Neuro DDx Flashcards
Hypo intense T2 brain lesions
Metastasis containing mucin: GI adenocarcinomas.
Hypercellular tumours: lymphoma, medulloblastoma, germinoma, some glioblastomas may be hypointense.
Hyper intense T1 tumours
Metastatic melanoma
Fat containing tumours: dermoid, teratoma.
Heamorrhagic mets: “MR CT BB”: Melanoma, RCC, Choriocarcinoma, Thyroid, Bronchogenic, Breast.
Trans-callosal Mass
Glioblastoma
Lymphoma
Demyelinating Disease.
Tumours / lesions with a cyst and an enhancing nodule:
Neurocysticercosis
Juvenile pilocytic astrocytoma
Haemangioblastoma
Pleomorphic xanthoastrocytoma (temporal lobe, dural thickening)
Desmoplastic infantile ganglioglioma
Ganglioglioma (temporal lobe, Ca++, calvarial remodelling).
Intra ventricular tumours:
Central neurocytoma
Choroid Plexus papilloma / carcinoma (cauliflower like)
Intra ventricular meningioma
Subependymal giant cell astrocytoma (tuberous sclerosis)
Subependymoma
Ring enhancing basal ganglia mass in immunocompromised:
Lymphoma
Toxoplasmosis
Posterior Fossa mass in Child
Medulloblastoma (Hyperdense on Ct, diffusion restriction).
Juvenile Pilocytic astrocytoma (Cystic mass with enhancing nodule)
Ependymoma (Intra ventricular, pushes through foramina)
Haemangioblastoma (Cystic mass with enhancing nodule, flow voids, hx vHL)
ATRT (young, agressive appearances, renal mass)
Posterior fossa mass in Adult:
Tumour like conditions:
- Metastasis (Hx of primary, enhancing mass with oedema, multiple)
- Haemangioblastoma (cystic mass with enhancing nodule, flow voids, Hx vHL).
- Astrocytoma (Minimal / little enhancement)
- Medulloblastoma (young adult, lateral location)
- Choroid Plexus Papilloma: (4th ventricle, enhancing papillary mass with hydrocephalus)
Infarction: e.g. PICA
Vascular malformation
Hypertensive haemorrhage.
CPA Mass
"AMEN" Acoustic Schwannoma (ice cream cone)
Meningoma
Ependymoma
Neuroepithelial cyst:
- Epidermoid Cyst (doesnt suppress on FLAIR and bright diffusion restriction.
- Arachnoid cyst (CSF intensity, does not diffusion restrict)
Aneursym (flow void)
Intra axial neoplasm with extension: exophytic glioma, medulloblastoma, ependymoma.
Intrinsic Pituitary Mass:
Normal sizes:
- child upto 6mm,
- males / post menopausal women upto 8mm,
- menstruating females upto 12mm, pregnant / post partum / lactating upto 14mm.
Pituitary hyperplasia
Pituitary microadenoma
Pituitary macroadenoma
Lymphocytic hypophysitis
Granulomatous Hypophysitis (Sarcoidosis, Wegener granulomatosis, Tb, LCH)
Rathke’s cleft cyst, usually extrinsic to pituitary
Suprasellar Mass:
“SATCHMO”
Sarcoidosis / Supra sellar extension adenoma
Aneursym
Teratoma / Tolosa Hunt
Craniopharyngioma / Cleft cyst (Rathke’s)
Hypothalamic Glioma (adults) / Hypothalamic Hamartoma (children)
Meningioma / Metastases (breast).
Optic Nerve glioma
Supra sellar mass in Child:
Craniopharyngioma: Calcified, enhancing complex cystic mass, distinct from pituitary.
Optic pathway glioma: T2 hyperintense, enhancing mass, signs of NF1.
Germ cell tumour: avidly enhancing midline mass - germinoma. Contains fat - dermoid.
Hypothalamic hamartoma: non enhancing grey matter isointense mass. Gelastic seizures, precocious puberty.
LCH hypophysitis: enhancing enlarged pituitary stalk. Diabetes insipidus.
