Neuro: Head/Neck Flashcards
optic canal –> contain what struct? (2)
- optic N
- ophthalmic A
superior orbital fissure –> contain what struct? (4)
- CN III
- CN IV
- CN V1
- CN VI
inferior orbital fissure –> contain what struct? (1)
- CN V2
foramen rotundum –> what struct? (1)
CN V2
orbit –> extraconal compartmt –> contain what struct? (3)
- lacrimal gland
- fat
- bony orbit
orbit –> conal compartmt –> contain what struct? (1)
EOM
orbit –> intraconal compartmt –> contain what struct? (4)
- optic N & sheath
- sensory & motor N
- LN
- fat
orbital hemangioma –> 2 types?
- cavernous
- infantile (capillary)
orbital hemangioma –> cavernous vs capillary –> epidemiology?
- cavernous: adult
- infantile (capillary): >1yo
orbital hemangioma –> infantile (capillary) type –> natural progression?
first few mo of life –> enlrg –> then spont involute
orbital hemangioma –> cavernous type –> CT appearance? MR?
CT: ovoid mass –> enhance
MR:
- T1 iso
- T2 hyper
- contrast: early patchy enhance –> progressive fill-in
orbital lymphoma –> MC location?
lacrimal gland
orbital lymphoma –> classic clinical presentation?
lymphoma –> lacrimal gland –> mass effect on globe –> painless downward proptosis
orbital mass –> mold to the globe –> ddx? (2)
- orbital lymphoma
- orbital pseudotumor
orbital lymphoma –> T1/T2 signal?
- T1 hypo
- T2 hypo
orbital lymphangioma (orbital venolymphatic malformation VLM) –> epidemiology?
Ped
what is lymphangioma?
benign hamartomatous lesion –> slow flow vascular
orbital lymphangioma (orbital venolymphatic malformation VLM) –> imaging appearance?
multilocular cystic mass –> slight peripheral/septa enhance –> usu complex int contents & fluid levels from prior hemorrhage
orbit –> schwannoma vs neurofibroma –> which is more common?
Schwannoma
orbit –> schwannoma/ neurofibroma –> MC nerve? location in orbit?
V1 sensory br –> sup orbit
orbit –> schwannoma/ neurofibroma –> MR appearance?
circumscribed ovoid mass:
- T1 hypo
- T2 hyper –> sometimes central hypo (target sign)
- enhance
adult –> mets to orbit –> which CA? (5)
- breast
- lung
- thyroid
- RCC
- melanoma
mets to orbit –> enophthalmos –> which CA? (1)
scirrhous breast CA
ped –> mets to orbit –> which CA? (1)
Neuroblastoma
lacrimal gland –> composed of what tissue types? (2)
- epithelial salivary tissue
- lymphoid tissue
lacrimal gland –> epithelial tumor –> benign %? Malig?
50% benign, 50% malig
what is thyroid ophthalmopathy? MOA?
thyroid dz –> lymphocyte –> hyaluronic acid –> orbit inflamm –> EOM fibrosis
thyroid ophthalmopathy –> EOM –> order of involvemt?
I’M SLow:
- inf rectus
- med rectus
- sup rectus
- lat rectus
differentiate: thyroid ophthalmopathy vs orbital pseudotumor (2)
thyroid ophthalmopathy:
- bilat
- spare muscle tendon
orbital pseudotumor:
- unilat
- involve muscle tendon
what is orbital pseudotumor?
idiopathic orbit inflamm
orbital pseudotumor –> clinical presentation?
painful proptosis
orbital pseudotumor –> dx of exclusion –> T/F?
T
orbital pseudotumor –> MC location?
lacrimal gland
orbital pseudotumor –> tx?
Steroid
orbital pseudotumor + involve cavernous sinus –> dx?
Tolosa-Hunt synd
optic N-sheath complex –> MC tumor? 2nd MC?
- # 1 optic N glioma
- #2 optic N meningioma
optic N glioma –> adult vs ped –> prognosis?
- adult: poor prognosis
- ped: indolent
optic N glioma –> ped –> assoc condition? (1)
NF 1
optic N glioma –> ped –> usu unilat or bilat?
