What portion of the spine is the most common location for a syringomyelia?

A

C2-T9 region but may descend to the conus medullaris

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37
Q

What are 3 congenital causes of syringomyelia?

A

Chiari malforrmation
Klippel-Feil syndrome
Myelomeningocele

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38
Q

What is the most common population for viral meningitis?

A

Children and young adults,

< 1 years old and between 5-10 years old

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39
Q

What is the classic presentation of viral meningitis?

A

Fever
Neck stiffness
Brudzinski sign (+)

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40
Q

Are there neurological dysfunction associated with viral meningitis?

A

No, neurological dysfunction is not a feature

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41
Q

Which virus is responsible for the majority of cases of viral meningitis?

A 
Enterovirus (90%)
Other viruses include:
Poliovirus
Echovirus
HPV
Herpes simplex
Epstein Barr virus
Cytomegalovirus
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42
Q

Acute transverse myelitis (ATM) is an inflammatory condition that affects both halves of the spinal. This is associated with what changes?

A

Motor, sensory, and autonomic dysfunctions that rapidly progresses

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43
Q

What is the peak age for acute transverse myelitis?

A

10-19 years old and 30-39 years old

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44
Q

Clinical symptoms for ATM presents within hours/days, they include the following

A

Para/tetraparesis (limb weakness)
Sensory impairment
Sphincter dysfunction

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45
Q

Approximately what percentage of people with ATM will recover with no sequelae?

A

Approximately 1/3 of patients will recover with no sequelae
1/3 will have moderate permanent disability
1/3 will have severe permanent disability

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46
Q

What are the MRI findings of acute transverse myelitis?

A

Variable enlargement of cord
T1 isointense/hypointense
T2 poorly delineated hyperintense

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47
Q

What is the most common type of multiple sclerosis (MS)?

A

Classic/Charcot type

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48
Q

MS is the _____ most common cause of neurological impairment

A

Second most common cause after trauma

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49
Q

What is the peak age for MS to present?

A

35 years old

Usually presents between adolescence to 6th decade

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50
Q

Is there a strong gender predilection for MS?

A

Females > males (2:1)

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51
Q

What are some classic clinical features of MS?

A 
Optic neuritis
Internuclear ophthalmoplegia (often bilateral)
Trigeminal neuralgia 
Diplopia
Vertigo
Ataxia and gait disturbances
Limb sensory loss 
Lhermitte sign (+): electric shock sensation on neck flexion
Urinary incontinence
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52
Q

Which pattern of MS is the most common type?

A

Relapse-remitting (70%)

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53
Q

What are the 3 pathological stages for MS lesions?

A

Early acute stage:
Active myelin breakdown
Plaque appears pink/swollen

Subacute stage:
Plaque is paler (“chalky”)
Abundant macrophages

Chronic Stage:
Inactive plaque/gliosis
Little/no myelin breakdown
Gliosis with associated volume loss
Appearance is gray/translucent
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54
Q

The “Dawsons finger” sign is associated with what pathology?

A

Multiple sclerosis

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55
Q

For intracranial involvement in MS, what are some differential diagnosis to consider?

A

CNS fungal infection
Mucopolysacchridosis
Susac syndrome
Antiphospholipid syndrome

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56
Q

For spinal involvement in MS, what are some differential diagnosis to consider?

A

Acute transverse myelitis
Infection
Spinal cord tumors (eg. astrocytomas)

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57
Q

Acute disseminated encephalomyelitis (ADEM) is demyelination of _____

A

Demyelination of white matter

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58
Q

ADEM typically follows _____

A

Typically follows a viral infection/vaccination

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59
Q

What part of the grey matter is typically involved with ADEM?

A

Basal ganglion

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60
Q

What is the typical age range for ADEM?

A

Children/adolescents usually < 15 years old

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61
Q

Symptoms of ADEM are more systemic rather than focal, including the following

A

Fever
Headache
Decreased consciousness (lethargy to coma)
Seizure

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62
Q

If treated, what percentage of patients with ADEM make a complete recovery without sequelae?