Supra sellar Mass adult:
Pituitary macroadenoma extension: pituitary mass extending superiorly. Expansion of sella.
Meningioma: intense enhancement with normal sella. Enhancing tail. Adjacent hyperostosis. Narrows adjacent vasculature.
Craniopharyngioma: calcified, enhancing complex cystic mass. Distinct from pituitary.
Rathkes cleft cyst: non enhancing cystic mass without Ca++, claw sign.
Aneursym: enhancement equal to blood pool, calcified rim.
Lymphocytic or granulomatous hypophysitis: enhancing enlarged pituitary stalk. Diabetes insipidus.
Intrinsic Pineal Mass:
“elevate internal cerebral veins”
Germinoma: avid enhancement, hypderdense, isointense, dark ADC, engulfs with central Ca++. Neuro axis seeding
Teratoma: Heterogenous, intra lesional fat, central course Ca++.
Pineal Cyst:
Pineocytoma: internal enhancement, cystic components. adults 20s-30s. Neuro axis seeding
Pineoblastoma: young children, tri lateral retinoblastoma, obstructive hydrocephalus, invasion restricted diffusion, exploded / blasts Ca++. Leptomeningeal spread.
Metastases
Extra Pineal Mass:
Gliomas (tectum, midbrain, splenium)
Vein of Galen aneurysm.
Meningioma: depress internal cerebral veins
Quadrigeminal / tectal plate lipoma: agenesis corpus callosum
Cortically Based Tumour:
"PDOG" Pleomorphic Xanthoastrocytoma DNET Oligodendroglioma Ganglioglioma
Intraparnechymal Haemorrhage:
HTN: Basal ganglia, thalamus, cerebellum. Microbleeds T2*, prior lacunar infarcts.
Amyloid angiopathy: normotensive elderly, lobar / cortical location. Microbleeds T2*
Aneurysmal haemorrhage: extensive SAH, aneurysm adjacent to haematoma.
Arteriovenous malformation: young patients. Enlarged feeding vessel, adjacent encephalomalacia.
Dural AV fistula: Haemorrhage adjacent to cavernous sinus or posterior fossa, enlarged meningeal artery or cortical vein.
Venous thrombosis: para sagittal or bilateral thalamic haemorrhage, young patient. Increased density cortical vein / dural sinus.
Haemorrhagic neoplasm: Gliobastoma, Mets (Choriocarcinoma, Thyroid, Melanoma, RCC, Breast, bronchogenic). More oedema than expected, more heterogenous signal, multiple enhancing lesions.
Cavernous malformation: angiographically occult. Adjacent DVA, multiple dark spots on T2*.
Haemorrhagic transformation of infarct:
Vasculitis: beaded vessels. Multifocal T2 bright deep white matter.
Moyamoya: progressive stenosis intracranial ICA causing fragile lenticulostriate vessels. Puff of smoke angiography. Multiple collateral vessels.
Intra medullary spinal cord lesion
" I'D HEAL" Infarction Demyelination Haemangioblastoma Ependymoma Astrocytoma Lipoma
T2 Hyper intense Basal Ganglia
“LINT”
Lymphoma Ischaemia Neurodegenerative conditions: - autoimmune encephalitis - CJD - Extra pontine myelinosis - Huntington disease - Mitochondrial diseases: Leigh disease - Wilson disease Toxins: - Carbon monoxide - Cyanide - Organophosphates - Hypoglycaemia - Methanol
Calcified glial tumours frequency
"Old Elephants Age Gracefully" Oligodendroglioma Ependymoma Astrocytoma Gliobastoma
NF 1 Features
"CAFE SPOT" Cafe au lait spots Axillary or inguinal freckling Fibromas Eye harmatomas - Lisch nodules Skeletal abnormalities: posterior vertebral scalloping, sphenoid wing dysplasia, leg bowing. Postive FHx Optic Tumour - Optic nerve glioma
NF 2 Features
“MISME”
Multiple inherited Schwannomas
Meningiomas
Ependymomas
Ring enhancing Lesion
"MAGIC DR" Metastasis Abscess Glioblastoma Infarct / Inflammatory - neurocysticossis / tuberculoma / toxoplasmosis Contusion Demyleinating Radiation necrosis
Posterior vertebral scalloping:
"SALMON" Spinal cord tumour: ependymoma, astrocytoma, schwannoma. Achrondroplasia, acromegaly. Loeys Dietz syndrome Marfans / mucopolysacchirdoses Osteogenesis NF 1
Intra dural extra medullary mass
"No More Spinal Masses" Neurofibroma Meningioma Schwannoma Metastases.
