Neuro Radiology

Question 1

A PT presents with C-Spine Px; which CXR views would you consider for this PT depending on their S/Sx?

Answer 1

Cross Table Lateral
A/P
Obliques  (L / R Neural Foramina)
Odontoid (open mouth)
Flexion and Extension

Question 2

A fracture of C1 is noted on CXR; what is this more commonly known as?

What could this be caused by?

Answer 2

Jefferson Fx

Axial loading-diving into pool

Question 3

What is a Skull Series of CXR and when would it be indicated?

Answer 3

Posterio/Anterior
Lateral
Oblique
Waters view- Sinuses

Indications: Trauma, congenital anomaly, bone neoplasms

Question 4

A C2 Fracture is noted upon CXR; what is the more common name for this Fx?

What could some potential causes be for this Fx?

Answer 4

Hangman Fx (Hyperextension / Fx of neural arches)

Odontoid

Hyperflexion
Extension
Rotation
Lateral Flexion
Sheering forces

Question 5

C2 - C7 fractures may be known as what kinds of Fx?

Answer 5

Compression
Teardrop
Burst Fx

Question 6

What is Spondylo-listhesis?

Answer 6

Forward SLIPPAGE of vertebral body

Question 7

What is Spondyl-itis?

Answer 7

Inflammation
Fused spine
Ankylosing Spondylitis

“Bamboo spine”

Question 8

Spondyl-osis

Answer 8

Degenerative (DJD)
Osteoarthritis - anterior spurs
Sclerosis / disc narrowing

Question 9

What is Spondylo-lysis?

Answer 9

Fracture of the pars interarticularis

Question 10

Compression Fx’s can be common in which regions of the PT’s spinal column?

Answer 10

In lumbar vertebrae but also T9-T10

Risk factors include
Osteoporosis
Alcohol abuse
Old age

Question 11

If you have a PT with positive crossover Px with SLR’s; what condition do you suspect and what imaging modality is most preferred?

Answer 11

Disc herniation

MRI is preferred and more sensitive over CT

Question 12

If you want to view the fourth ventricle; what CT view

Answer 12

Infratentorial

Question 13

When are CT scans of the brain implicated?

Answer 13

1. Trauma (dural bleeds)
2. Vascular event (stroke or suspected subarachnoid bleeds)
3. Neoplasms
4. Inflammatory Dz’s (Abscesses, MS, Vasculitis, Edema)
5. Congenital (Hydrocephalus)

Question 14

A fracture of the temporal bone is visualized on CT… What associated hematoma should you be concerned about?

Answer 14

Epidural hematoma

ARTERIAL bleeds (Middle meningeal artery common)

Temporal bone Fx MC

Question 15

A half-moon appearance is visualized on CT in the middle of the brain after an injury 4 days ago. What should be your primary bleed on your differential?

Answer 15

Subdural hematoma

VENOUS; shearing type of injury from falls or MVA

B/t dura and pia mater

Question 16

What is the typical presentation of a Subarachnoid Hemorrhage?

What are some associated risk factors?

Answer 16

Worst headache of their life
Sudden and severe “Thunderclap” HA

Uncontrolled hypertension
Familial Hx
Aneurysm Hx (circle of Willis -berry aneurysm MC)

Question 17

What CSF color will associated T1 and T2 images have on MRI’s of the brain?

Answer 17

T1- CSF appears darker

T2- CSF appears brighter

Question 18

What is FLAIR imaging; when would you consider ordering a FLAIR?

Answer 18

Fluid Attenuated Inversion Recovery (FLAIR)

Indicated for MS

T2 images but normal CSF is darker

Question 19

What are some contraindications for an MRI?

Answer 19

Unstable PT
Implanted metallic devices
Intraocular metallic FB
Claustrophobia / Agitation

Question 20

What are some limitations of an MRI?

Answer 20

Motion artifact
Inferior to CT (for ID of acute hemorrhage and bony injuries)
Prolonged time for imaging

Question 21

What are some indications for a PET scan?

Answer 21

Dementia
   ~~Alzheimer's 
   ~~Fronto-Temporal Dementia
   ~~ Neurodegen Disorders
Epilepsy
NEOPLASMS