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radiology > neuro rads head and brain > Flashcards

neuro rads head and brain Flashcards

1
Q

intersection of the Frontal, Parietal, Temporal and Sphenoid bones

A

● Pterion​:

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2
Q

Thinnest part of the skull

A

Pterion

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3
Q

trauma in the pterion can cause

A

○ Trauma here may cause epidural hematoma because the Middle meningeal artery courses through this area

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4
Q

abbreviations of the sutures

A

Squamosal = Parietal = P Occipital = O Lamboidal = L Coronal = C Sagittal = S Dotted line = anterior fontanelle

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5
Q

standard and customary to only get _____ sliclies with a CT of the head

A

axial need to request reconstructions

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6
Q

what are we looking for with CT

A

Symmetry, densities, lucencies ○ Blood: new, old - in trauma, hemorrhage ○ Ischemia, infarction, edema ○ Tumors, metastases ○ Hydrocephalus ○ Bony windows - skull fractures

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7
Q

how wide are

A

typically between 3-5 mm from the base of the skull to the vertex should be able to see the frontal sinuses

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8
Q

white matter on CTS

A

appears darker than grey

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9
Q
A
  1. eye
  2. sphenoid sinus
  3. temporal lobe
  4. mastoid oracle of the ear (pinna) can be seen outside
  5. Pons
  6. 4TH VENTRICLE
  7. cerebellum
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10
Q
A

A. forntal lobe

b. sylvian fissure

c

temporal love

d. suprasella cistern
e. midbrain
f. 4th vent
g. cerebullum

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11
Q
A

A. sup sagitaal sinus

b. frontal lobe
c. laterla vantricle
d. 3rd vent

e 4th vent

f cerebellum

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12
Q

gryi

A

● Grooves = elevations (worms)

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13
Q

sulci

A

● Sulci = grooves (space btw the worms)

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14
Q

out to in brain layers

A

skull

epidural

DAP

DURA

subdural

ARACHNOID

PIA

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15
Q

what kind of contrast do we have with CT

A

IV not PO

get a creatinin

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16
Q

what is standard ct? CON or NAH

A

non con is standard

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17
Q

when would you get a non con CT

A

Suspected acute CVA/TIA, focal neuro deficit

● Headache - atypical, worst of life

● Delirium* ○ If delirium has obvious cause – infection, etc…CT may not be ordered ● HA + fever: Meningitis/Abscess/Encephalitis

● Seizure - first one

● Vertigo/Dizziness w/ central sx’s*

○ Central vertigo – MRI best. CT considered if cannot obtain MRI readily

● Cancer Hx w/ new headache, HIV w/ new HA, ALOC (altered level of consciouness), focal neuro findin

○ Vomiting w/o abdominal sx’s (vomiting is often first sign of increased ICP)

○ Suspected child abuse

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18
Q

when do you get a CTA for a strok pt

A

if the person has a stroke we can interviene

ALWAYS get a non con CT for stroked person first to determine ischemic or hemorrahgic

if their stroke score if very high you get NON con first

THN you get a CTA of the head and neck

contrast makes everything look white and blood is white you don’t want to confuse a ischemic with a hemorrahgic

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19
Q

other than stroke pts when do we have CTA for pts

A

Tumors ● Brain abscess, encephalitis ● MRI now often utilized in these conditions

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20
Q

Hypoattenuation

A

Hypoattenuation (gray) ○ Edema, ischemia, ol

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21
Q

Hyperattenuation

A

white

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22
Q

system for CT

A

Check name, date, study, rotation (contrast?)

● Check symmetry ○ Midline shift (mass effect)? Effacement? ○ Effacement​ = narrowing, obliteration of sulci, ventricles - literally they are squished from mass effect, edema

● Hyperattenuation (white) ○ Acute bleed, calcifications, FB’s

● Hypoattenuation (gray)

○ Edema, ischemia, old blood, tumor, air

● Cisterns, CSF spaces

● Ventricle size, symmetry

● Gyri, sulci symmetric? Edema? Atrophy?