Multiple Endocrine Neoplasia types:
MEN 1: “PPP”
- Pituitary adenoma
- Pancreatic islet cell tumour: gastrinoma.
- Parathryoid hyperplasia / adenoma
MEN 2A: “PMP”
- Phaeochromocytoma
- Medullary thryoid cancer
- Parathyroid hyperplasia
MEN 2B: “MPM”
- Medullary thyroid cancer
- Phaeochromocytoma
- Mucosal neuromas
von Hippel Lindau disease features:
“HIPPEL”
Haemangioblastoma
Increased risk of RCC
Pheochromocytoma
Pancreatic lesions (cyst, cystadenoma, cystadenocarcinoma)
Eye dysfunction: retinal haemangioblastoma, endolymphatic sac tumour.
Liver / renal / pancreatic cysts.
Confluent White matter lesions:
Demyelinating disease:
- MS: Periventricular Dawson fingers, usually no mass effect, incomplete ring of enhancement.
- ADEM
- Lyme disease
Neoplasm:
- Gliomatosis cerebri
- anaplastic astrocytoma
- Lymphoma
Progressive multifocal leukoencephalopathy: (PML)
- periventricular subcortical WM T2 hyperintensity
- without mass effect
- Involves U-fibres (lots of “U” in PML)
- No enhancement, or faintly peripheral.
- No atrophy.
HIV encephalitis:
- diffuse bilateral, sparing sub cortical WM ( no “U” in HIV encphalitis),
- cerebral atrophy.
Vascular: Ageing normal brain Arteriosclerosis Chronic hypertensive encephalopathy: - BG lacunae, periventricular T2 bright, - microhaemorrhages. Multi infarct dementia Cerebral amyloid: CADASIL: - Symmetric sub cortical WM, anterior temporal lobe or para median frontal lobe, external capsule
Radiation
Inherited metabolic disorders:
- Alexander disease (frontal)
- Metachromatic leukodystrophy (“Middle” central)
- X Linked adrenoleukodystrophy (posterior)
- Canavan disease: peripheral lateral
Multiple parenchymal Calcifications:
Basal Ganglia: - Thyroid / parathryoid - Inflammatory / infectious Cortex: - Neurocysticercosis - Tb - Sturge Weber Grey White junction: - Fahr disease - Tuberous sclerosis complex - Mets: treated - Radiation. Periventricular: - Fahr disease - TORCH infection - Tuberous sclerosis complex NF 2.
Neurocysticercosis: multiple, small Ca++ lesions.
Cavernous malformation: variable size
TB: Healed granuloma, target sign.
Tuberous Sclerosis: Ca++ subependymal nodules.
Sturge Weber Syndrome: gyral, tram track Ca++, atrophy
Mets:
TORCH: CMV periventricular Ca++.
Fahr disease: extensive BG Ca++
MELAS: cortical & BG lacunae, BG Ca++
Basal Ganglia Ca++:
Infection:
- Neurocysticercosis
- TB
- Toxoplasmosis
- Congenital infections: CMV, HIV
Metabolic:
- Fahr Disease
- Mitchondrial Disorders; Leigh Syndrome
Endocrine:
- hypo PTH, / hyper PTH
- hypothyroidism
Hypoxic Ischaemic Injury
Radiation.