A

50-60%, this is the most common result

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63
Q

What percentage of patients with ADEM recovery but with sequelae?

A

20-30% of patients will have persisting sequelae, most commonly seizures

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64
Q

Multiple benign peripheral nerve sheath tumors (neurofibromas) are strongly associated with which disease?

A

Neurofibromatosis type I

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65
Q

What percentage of spinal neurofibromas are localized intraneural lesions?

A

90%

Majority of them are sporadic and solitary

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66
Q

What are the normal components of a spinal neurofibroma?

A

Schwann cells
Fibroblasts
Collagen fibers

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67
Q

Schwannomas are encapsulated while neurofibromas are _____

A

Not encapsulated
They infiltrate between nerve fascicles
Primarily affecting superficial cutaneous nerves

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68
Q

The “target” sign is seen with what condition?

A

Hyperintense rim seen on MRI due to central area of collagen. Seen with neurofibromas

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69
Q

The “fascicular” sign is seen with what condition?

A

Neurofibromas, demonstrating multiple, small ring-like structures

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70
Q

Neurofibromas are slow growing and often asymptomatic but can cause remodeling of adjacent bone. That often includes the following

A

Widening of neural foramen
Thinning of pedicle
Posterior vertebral body scalloping

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71
Q

What is the most common nerve sheath tumor of the spine?

A

Spinal schwannoma

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72
Q

Where do spinal schwannomas typically arise?

A

Usually from nerve roots

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73
Q

What is the most common intradural extramedullary lesion?

A

Meningioma (25-30%)

74
Q

What is the second most common intradural extramedullary lesion?

A

Schwannoma (15-50%)

75
Q

What percentage of spinal shwannomas are sporadic and solitary?

A

90%

76
Q

What condition is associated with multiple spinal schwannomas?

A

Neurofibromatosis type II

77
Q

What is the most common location for spinal schwannomas?

A

Cervical and lumbar spine

78
Q

What is the peak age for spinal meningiomas?

A

Between the 6th and 8th decade

79
Q

Is there a gender predilection for spinal meningiomas?

A

Strong females > males predilection in adults

80
Q

What are some risk factors associated with spinal meningiomas?

A

Increased ionizing radiation

Prior trauma

81
Q

What condition is strongly associated with multiple spinal meningiomas?

A

Neurofibromatosis type II

82
Q

Where in the spine is the most common location for meningiomas?

A

Thoracic spine

83
Q

The “dural tail” sign associated with spinal meningiomas is seen in what percentage of patients?

A

60-70% of patients, caused by thickened dura

84
Q

What is the most common spinal cord tumor overall in adults?

A

Spinal ependymoma

85
Q

A spinal ependymoma is a considered a _____ cell tumor

A

Glial cell tumor

86
Q

Ependymomas arise from the which 2 locations?

A

Ventricles of the brain

Central canal lining of the spinal cord

87
Q

What is the most common location for an ependymoma?

A

Posterior fossa (60%)
Followed by:
Supratentorium (30%)
Spine (10%)

88
Q

There is an increased coincidence of epnedymomas with what condition?

A

Neurofibromatosis type II

89
Q

MRI findings of an ependymoma include the following

A 
T1 isointense/hypointense
T2 hyperintense 
Peritumoral edema (60%)
"Cap" sign from hemorrhage may be present
90
Q

What is the most common spinal cord tumor in children?

A

Spinal astrocytoma

91
Q

What is the second most common spinal cord tumor overall?

A

Spinal astrocytoma

92
Q

Astrocytomas account for what percentage of intramedullary tumors?

A

40%

93
Q

Astrocytomas account for what percentage of pediatric intramedullary tumors?

A

60%

94
Q

What underlying condition is associated with an increased chance of developing spinal astrocytomas?