Bilat
optic N glioma –> ped –> MC MRI appearance?
variable appearance: optic N –> fusiform enlrg –> variable enhance
optic N glioma –> adult –> MC imaging appearance?
enhancing mass –> involve optic chiasm
optic N meningioma –> classic clinical presentation?
mid age F –> slow progress visual impair –> preserved central visual field
optic N meningioma –> imaging appearance?
tram-track sign:
- N-sheath –> circumferential thick –> uniform contrast enhance
- central –> optic N –> not enhance
ostiomeatal complex/unit –> common pathway for drainage of what sinuses (3) into which meatus?
frontal, ant ethmoid, maxillary –> ostiomeatal complex/unit –> middle meatus
post ethmoid & sphenoid sinus –> what is the common pathway? drains into which meatus?
sphenoethmoidal recess –> sup meatus
what is agger nasi cell? why is it significant?
ant-most ethmoid air cell located ant to frontal recess
lrg agger nasi cell –> narrow frontal recess
sinus: what is supraorbital cell? why is it significant?
ant ethmoid cell –> extend sup to orbit & ant ethmoidal notch (contain ant ethmoidal A) –> inc risk to ant ethmoidal A during surg
sinus: what is Haller (infraorbital) cell? why is it significant?
ethmoid air cell –> along medial orbital floor –> if lrg or inflamm –> narrow maxillary ostium
sinus: what is Onodi (sphenoethmoidal) cell? why is it significant?
post-most ethmoid cell –> extend sup & lat to sphenoid sinus
inc risk of intraoperative damage to adjacent optic N
fungal sinusitis –> MC type?
allergic fungal rhinosinusitis
what is allergic fungal rhinosinusitis?
chronic rhinosinusitis subtype/variant –> hypersens rxn to fungi –> nasal polyposis
allergic fungal rhinosinusitis –> imaging appearance?
- CT density?
- T2?
mult sinus –> complete opacify –> secretions:
- CT hyper
- T2 hypo
sinus walls:
- expansile remodel
- pressure erosion
fungal sinusitis –> what is fungus ball?
aggregate of hyphae + mucin –> often intra-lesional calc –> sep from sinus mucosa
immunocomp pt –> invasive fungal rhinosinusitis –> imaging sign that is highly suggestive of necrosis?
“black turbinate” sign –> nasal turbinate nonenhance
what is invasive fungal rhinosinusitis?
acute/chronic fungal infx –> invade mucosa, vessel, other sinonasal tissue –> necrosis
what is Pott’s puffy tumor
acute frontal sinusitis –> c/b osteomyelitis –> subgaleal/subperiosteal abscess
sinus: what is mucocele?
paranasal sinus –> obstructed drainage –> fill w mucoid secretions –> expansile remodeling & bony thinning
silent sinus synd –> MOA?
maxillary sinus ostium –> chronic obstruct –> air resorb –> max sinus atelectasis
silent sinus synd –> imaging features? (3)
- unilat max sinus volume loss
- partial-complete opacification of sinus
- enophthalmos
sinus: what is choanal polyp?
polyp –> nasal cavity –> extend to post nasal aperture (choana)
sinus: what is antrochoanal polyp?
choanal polyp that originate in max sinus
sinonasal (Schneiderian) papilloma –> 3 histologic types?
- exophytic
- inverted
- oncocytic
sinonasal (Schneiderian) papilloma –> 3 histologic types –> which have malig potential? (2)
- inverted
- oncocytic
sinonasal (Schneiderian) papilloma –> inverted type –> classic MRI appearance?
alternating curvilinear bands of low & high intensity –> “cerebriform” pattern
juvenile nasopharyngeal angiofibroma –> 2 imaging signs?
- salt & pepper appearance –> enhance & vasc flow voids
- Holmer-Miller (antral) sign –> mass extend into & expend pterygopalatine fossa –> ant displace post max sinus wall
pediatric midline nasal mass –> dermoid vs epidermoid cyst –> how differentiate?
dermoid:
- fat
epidermoid cyst:
- restrict diff
pediatric midline nasal mass –> ddx? (3)
- epi/dermoid cyst
- encephalocele
- nasal glial heterotopia (nasal glioma)
Mc-Cune Albright synd –> synd? (3)
- fibrous dysplasia
- endocrine hyperfx
- cafe au lait macules
Mazabraud synd –> synd? (2)
- fibrous dysplasia
- intramuscular myxoma
olfactory neuroblastoma (esthesioneuroblastoma) –> intracranial extension –> what imaging finding is highly suggestive of olfactory neuroblastoma?
intracranial portion –> cysts at margins
cavernous sinus thrombosis –> direct imaging findings? (2)
- lat wall –> convex bulge
- postcontrast –> filling defect
cavernous sinus thrombosis –> indirect imaging finding?
sup ophthalmic V –> dilate/thrombosed
endophthalmitis –> imaging findings?