T1 Hyperintense Basal Ganglia:
NF1 Hepatic encephalopathy Hyperalimentation Hypoxic ischaemic injury Hypotensive cerebral infarction Carbon monoxide poisoning Kernicterus Wilson disease
Cerebellar Hemisphere Mass:
Cerebellar ischaemia / infarction Hypertensive bleed Medulloblastoma Pilocytic astrocytoma haemangioblastoma Mets
Tumefactive demyelinating: MS, ADEM. Abscess Cavernous malformation Arteriovenous malformation Atypical teratoid rhabdoid tumour.
Brain tumour child > 1 year by location
Posterior Fossa:
- Pilocytic astrocytoma
- Medulloblastoma
- Ependymoma
- Brainstem glioma
Supra tentorial:
- Diffuse astrocytoma low grade
- Craniopharyngioma
- SEGA (TS)
Midline pineal / supra sellar:
- Germinoma
- Teratoma
- Phineoblastoma
Intra axial: peripheral and cortical:
- DNET
- Pleomorphic xanthoastrocytoma
- Ganglioglioma
- Oligodendroglioma
Intra axial Deep and hemispheric:
- Anaplastic astrocytoma
- CNS embryonal tumour
- Glioblastoma
Extra axial:
- Chorid plexus tumour
NF2
Thickened Dura
Post operative Dural Mets Chronic sub dural haematoma Intra cranial hypotension Meningitis Neurosarcoid Tb Syphillis Metastatic intracranial lymphoma Meningioma IgG 4 related hypertrophic pachymeningitis.
Sacral Mass:
Chordoma Chondrosarcoma Neurofibroma Giant Cell tumour Osteoblastoma. Plasmacytoma
Unilateral thalamic Lesion
Lacunar infarction Hypertensive intracranial haemorrhage NF1 Low grade astrocytoma Glioblastoma Anaplastic astrocytoma ADEM (usually bilateral) Cavernous malformation AV malformation
Bithalamic lesion
Reduced diffusion:
- artery of Percheron infarct
- Bilateral PCA infarcts
- Encephalitis (Japanese encephalitis)
- Hypoxic ischaemic encephalopathy
- Mitochondrial disorder
Haemorrhagic:
- Deep venous thrombosis
- Vasculitis
- Encephalitis
Symmetrical:
- Wernicke encephalopathy
- Osmotic myelinolysis
- Hypoxic ischaemic encephalopathy.
- CJD
- Inborn errors metabolism.
- Viral encephalitis (japanese) doesnt have to be DWI bright)
MRS Disease summary
Gliomas: as grade increases, NAA and creatine decrease, and choline, lipids and lactate increase.
Radiation: Recurrent tumour choline will be elevated. Radiation change NAA, choline, and creatine will all be low.
Ischaemia / infarction: lactate increases. With infarction lipid peak appears.
Infection: NAA is absent. Bacterial abscess shows lactate, alanine, systolic acid and acetate elevation. Choline low / absent in toxoplasmosis, while it is elevated in lymphoma.
PML: elevated myoinositol.
Canavan disease: elevated NAA.
Leigh syndrome: elevated choline, reduced NAA, may have elevated lactate.
Herpes encephalitis DDx:
Acute cerebral ischaemia
Status epilepticus
Limbic encephalitis
Infiltrating neoplasm / gliomatosis cerebri.