A

Neurofibromatosis type I

95
Q

Astrocytomas arise from what kind of cells?

A

Astrocytic glial cells

96
Q

Astrocytomas are characterized by hypercellularity as well as absence of surrounding _____

A

Absence of surrounding capsule

97
Q

What are the 2 most common locations for spinal astrocytomas?

A 
Thoracic spine (67%)
Cervical spine (49%)
98
Q

Spinal astrocytomas will typically span multiple vertebral segments, this causes the following findings

A

Thin pedicles and/or lamina

Posterior body scalloping

99
Q

Hemangioblastoma is the _____ most common intramedullary spinal tumor

A

3rd most common

100
Q

Spinal hemangiomblastomas are rarely seen in children, the peak age range is what?

A

4th decade

101
Q

Spinal hemangioblastomas consists of what?

A

Large stromal cells

Packed between blood vessles

102
Q

If multiple spinal hemangioblastomas are present, a strong association to which condition is suspect?

A

Von Hippel Lindau syndrome

103
Q

What are the 2 most common locations for spinal hemangioblastomas?

A 
Thoracic cord (50%)
Cervical cord (40%)
104
Q

What percentage of spinal hemangioblatomas are sporadic?

A

80%

105
Q

Tarlov cysts (aka perineural cyst) are defined as what?

A

CSF filled dilations of nerve root sheath
Located at dorsal root ganglion
Extradural in location

106
Q

What kind of underlying condition is associated with Tarlov cysts?

A

Connective tissue disorders:
Marfans syndrome
Ehlers Danlos
Sjogren syndrome

107
Q

What are the most common locations for Tarlov cysts?

A

Lower lumbar spine

Sacrum

108
Q

On MRI, Tarlov cysts have the following appearance

A

T1 hypointense
T2 hyperintense
No enhancement with contrast

109
Q

Arachnoid cysts are relatively common and benign. They can be located at which 2 locations?

A

Intracranial or within spinal cord

110
Q

Imaging features of arachnoid cysts are as follows

A

Well defined
Imperceptible wall
Follows CSF patterns

111
Q

Arachnoid cysts are seen with increased frequency in which type of underlying condition?

A

Mucopolysacchridosis

112
Q

What is the most common location for arachnoid cysts?

A

Middle cranial fossa (50-60%)

Can cause widening of the Sylvian fissure

113
Q

What is the second most common location for arachnoid cysts?

A

Retrocerebellar (30-40%)

114
Q

An intracranial epidermoid cyst is an uncommon congenital cyst caused by the following

A

Inclusion of ectodermal elements during neural tube closure

115
Q

Intracranial epidermoid cyst has a thin capsule made up of _____

A

Squamous epithelium

116
Q

What is the most common location for an epidermoid cyst?

A 
Intradural (90%)
Cerebellarpontine angle (40-50%)
117
Q

Image findings for an epidermoid cyst includes the following

A

Lobulated lesion
Fill and expand CSF spaces
Exert gradual mass effect (slow growing)
Displacement of vertebral artery from pons

118
Q

What is the Currarino triad?

A

Anorectal anomalies
Sacral anomalies
Presacral mass

119
Q

What are the presacral masses that are associated with the Currarino triad?

A

Anterior sacral meningocele (most common)
Mature teratoma (common)
Dermoid/epideroid cyst (rare)

120
Q

Which 2 CN originate from the cerebrum?

A

CN I: olfactory

CN II: optic

121
Q

Which 2 CN originate from the midbrain?

A

CN III: oculomotor

CN IV: trochlear

122
Q

Which 4 CN originate from the pons?

A

CN V: trigeminal
CN VI: abducens
CN VII: facial
CN VIII: vestibulocochlear

123
Q

Which 4 CN originate from the medulla oblongata?

A

CN IX: glossopharyngeal
CN X: vagus
CN XI: accessory
CN XII: hypoglossal

124
Q

What is the definition of benign multiple sclerosis (MS)?