● Soft tissue, sinuses, mastoids

● Bone Windows

● *Always interpret with attending physician, confirm with radiologist

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23
Q

B​lood C​an B​e V​ery B​ad stands for

A

Blood, Cisterns, Brain, Ventricles, Bones/Bony Windows

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24
Q

blown pupil

A

brain can come from the foramen magnum and squeeze the 3rd ventricle and cause a blown pupil

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25
Q

official medical term for squished brain

A

effaced

effacement

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26
Q

“White things” without IV contrast

A

Abnormal = blood, calcified masses

  • acute bleeding or recent bleeding is white
  • tumors can be calicified

Normal = bone, typical calcifications

  • pineal gland, choroid plexus, falx, basal ganglia
    • therse
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27
Q

“White things” with IV contrast

A

Normal = vasculature, choroid plexus, pituitary

Abnormal = blood, tumor/mass/infection

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28
Q

“Dark things”:

A

: Cisterns, CSF spaces

Abnormal = air, edema, ischemia, encephalomalacia

  • air from entery point of fracutred skull
  • encephalomalacia
    • defined as soft brain
      • comes from brain degeneration due to lack of vascular supply
  • Artifacts: Motion, Metal - scatter effect, streaks
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29
Q

what can efface your sulci

A

edema

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30
Q

what type of CT would you get for head trauma

A

NON ct

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31
Q

what are you looking for with a CT trauma

A

Subdural Hematoma

Epidural Hematoma

Intracerebral Hemorrhage

Cerebral Contusion

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32
Q

indications for CT trauma

A

Focal neuro finding

GCS <8

Loss of consciousness

Altered level of consciousness

Skull penetration

Worsening HA, vomiting after head trauma

Post-traumatic seizure

Suspected child abuse

Coagulopathy + trauma

Significant mechanism

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33
Q

why can people walk around with subdural hematomas

A

venous hemorrhage

damage is with the bridging veins between the dura and the arachnoid

shapped like a crescent

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34
Q

subdural hematoma cross the medline T or F

A

Does not cross midline

● May cross suture lines

doesn’t wrap around the scull

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35
Q

what does acute blood look like on non contrast ct

A

acute blood is white on non-contrast head CT. Midline shift present

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36
Q

after about a week after a subdural hematoma

A

Subacute subdural – blood becomes more isodense. Midline shift present

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37
Q

what does a chronic subdural hematoma look like on a CT

A

acute on chronic subdural – new, hyperdense blood seen in old subdural. Subtle midline shift present

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38
Q

Epidural Hematoma occurs between wehat

A

Hemorrhage between dura and skull table

39
Q

what shape and color do you see with epidural hematoma

A

Lens shape, biconvex

Hyperattenuation

40
Q

why do we see regain consciousness with epidural hematoma followed by sudden death

A

when the bleeding occurs and accumulates you get effacement of the ventricles and eventually the brain will herniate and person will die in respiratory failure

41
Q

what is characteristic of the movement of epidural hematoma

A

Does not cross suture lines

exapnding arterial hematoma

42
Q

what is the most common hematoma

A

traumatic subarachnoid hematoma is the most common

43
Q

Coup-contrecoup injury

A

= damage to the brain on both sides: the side that received the initial impact (coup) or blow and the side opposite the initial impact (countrecoup)

○ Common in boxing

44
Q

Cerebral contusions:

A

Significant head trauma, coup-contrecoup mechanism common ○ Cerebral contusions often frontal or at periphery ○ Edema is common

45
Q

who get’s a CT scan for a HA

A

Indications for CT in headache

○ Focal neuro findings + HA

○ ALOC + HA ○ Fever + HA

○ Vomiting (atypical) + HA

○ HA + vomiting after head trauma

○ Severe, persistent, new HA

○ “Worst HA of my life”

headache in young obese female with vision changes n/v BIH pesudotumor cerebry

46
Q

Idiopathic intracranial hypertension

A

pseudotumor cerebri

obese woman n/v HA

47
Q

how do you dx subarachnoid hemorrhage

A

are there white things are where are they?