Infra tentorial Midline Cyst:
Mega Cisterna Magna Arachnoid cyst Neurocysticercosis Dandy Walker Malformation Obstructive hydrocephalus with trapped 4th ventricle Pilocytic astrocytoma Haemangioblastoma Epidermoid cyst Dermoid cyst
Cystic appearing posterior fossa lesion:
Mega cisterna magna Arachnoid cyst Dandy Walker malformation Blake Pouch Cyst Joubert syndrome
Pilocytic astrocytoma Encephalocele Obstructive hydrocephalus Abscess Epidermoid Dermoid Haemangioblastoma
Thick Cortex:
Viral encephalitis Autoimmune encephalitis Tuberous Sclerosis Focal cortical dysplasia PAchygyria poly microgyria Hemigalencephaly
Thin cortex:
aging brain Obstructive hydrocephalus Chronic ifarction General encephalomalacia Multiple Sclerosis Alzheimer dementia Vascular dementia Parkinson disease
Focal Cortical Mass:
Acute cortical ischaemia / infarction Mets Pleomorphic Xanthoastrocytoma Oligodendroglioma DNET Ganglioglioma Diffuse astrocytoma Cerebritis Venous infarction Viral encephalitis
Abnormal shape Corpus callosum:
Normal vairant Callosal dysgenesis Neoplasm: lipoma, glioblastoma, lymphoma. Decreased white matter volume Obstructive hydrocephalus Marchiafava Bignami
Fat like Lesions:
Choroid plexus xanthogranloma Lipoma Craniopharyngioma Teratoma Dermoid cyst Petrous apex cholesterol granuloma White epidermoid
Enlarged Cortical Veins:
Developmental Anamoly AV malformation Dural arteriovenous fistula Dural sinus thrombosis Cortical venous thrombosis Vein of Galen malformation
Enlarged deep veins:
Developmental venous anomaly AV malformation Sturge Weber Syndrome THrombosis deep vein Thrombosis dural sinus. Glioblastoma Intracranial hypotension
Solitary parenchymal Ca++
Neurocysticercosis TB Cavernous malformation Oligodendroglioma Ganglioglioma Low grade astrocytoma Pilocytic astrocytoma
Multiple parenchymal Ca++
Neurocysticercosis Multiple cavernous malformations TB Tuberous sclerosis complex Sturge Weber SYndrome Mets Oppurtunistic infection in AIDS TORCH infection Metabolic diseases: Fahr disease, MELAS.
Multiple Hypointense Foci GRE/SWI:
Chronic HTN Cerebral amyloid angiopathy Traumatic axonal injury Mets Pneumocephalus Multiple cavernous malformations Neurocysticercosis TB Fat embolisation syndrome Radiation induced telangiectasia.
Cortical Hyperintensity T2 / FLAIR
Acute cerebral ischaemia / infarction Cerebral contusion Hypotensive cerebral infarction status epilepticus Herpes Encephalitis
Low grade diffuse astrocytoma - T2 FLAIR mismatch can suggest IDH status.
PRES (acute hypertensive encephalopathy)
Cortical Enhancement:
Subacute cerebral infarction herpes encephalitis Hypotensive cerebral infarction status epilepticus Acute hypertensive encephalopathy / PRES Cerebritis Malignant glioma
T2 Hyperintense Basal Ganglia:
Enlarged perivascular spaces Hypoxic injury NF1 ADEM Vasculitis Toxic insults: CO, cyanide, methanol. Metabolic: leigh syndrome, Wilson disease, MELAS.
Bilateral Basal Ganglia Lesions:
Enlarged perivascular spaces Mineralisation Metallic ion deposition Lacunar infarction Hypoxic ischaemic injury Glioma / lymphoma. Infection: cryptococcus, toxoplasmosis, viral encephalitis.
Bithalamic lesions:
Arterial ischaemia Venous ischaemia Acute disseminated encephalomyelitis VIral encephalitis astrocytoma PRES MS Lymphoma Wenicke encephalopathy.
Restricted Diffusion:
Cerebral ischamie / infarction. abscess Empyema Epidermoid cyst Intracerebral haematoma Choroid plexus cyst Ventriculitis Diffuse axonal injury Meningioma Lymphoma Status epilepticus Osmotic demyelination
Hyperdense dural sinus:
Physiologic hyperdensity
Dural sinus thrombosis
Polcythema
Multiple Parenchymal Ca++
Neurocysticercosis Multiple cavernous malformations TB Tuberous sclerosis COmplex Sturge Weber SYndrome Parenchymal Mets Remote Brain injury. TORCH infection Fahr Disease MELAS
Solitary Ring Enhancing Lesion
Parenchymal Met GBM Abscess Sub acute intra cerebral haematoma Subacute cerebral infarction Radiation necrosis Tumefactive demyelination Neurocysticercosis Lymphoma Toxoplasmosis Tuberculoma Ganglioglioma Pilocytic astrocytoma
Multiple ring enhancing lesions:
Parenchymal Mets Abscess MS ADEM Neurocysticercosis TB Oppurtunistic infection Lymphoma Multifocal GBM
Cyst with Nodule
Neurocysticercosis Pilocytic astrocytoma Ganglioglioma Haemangioblastoma PXA Demosplastic infantile ganglioglioma Intraparenchymal schwannoma.