- ocular wall thick & enhance
- periocular fat stranding
- vitreous –> hyper
what is dacryoadenitis? poss etiologies? (4)
lacrimal gland inflamm:
- virus/bact infx
- idiopathic
- IgG4-related dz
- granulomatous dz
dacryoadenitis –> imaging appearance?
lacrimal gland –> diffuse enlrg
what is dacryocystitis? MOA?
lacrimal duct obstruct -> bact infx –> lacrimal sac inflamm
dacryocystitis –> imaging appearance?
lacrimal fossa near medial canthus –> rim-enhance struct –> adj fat stranding
infant –> dacryocystitis –> poss etiologies? (2)
- dacryostenosis
- dacryocystocele
idiopathic orbital inflamm (pseudotumor) –> 3 main anatomic subtypes?
- dacryoadenitis
- orbital fat inflamm
- orbital myositis
idiopathic orbital inflamm (pseudotumor) –> orbital myositis subtype –> MC affected EOM?
LR
what is IgG4-related dz?
multisystem fibro-inflamm disorder
IgG4-related dz –> involve ophthalmic system –> MC involved struct?
lacrimal gland
IgG4-related ophthalmic dz –> distinguishing feature?
infiltration/enlrg infraorbital N
IgG4-related dz –> lacrimal + major salivary gland involvemt –> dx?
IgG4-related chronic sclerosing dacryoadenitis & sialadenitis
sarcoidosis –> extraocular orbit –> MC involved struct?
lacrimal gland
granulomatosis w polyangiitis –> orbit involvemt –> 3 MC manifestations?
- # 1 infiltrative mass in orbital fat
- dacryoadenitis
- extraocular myositis
thyroid orbitopathy –> early dz –> imaging findings? (2)
- proptosis
- orbital fat expansion
thyroid orbitopathy –> late dz –> imaging sign?
fusiform EOM enlrg –> spare tendon –> “Coca Cola bottle” sign
what is optic neuritis?
optic N inflamm
optic neuritis –> MCC?
MS
optic neuritis –> epidemiology? clinical presentation?
YA –> acute painful central vision loss
old pt –> central vision loss –> ddx? (1)
ischemic optic neuropathy
optic neuritis –> acute dz –> imaging findings? T2? contrast?
optic N:
- enlrg
- T2 hyper
- enhance
optic neuritis –> chronic dz –> imaging finding?
optic N atrophy
orbital lymphangioma (orbital venolymphatic malformation VLM) –> key imaging clue?
mass –> span mult compts
ped –> neuroblastoma –> mets to orbit –> clinical presentation?
periorbital ecchymosis –> “raccoon eye”
ped –> neuroblastoma –> mets to orbit –> imaging appearance?
- location
- bone involve?
- calcs?
- extraconal –> orbital wall –> lat or sup
- permeative bony destruction
- calcs
- aggressive periosteal rxn
neuroblastoma –> suspect bone mets –> preferred imaging study?
I-123 MIBG scintigraphy
orbital venous varix –> etiology? (3) MC?
- # 1 congenital malformation
- AVM
- AVF
what is Coats dz?
idiopathic –> retina –> telangiectasia + exudate –> retinal detach
what is persistent hyperplastic primary vitreous (PHPV)?
vitreous –> persistent embryonic vasc –>
- hemorrhage
- cataract
- retina detach
persistent hyperplastic primary vitreous (PHPV) –> imaging sign?
“martini glass” sign
septo-optic dysplasia –> part of what dz spectrum?
holoprosencephaly
septo-optic dysplasia –> synd? (3)
- optic N hypoplasia
- septum pellucidum agenesis
- hypothal-pit dysfx
orbital globe rupture –> imaging sign?
wall irreg & dec globe vol –> “flat tire” sign
Le Fort I fx:
- involve fx of what struct?
- free movemt of what struct?
- lat margin of pyriform (nasal) aperture
- floating palate
Le Fort II fx:
- involve fx of what struct?
- free movemt of what struct?
- inf orbit –> med orbit
- floating maxilla
Le Fort III fx:
- involve fx of what struct?
- free movemt of what struct?
- zygomatic arch
- lat orbit –> med orbit
- craniofacial dissociation
salivary gland –> MC tumor?
pleomorphic adenoma (benign mixed tumor)
pleomorphic adenoma (benign mixed tumor) –> benign or malig?
benign –> risk of malig transform
pleomorphic adenoma (benign mixed tumor) –> MR appearance?