Hyperattenuation (non-contrast CT scan)

● Suprasellar cisterns (Circle of Willis) or other basilar cisterns

● Sulci look white, effacement of sulci

● “Worst HA of life”

● Causes: aneurysm, AV malform tumors, trauma *

MCC

● Common to see subarachnoid hemorrhage in the Sylvian fissure

48
Q

Increased Intracranial Pressure comes from

A

mass effect

or brain swelling cerebral edema

49
Q

first thing you will see on Increased intracranial pressure CT

A

■ First thing you lose is normal definition of gyri/sulci ■ Infection, reactive, malignancy, toxic, anoxic (don’t have O2)

50
Q

Hydrocephalus seen with Increased Intracranial Pressure

A

from CSF

51
Q

vasogenic type cerebral edema

A

edema is an area of hypoattenuation that is not as dark as air and surrounds whatever is going on

● Local edema around infection, malignancy

● Vasogenic edema around acute hemorrhage

● Possible midline shift, herniation

● Predominantly affects white matter

52
Q

Cytotoxic Cerebral Edema

A

Hypoattenuation

● Cell death after cerebral ischemia (infarct)

● Possible midline shift, herniation

● Affects both white and grey matter

53
Q

● Dilated ventricles, temporal horns visible

A

Hydrocephalus

54
Q

two types of hydrocephalus

A

Communicating:extraventricular cause

2) Non-communicating​ - intraventricular cause

55
Q

describe communicating hydrocephalus

classic finding*

A

Decreased reabsorption of CSF

■ Acute/chronic, affects the entire ventricular system

● Hallmark = 4th ventricle enlarged

■ Normal Pressure Hydrocephalus

56
Q

■ Normal Pressure Hydrocephalus is what type of hydrocephalus

A

Communicating​ - extraventricular cause

57
Q

CT findings with non-communicating​ - intraventricular cause

A

Obstruction of outflow of CSF - usually d/t tumor or mass

Narrow site - 3rd or 4th vent, fora

■ 4th ventricle normal sized, sulci normal

58
Q

>50 years old ○ Gait disturbance ○ Dementia ○ Urinary incontinence

classic presentation of

A

Normal Pressure Hydrocephalus

Special hydrocephalus – Communicating type

59
Q

Normal Pressure Hydrocephalus is caused by

A

Dilated ventricles out of proportion to atrophy

Giant ventricle but normal sulci

60
Q

Diffuse prominence of sulci, ventricles

● Space between edges of brain and skull table

● Normal CSF production, absorption

● Incidental finding, chronic (happens over time)

all characteristic of

A

Cerebral Atrophy

61
Q

Cerebral Atrophy seen most commonly

A

dementia (Alzheimer’s), alcoholism (cerebellar)

higher incidence of subdural hematoma

62
Q

what window period might we see a falsely negative CT with a CVA

A

<6hrs sx’s, CT often falsely negative if ischemic ○ MRI more sensitive early on if ischemic

63
Q

Hemorrhagic CVA →

A

call neurosurgeon

may have to have surgery to stop the bleed

64
Q

Ischemic CVA (negative CT)

A

call neurologist for stent or TPA

65
Q

Acute: hyperattenuation: collections of blood seen without a shift and with edema

A

could be a hemorrhagic stroke

66
Q

what spots of the brain does hemorrahgic stroke favor

A

● Favor basal ganglia, thalamus, pons, cerebellum

67
Q

Local vasogenic edema

● Effacement of gyri/sulci & midline shift common

● Risks: HTN, coagulopathy, stimulants (cocaine, meth

) ● Less common than ischemic; more morbidity/mortality

A

Hemorrhagic CVA

68
Q

more sensitivity with this type of imaging in ischemic CVA

A

● MRI more sensitive early

69
Q

Vascular watershed” distribution of ischemia seen in

A

ischemic CVA

70
Q

4 subtle CVA signs

A
  1. Hyperdense vessel sign
  2. Loss of “insular ribbon” - grey matter stripe or interface with white matter
  3. Lentiform nucleus and caudate nucleus are not distinctly visible
  4. Effacement of sulci
71
Q