Mets Glioblastoma Abscess Toxoplasmosis DNET Supratentorial ependymoma
Sulcal / Cisternal Enhancement
Meningitis Meningeal carcinomatosis Lymphomatous Meningitis Neurocysticercosis TB meningitis Neurosarcoid Sturge Weber Fungal disease Aneurysmal SAH
Ependymal Enhancement:
Developmental Venous anomaly MS Ventriculitis Oppurtunistic infction in AIDS Neoplasm with CSF seedig Lymphoma Neurosarcoid TB
Large Ventricles:
Aging brain
Intraventricular obstructive hydrocephalus
Extraventricular obstructive hydrocephalus
Obstructive hydro cephalus: shunt failure
Encephalomalacia
Normal pressure hydrocephalus
Enlarged subarachnoid spaces
Small ventricles:
CSF shunts and complications Cerebral oedema Herniation syndromes Hypoxic ischaemic injury Cerebral infection Intracranial HTN and Hypotension
Asymmetric lateral ventricles:
Normal variant Extrinsic mass effect Encephalomalacia Intraventricular haemorrhage Herniatin syndromes Surgical defects Obstructive hydrocephalus Choroid plexus cyst Ventriculitis
Irregular lateral ventricles:
CSF shunt / complication Surgical defect Periventricular leukomalacia Chronic cerebral infarction Porenchepahlic Cyst Chiari 2 Heterotopic Grey matter Tuberous sclerosis complex Mets
Large Brainstem:
Brainstem glioma HTN intracranial Haemorrhage Intracranial hypotension Osmotic demyelination syndrome Acute cerebral ischaemia / infarction Demyelination Cavenrous malformation
Pontine lesion:
Ischaemic rarefaction / arteriosclerosis Acute cerebral ischamia / infarction HTN haemorrhage Vascular malformation: capillary telangiectasia, cavernous malformation. Demyelination Diffuse infiltrative pontine glioma Malignant glioma Pilocytic astrocytoma Wallerian degeneration PRES Osmotic demyelination syndrome
Medulla Lesion:
Lateral medullary infarct Medial medullary infarct Wallerian degeneratino Demyelination Cavernous malformation Paeds: diffuse fibrillary astrocytoma Adults: glioma, haemangioblastoma.
Brain tumour child < 1year:
Posterior Fossa:
- Pilocytic astrocytoma
- Medulloblastoma
- Ependymoma
- Brainstem glioma
Supratentorial:
- Diffuse low grade astrocytoma
- Crainopharyngioma
- SEGA
Midline Pineal / Supra sella:
- Germinoma
- Teratoma
- Pineoblastoma
Intra axial peripheral and cortical:
- DNET
- PXA
- Ganglioglioma
- Oligodendroglioma
Intra axial deep white matter and hemispheric:
- Anaplastic astrocytoma
- CNS embryonal tumour
- Glioblastoma.