- T2
- contrast
well-defined mass –> bosselated margins:
- T2 very hyper
- very enhance
Warthin tumor (papillary cystadenoma lymphomastosum, adenolymphoma) –> epidemiology?
old M –> smoke
Warthin tumor (papillary cystadenoma lymphomastosum, adenolymphoma) –> MC location?
parotid tail
Warthin tumor (papillary cystadenoma lymphomastosum, adenolymphoma) –> benign or malig?
benign
Warthin tumor (papillary cystadenoma lymphomastosum, adenolymphoma) –> imaging appearance?
mass:
- well-defined
- hetero
- weak enhance
- some –> complicated cystic compts
1ary salivary gland malig –> MC? 2nd MC?
- # 1 mucoepidermoid CA
- adenoid cystic CA
pleomorphic adenoma (benign mixed tumor) –> malig transform to what?
CA ex pleomorphic adenoma
b/l uvetitis + parotitis + facial N palsy –> dx?
sarcoidosis –> Heerfordt synd (uveoparotid fever)
gallium-67 scan –> what is panda sign? dx?
sarcoidosis:
- uptake in b/l lacrimal glands
- uptake in b/l parotid glands
- physiologic uptake in nasopharynx
Sjogren synd –> parotid glands –> MRI appearance?
“salt & pepper” or “honeycomb” appearance –> T1/T2 –> mixed low & high signal:
- benign lymphoepithelial lesions
- fibrosis
- calcs
- fatty infiltration
1st brachial cleft cyst –> location?
bw ext aud canal & submandibular region –> usu in parotid gland
ant pit –> embryologic tissue of origin?
Rathke pouch
persistent Rathke pouch –> possible conditions? (2)
- Rathke cleft cyst
- craniopharyngioma
foramen ovale –> contains what struct? (2)
- CN V3
- access meningeal A
severe HA + visual impair + hypopituitarism –> dx? MCC?
pit adenoma –> pit apoplexy
pituitary lesion –> “snowman” sign –> dx?
pit macroadenoma
Rathke cleft cyst –> intrasellar or extrasellar?
intrasellar
sella –> cyst –> nonenhancing intracystic nodule –> dx?
Rathke cleft cyst
craniopharyngioma –> intrasellar or extrasellar?
suprasellar
craniopharyngioma –> MC subtype in children? In adults?
- child –> adamantinomatous subtype
- adult –> papillary
craniopharyngioma –> adamantinomatous subtype –> MRI appearance?
- complex cystic lobulated mass
- calcs
- “machine oil” cystic contents –> T1 hyper
craniopharyngioma –> papillary subtype –> MRI appearance?
- round solid mass
- no calcs
intracranial germ cell tumor –> MC location? 2nd MC?
- # 1 pineal
- #2 suprasellar
MC type of intracranial germ cell tumor?
germinoma
epidermoid cyst –> MRI signal?
- T1
- T2
- FLAIR
- DWI
- CSF signal –> T1 dark, T2 bright
- FLAIR hyper
- restrict diff
what is hypothalamic hamartoma (tuber cinereum)?
gray matter heterotopia bw pit stalk & mammillary bodies
precocious puberty + gelastic sz (laughing spells) –> ddx? (1)
hypothalamic hamartoma (tuber cinereum)
child –> diabetes insipidus –> suprasellar mass –> pit stalk –> enlrg, enhance –> ddx? (1)
Langerhans cell histiocytosis (LCH) hypophysitis
child –> suprasellar mass –> midline mass –> avid enhance –> ddx? (1)
germ cell tumor –> germinoma
child –> suprasellar mass –> midline mass –> avid enhance, contain fat –> ddx? (1)
dermoid cyst
adult –> diabetes insipidus –> suprasellar mass –> pit stalk –> enlrg, enhance –> ddx? (1)
Langerhans cell histiocytosis (LCH) hypophysitis
adult –> suprasellar mass –> cystic, nonenhance, no calcs –> ddx? (1)
Rathke’s cleft cyst
what is ecchordosis physaliphora?
benign –> ectopic notochord remnant –> dorsal clivus –> project into post cranial fossa
chordoma –> ped or adult?
adult
chordoma –> 3 MC locations?
- # 1 sacrum
- # 2 clivus
- # 3 vertebra
chordoma –> tissue type?
notochord
how differentiate chordoma vs benign notochordal tumor? (3)
- bone destruct
- extraosseous extension
- enhance
chordoma –> extraosseous extension –> potential imaging sign?
“thumb” sign: post tumor –> indent pons
how differentiate clival chordoma vs petroclival synchondrosis chondrosarcoma? (1)
location:
- chordoma –> midline
- chondrosarcoma –> off-midline
what is necrotizing otitis externa (malig otitis externa)?
otitis externa + temporal osteomyelitis
otitis externa –> chronic –> potential comp?
medial canal fibrosis
chronic otitis externa –> medial canal fibrosis –> imaging appearance?
tympanic membrane –> outer surface –> crescentic soft tissue thickening
what is keratosis obturans?
keratin plugs –> accum –> occlude & expand ext aud canal –> no bone involvmt
keratosis obturans –> usu unilat or bilat?
bilat
keratosis obturans –> imaging appearance?