lacunar infarcs

A

very very deep

seen as a deep area of hypoattunation

DM, HTN pts, not horribly insignificant unless there are many

occur with tiny vessels

72
Q

intra-axial tumor is

A

within brain parenchyma

■ Glioma, astrocytoma, etc

73
Q

extra axial tumors on CT are located

A

outside of brain itself

■ Meningioma, acoustic neuroma

74
Q

Big, round, multiple, enhance w/ contrast

A

METS

75
Q

Glioma and astrocytoma

are both what type of tumor (location)

A

intra axial

76
Q

sxs of braintumors

A

HA, vomitting, altered mental status or nothing

77
Q

neurocystocitosis !

A

first time seizure in an otherwise well person in an endemic area casued by a worm in the brain

cysticercosis cyst with edema

parascitic agent

78
Q

Weighting: ​T1 or T2? ■ CSF is WHITE on _______

A

Weighting: ​T1 or T2? ■ CSF is WHITE on T2-weighted image

79
Q

indications for MRI

A

More sensitive than CT for cerebellar lesions, central vertigo, multiple sclerosis (test of choice along with an LP), diffuse axonal injury, tumors

○ *Need an MRI for the diagnosis of multiple sclerosis → looking for MS plaques (not found on CT)

seen as plawues with MRI also need a lumbar puncture

80
Q

EDH is usually due to injury to the _______ secondary to an _______

A

EDH is usually due to injury to the middle meningeal artery or vein secondary to an associated skull fracture. Unlike subdural hematoma, EDHs do not cross suture lines, but can cross the tentorium.

81
Q

high density, extra-axial, biconvex lens- shaped mass lesion usually in the temporal-parietal region of the brain

A

EDH

82
Q

MCC of SAH

A

Rupture of an aneurysm is the most common cause of a SAH (50-70%)

83
Q

Suprasellar cisterns (Circle of Willis) or other basilar cisterns

● Sulci look white, effacement of sulci

A

SAH

worst ha of my life

84
Q

Rupture of an aneurysm is the most common cause of a SAH (50-70%) but not the only cause as trauma these tow things can also produce a SAH

A

, arteriovenous malformations or breakthrough of an intraparenchymal bleed can also produce subarachnoid hemorrhage.

85
Q

a shift of the frontal horns of the lateral ventricles (o the right of midline (dotted line), would indicats the presence of__________

A

a shift of the frontal horns of the lateral ventricles (o the right of midline (dotted line), would indicats the presence of subfalcine herniation.

86
Q

Communicating hydrocephalus is due to abnormalities that inhibit _______, most often at the level of the _______and is usually treated with a ventricular shunt.

A

Communicating hydrocephalus is due to abnormalities that inhibit the resorption of cerebrospinal fluid, most often at the level of the arachnoid villi and is usually treated with a ventricular shunt.

87
Q

the thalami are on either side of the ____, and the caudate nuclei (C) are on either side of the __________

A

the thalami are on either side of the third ventricle (black arrow), and the caudate nuclei (C) are on either side of the frontal horns of the lateral ventricles.

88
Q

Headache in young, obese female with vision changes, n/v

A

Benign Intracrainial Hypertension or Pseudotumor Cerebri

89
Q

Hypoattenuation from encephalomalacia is typically seen as this type of edema

A

Cytotoxic Cerebral Edema

90
Q

Dilated ventricles, temporal horns visible seen with this type of edema

A

Hydrocephalus

91
Q
A

CSF build up in the brain

= non communicating Hydrocephalus
you can tell because the fourth ventricle is not enlarged

92
Q

diffuse prominent sulci and ventricles are characteristic of

A

cerberal atrophy

93
Q

deep in the brain

HTN

DM

A

radiology (13 decks)

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