Bubbly intra ventricular mass:
Choroid plexus cyst Neurocysticercosis Choroid plexus papilloma / carcinoma Central neurocytoma Ependymoma Subependymoma Ependymal cyst Epidermoid cyst
Ependymal / subependymal Lesions:
Tuberou Sclerosis complex SEGA Focal cortical dysplasia Heterotopic Grey Matter Developmental venous anomaly MS GBM Lymphoma Ependymoma Ventriculitis Subependymoma Neurosarcoid
Ependymal Enhancement:
Developmental venous anomaly MS Ventriculitis Oppurtunistic infection AIDS CSF tumour seeding CNS lymphoma Neurosarcoid Neuromyeltis optica TB LCH
Periventricular Enhancing Lesions:
MS / tumefactive demyelination ADEM GBM Lymphoma Mets Abscess Septic emboli Toxoplasmosis Neurocysticercosis Neurosarcoid
Thick Infundibular Stalk:
Neurosarcoid (adult) Germinoma (young) Basilar Meningitis LCH (young) Lymphocytic Hypophysitis (adult) Lymphoma (adult)
Solitary Dural Based Mass:
Epidural Haematoma Meningioma Meningeal Mets Neurosarcoid Metastatic lymphoma Empyema Benign mesenchymal tumours Leukaemia
Multiple Dural Based Mass:
Meningioma Meningeal Mets Chronic Subdural Haematomas Neurosarcoid NF2 Lymphoma Erdheim-Chester Disease.
Cystic CPA Mass:
Epidermoid Arachnoid Cyst Vesticular Schwannoma with intramural Cyst Haemangioblastoma Large endolymphatic sac anomaly Neurocysticercosis Neuroenteric cyst
CSF like Parenchymal Lesions:
Enlarged perivascular space Encephalomalacia Lacunar infarction Neurocysticerosis Porencephalic Cyst MS Hippocampal sulcus remnants Cryptococcus
CSF Like Extra Axial Fluid Collection:
Enlarged subarachnoid spaces Mega Cisterna Magna Chronic Subdural Haematoma Subdural hygroma Subdural effusion Arachnoid cyst
Hypodense Extra Axial Mass:
Arachnoid cyst Chronic Subdural Haematoma Post op epidural fluid Pneumocephalus Neurocysticercosis Lipoma
Choroid Plexus Lesion:
Choroid plexus cyst Enlarged choroid plexus Choroid plexus papilloma Meningioma Intra ventricular Mets Ventriculitis
Enlarged perivascular Spaces:
Normal Variant Aging brain Tumefactive perivascular spaces Cryptococcosis Mucopolysaccharidoses CADASIL
Multi focal WM abnormalities in child:
MS (teens) ADEM Neuromyelitis optica PRES Tuberous sclerosis complex NF1 Viral encephalitis Metabolic brain disease: usually symmetrical. Lyme disease: CrN enhancement CADASIL (usually adults).
White matter disease with sparing subcortical U-fibres:
Chronic small vessel ischaemic changes. CADASIL HIV encephalopathy Toxic leukoencephalopathies: - Chasing the dragon - Radiation / chemo. Leukodystrophies: - X-linked adrenoleukodystrophy - Metachromatic leukodystrophy - Krabbe disease. Inborn errors metabolism: - Phenylketonuria - Maple syrup urine disease
White matter disease involving subcortical U-fibres early:
MS
Progressive multifocal leukoencephalopathy (PML)
Acute disseminated encephalomyelitis (ADEM)
Canavan disease
Alexander disease
Imaging features Intracranial Hypotension:
Pachymeningeal enhancement Venous distension - dural sinuses Enlarged pituitary gland Eventual subdural effusions and haematomas Reduced CSF volume: - tonsillar ectopia, - drooping splenium, Reduced maillopontine distance.
Imaging features of intracranial hypertension:
MOVES M: Meckel's cave enlargement O: optic disc protrusion V: venous sinus stenosis E: empty sella S: slit like ventricles
Can have tonsillar ectopia
Common fat neck soft tissues.
Increased T2 signal basal ganglia / thalami in a child:
Ischaemia Carbon monoxide poisoning Wilson disease Mitochondrial disorder Kernicterus osmotic demyelination
Cerebellar Atrophy:
Alcohol abuse anticonvulsant therapy Paraneoplastic syndrome Sporadic olivo-ponto-cerebllar atrophy Cerebello-pontine degeneration Friedreich ataxia.
Prominent periventricular / basal ganglia cystic lesions:
Virchow robin spaces Lacunar infarct Infection: - Neurocysticercosis - Cryptococcus Cystic neoplasm Neuroglial cyst