EAC –> soft tissue opacification –> smooth, expansile remodeling of bony canal
what is cholesteastoma?
collection of keratin –> lined by squamous epithelium
keratosis obturans –> epidemiology?
child & YA
cholesteastoma –> epidemiology?
mid to older adult
cholesteastoma –> imaging appearance?
EAC –> soft tissue mass –> focal bony erosion or sequestered bone frgmt
cholesteastoma –> usu unilat or bilat?
unilat
pulsatile tinnitus –> exam –> red retrotympanic mass –> ddx? (2) MCC?
- # 1 aberrant int carotid A
- paraganglioma
absent foramen spinosum –> ddx? (1)
persistent stapedial A
what is stapedial A?
hyoid A –> br –> connect int & ext carotid A –> normally regress
pulsatile tinnitus –> exam –> blue retrotympanic mass –> ddx? (1)
dehiscent jugular bulb
what is paraganglioma?
(para)sympathetic paraganglionic tissue –> extra-adrenal neoplasm
head & neck –> paraganglioma –> MC locations? (4)
- carotid bifurcation
- suprahyoid neck –> along course of vagus N
- jugular foramen
- middle ear
what is glomus tympanicum tumor?
paraganglioma –> isolated to middle ear –> jugular plate intact
what is glomus jugulotympanicum tumor?
paraganglioma –> involve middle ear & jugular foramen
lrg paraganglioma –> classic MRI appearnce?
“salt & pepper” appearance –> intratumoral flow voids
paraganglioma –> most sensitive imaging study?
Ga-68 DOTATE PET-CT
epidermoid cyst in the temporal bone is called what?
cholesteatoma
cholesteatoma –> CT appearance?
- soft tissue mass –> opacify part of middle ear
- adj bone erosion
foramen spinosum –> contain what struct? (1)
middle meningeal A
jugular foramen –> contain what struct? (4)
- pars nervosa: CN9
- pars vascularis: CN10 & 11
internal auditory canal –> contain what struct? (4)
- CN7
- CN8
- sup & inf vestibular compt
meckel cave –> contain what struct? (1)
trigeminal ganglion
dorello’s canal –> contain what struct? (2)
- CN6
- inf petrosal sinus
external carotid branches (in order)? (8)
Some Admin Love Fucking Over Poor Med Students:
- Sup thyroid
- Ascending pharyngeal
- Lingual
- Facial
- Occipital
- Post auricular
- Maxillary
- Sup temporal
intracranial ICA –> branches? (3)
- ophthalmic
- post comm
- ant choroidal
CN3 palsy –> etiology –> ddx? (1)
Pcomm aneurysm
CN6 palsy –> etiology –> ddx? (1)
inc ICP
older F –> rapidly expansile, painful thyroid –> what type of thyroid CA?
anaplastic
thyroid US –> most suspicious feature?
microcalcs
thyroid US –> microcalcs –> hallmark of what dx?
papillary thyroid CA
thyroid US –> what echotexture is a feature of malig?
solid hypoechoic
bad looking delphian node (level 6) –> dx?
layrngeal CA met
thyroid CA –> anaplastic type –> RF? (2)
- elder
- radiation tx
thyroid CA –> papillary type –> US appearance? CT? MR?
- US: hyper compared to normal nodes
- CT: hypervasc
- MRI: T1 bright
thyroid CA –> lung mets –> classic pattern?
miliary
thyroid CA –> lung mets –> tx: I-131 –> comp? (1)
pulm fibrosis
Enhancement of the facial nerve accompanied by enhancement in the internal auditory canal and labyrinth, and vesicles within the EAC –> dx?
Ramsay Hunt syndrome (herpes zoster otica) –> shingles of facial N
cervical LN levels: level of submandibular glands –> what level LN? (2)
- ant to submandibular gland –> level 1
- post –> 2
cervical LN levels: how differentiate level 2A & B?
- A: ant to SCM
- B: post to SCM
cervical LN levels: bw level of hyoid & cricoid –> ie. at thyroid cartilage –> what level LN? (2)
- ant to SCM –> 3
- post to SCM –> 5A
cervical LN levels: below cricoid –> ie at thyroid gland –> what level LN? (3)
- midline –> 6
- lat to SCM –> 5B
- post to SM –> 4