A

Defined as remaining functional for > 15 years

Accounts fo 15-50% of MS patients

125
Q

What is a common diagnostic criteria system used for MS?

A

McDonald diagnostic criteria

126
Q

Susac syndrome (aka SICRET syndrome) stands for what?

A

Small infarctions of cochlear, retinal, encephalic tissues

127
Q

What is the most common population to be affected by Susac syndrome?

A

Young-middle aged females

128
Q

What triad is seen with Susac syndrome?

A

Acute/subacute encephalopathy
Bilateral sensorineural hearing loss
Branch retinal arterial occlusions

129
Q

Acute/subacute encephalopathy in Susac syndrome leads to the following?

A 
Memory impairment
Confusion
Behavioral disturbances
Headaches
Psychosis
130
Q

on MRI images for Susac syndrome, low signal T1 lesions known as “black holes” and high signal T2 lesions known as “snowball” lesions are seen in which stage of the disease?

A

Chronic stage of Susac syndrome

131
Q

Sjorgren syndrome affects which 2 glands?

A

Lacrimal glands

Salivary glands

132
Q

After rheumatoid arthritis, what is the second most common autoimmune disease?

A

Sjorgren syndrome

133
Q

What is the gender predilection for Sjorgren syndrome?

A

Females > males (9:1)

134
Q

What is the typical age range for presentation of Sjorgren syndrome?

A

40-50 years old

135
Q

What are some clinical features of Sjorgren syndrome?

A

Bilateral parotid gland enlargement
Dryness of mucous membranes of mouth (xerostomia)
Keratoconjunctivitis sicca (dryness)

136
Q

Describe the MRI findings of the parotid glands in Sjorgren syndrome

A

“Salt and pepper” appearance
“Honeycomb” appearance
Fat deposits

137
Q

What is a possible malignancy that is associated with Sjorgren syndrome?

A

Development of malignant lymphoma

138
Q

The temporal bone consists of which 5 parts?

A 
Squamous 
Mastoid
Petrous
Tympanic
Styloid process
139
Q

The mandible bone consists of which parts?

A 
Body
Ramus
Coronoid process
Mandibular notch
Condylar process
140
Q

Chronic small vessel disease is more common in those with which 2 underlying disease?

A

Alzheimer disease

Lewy body disease

141
Q

Chronic smell vessel disease is also known as what other name?

A

Leukoaraiosis (diffuse white matter changes)

142
Q

Histologically in chronic small vessel disease, what do the lesions show?

A

Atrophy of axons

Decreased myelin

143
Q

Diffuse axonal injury (DAI) aka traumatic axonal injury is caused by what kind of forces?

A

Shearing focus

Typically rotational acceleration forces

144
Q

What location does DAI have a predilection for?

A

Gray/white matter junction
Especially the corpus callosum
Severe cases involve the brainstem

145
Q

The absence of imaging findings do not exclude DAI, MRI findings include the following

A

Surrounding edema will increase during first few days
Some lesions may be non-hemorrhagic
Lesions are hyperintense on FLAIR

146
Q

What are 2 complications associated with DAI?

A

Herniation

Hydrocephalus

147
Q

Months following the original trauma, DAI patients demonstrate _____ brain volume

A

Decreased brain volume

148
Q

Clinical findings for DAI include the following

A

Loss of consciousness at the time of the accident

Long post traumatic coma

149
Q

Arachnoiditis is the inflammation of what 2 structures/spaces?

A

Meninges and subarachnoid space

150
Q

Arachnoiditis of the cauda equine is known as what?

A

Spinal/lumbar adhesive arachnoiditis

151
Q

Clinical presentation for arachnoiditis includes the following

A

Leg pain
Sensory changes
Motor changes

152
Q

Arachnoiditis with impaired CSF can cause what condition in the spinal cord?

A

Syringomyelia

153
Q

Causes of arachnoiditis includes the following

A

Infections

Inflammatory such as hemorrhagic and iatrogenic

154
Q

MRI appearance of arachnoiditis includes the following

A

Most easily seen at lumbar region: cauda equina
Nerve roots adhere together
Nerve roots may also adherer to theca

155
Q

What are the different types of arachnoiditis seen at the cauda equina?

A

Type I:
Nerve roots clumped together and distorted

Type II:
Nerve roots adhere to the theca
“Empty theca” sign

Type III:
Nerve roots and theca clumped together
Becomes a single soft tissue mass

156
Q

Occasionally ossification can occur at the cauda equina due to arachnoiditis, what is this called?

A

Arachnoiditis Ossificans

157
Q

Cortical contusions is often a differential diagnosis to consider for which condition?

A

Diffuse axonal injury (DAI)

158
Q

Cortical contusions (aka cerebral hemorrhagic contusion) is a type of _____ hemorrhage

A

Intracerebral hemorrhage

159
Q

Cortical contusions can occur anywhere but the predilections are as follows

A

Anterior cranial fossa floor
Temporal pole
Coup and coutrecoup pattern

160
Q

What is the most common cause for cortical contusions?

A

Motor vehicle accidents

161
Q

What is the MRI appearance of cortical contusions?

A

T1: hyperintense
T2: hypointense

162
Q

In cases of acute transverse myelitis (ATM), what percentage of patients will demonstrate a normal MRI?

A

40%

163
Q

Lesions can occur anywhere along the spinal cord for acute transverse myelitis but what is the most common location?

A

Thoracic spine (usually spanning 3-4 segments)

164
Q

Most frequent areas to check for cortical contusions that resulted from a coup and coutrecoup pattern is where?

A

Temporal pole

Inferior surface of frontal lobe

165
Q

Subdural hemorrhage (SDH) aka subdural hematoma is located where?

A

Within the dura space, between the dura and arachnoid

166
Q

What is the main cause of subdural hemorrhage?

A

Main cause is due to trauma

167
Q

Subdural hemorrhage is seen in all age groups

A

Infants: suspected abuse
Young adults: vascular lesions, motor vehicle accidents
Elderly: falls

168
Q

Some common clinical symptoms associated with subdural hemorrhage includes the following

A

Commonly coexist with cerebral contusions
Severely depressed cognitive state ( 65-80%)
Pupillary abnormalities (40%)

169
Q

Potts disease is another name what condition?

A

Tuberculosis causing osteomyelitis and diskitis at the spine

170
Q

What is the most common musculoskeletal location for tuberculosis?

A

Spine

171
Q

What is the typical location for Potts disease?

A

Lower thoracic spine

Upper lumbar spine

172
Q

Early radiographic findings of Potts disease includes the following

A

Decreased vertebral body height
Irregular endplates
Paraspinal collections

173
Q

What are some common radiographic findings of Potts disease?

A

Typically sub-ligamentous involvement beneath ALL
Posterior elements are usually spared
Often involves multilevel
Irregularity of anterior vertebral bodies

174
Q

Spondylodiskitis is infection that involves the intervertebral disc and adjacent vertebral bodies. What is the most common age range?

A

Pediatric

Older patients > 50 years old

175
Q

Low back pain is present in what percentage of patients with spondylodiskitis?

A

90%

176
Q

Risk factors that are associated with spondylodikitis includes the following

A 
Remote infection
Spinal instrumentation/trauma
IV drug users
Immunocompromised individuals
Long term steroid use
Organ transplant 
Malnutrition
Cancer
177
Q

What is the most common location for spondylodiskitis?

A

Lumbar spine

178
Q

What is the most common distribution of spondylodikitis?

A

Single level (65%)
Multiple contiguous levels (20%)
Multiple non-contiguous levels (10%)

179
Q

What is the most common organism that causes spondylodikitis?

A

Staph. aureus

180
Q

Those with spondylodikitis can present with normal radiographs for how long?

A

2-4 weeks

Neuro Imaging (3 decks)

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