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ST2 Radiology > Neurology > Flashcards

Neurology Flashcards

1
Q

What is Lhermitte’s sign and what is it associated with ?

A

Electrical shock signal that shoots down the spine during neck flexion. Associated with MS

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2
Q

What are the three cortical defects (types ) of fronto-temporal dementia

A

1) Frontal - (associated with Picks disease) Personality disorders
2) Primary Progressive - loose the ability to use language to speak, read, write, and understand what others are saying.
3) Semantic - loose vocabulary over time

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3
Q

What is parinaud syndrome and what is it associated with ?

A

inability to gaze upwards due to a pineocytoma - pineal gland tumour. The syndrome occurs when there is compression of the superior colliculus.

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4
Q

Where do JPA astrocytomas occur and what syndrome is it associated with> (Juvenille pilocytic astrocytoma )

A

Posterior fossa - midline cerebellum when not associated with NF1
. Associated with NF1- most common is optic nerves
Defining feature is increased diffusion ( so bright on ADC)

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5
Q

What grade 1 astrocytome is found at the foramen of monro and which patients develop them ?

A

Subependymal giant cell astrocytoma.
Tuberous sclerosis

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6
Q

What are the characteristic features of a pleomoprhic xanthoastrocytoma ?

A

Cystic lesions with part solid component which enhances post contrast. Slow growing with remodelling of the overlying skull
Enhancing dural tail

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7
Q

Where are astrocytomas IDH-mutant located ?

A

2/3 are supratentorial
Frontal lobe > temporal > parietal > occipital

Peripherally, they are cystic lesions which are
Hyperintense on T2/ Hypointense on FLAIR. = T2/FLair mismatch
They do not restrict diffusion

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8
Q

What doe oligodendric cells do?

A

Myelination of the neurones

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9
Q

What WHO grading are Oligodendroglial Tumours?

A

WHO 2/3 .
Higher grade is decided by histology - showing increased mitotic activity, endothelial proliferation and necrosis

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10
Q

Where are Oligodendroglial Tumours usually found?

A

Frontal and peripheral. 90% have calcification.

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11
Q

Where are choroid plexus tumours mots commonly found in children?

A

The lateral ventricles
Adults - 4th ventricles

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12
Q

Where are Dysembryoplastic neuroepithelial tumours usually found and what do they commonly present with?

A

Multicystic lesions usually within the temporal lobe - therefore presenting with epilepsy

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13
Q

What are the most common locations for a ICH in bleeds caused by hypertension

A

Basal ganglia, cerebellum, thalamus and pons

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14
Q

What are the main causes of masses within the posterior cranial fossa in adults

A
  1. Cerebella metastasis - lung/melanoma/breast/thyroid
  2. Haemangioblastoma
  3. Lymphoma
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15
Q

What disease is associated with haemangioblastoma?

A

Von Hippel lindau disease or sporadic

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16
Q

What is the classic location of CADISIL

A

Anterior temporal lobe and external capsule

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17
Q

What is amyloid angiopathy

A

Accumulation of amyloid plaques within the small and medium vessels of the brain.

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18
Q

What disease is the sign, ‘puff of smoke’ associated with ?

A

Moyamoya disease. It is caused by the neo-vascularlisation resulting in the formation of small, abnormal vessels

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19
Q

What is moyamoya disease ?

A

Progressive narrowing of the distal portion of the ICA and circle of Willis with secondary collaterasliastion .

Moyamoa - is a puff of smoke due to collaterisation

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20
Q

What is clocc ? Is it a problem

A

Cytotoxic lesions of the corpus callosum , it is a benign condition

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21
Q

What condition is spinal ependymomas associated with ?

A

NF2

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22
Q

Where in the spinal cord are ependymomas located ?

A

Centrally within the spinal cord, causing expansion of the cord

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23
Q

Do ependymomas enhance ?

A

Yes they have heterogenous enhancement

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24
Q

What is the most common intramedullary tumour in children ?

A

Astrocytoma

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25
Q

What are astrocytomas associated with ?

A

NF1

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26
Q

What WHO grading is a spinal epdenymoma ?

A

WHO grad 2

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27
Q

What is the WHO grading for an intramedullary astrocytoma ?

A

WHO Grade 1/2

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28
Q

Which cancers most commonly metastases to the intramedullary spine ?

A

Lung and then breast

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29
Q

What condition should you think of in a patient with multiple hemangioblastomas ?

A

Von Hippel-Lindau syndrome

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30
Q

What is diastomytemylia , what is it associated with ?

A

The cord is split.
Desmoid cysts

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31
Q

what is communicating hydrocephalus and what causes it

A

increase in ventricles due to more csf volume - but no obstructing lesion.

It is caused by a destruction in CSF absorption by the arachnoid granulations, such as subarachoidnoid haemorrhage,meningitis or leptomeningeal metastasis

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32
Q

what is the classic triad of normal pressure hydrocephalus ?

A

ataxia, incontinence and dementia

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33
Q

what is cytotoxic oedema caused by

A

damaged sodium - potassium ATPase ion pumps which is due to acute ischameia

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34
Q

on imaging what does cytotoxic oedema look like ?

A

affects both grey-white matter
restricted diffusion due to the cells swelling

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35
Q

what is affected in vasogenic oedema

A

the blood Brain barrier is effected .
this causes fluid to go from the intracellular space to the extracellular space
there is increased grey-white matter differentiation
high t2/flair with facilitated diffusion

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36
Q

what is affected in vasogenic oedema

A

the blood Brain barrier is effected .
this causes fluid to go from the intracellular space to the extracellular space
there is increased grey-white matter differentiation

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37
Q

what does ionic oedema look like

A

this is associated with cytotoxic oedema and it results in fluid going from the blood to the extracellular space (do to the osmotic changes that occur with the cytotoxic oedema). there I therefore more fluid within the extracellular space which causes a high T2/Flair signal

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38
Q

what causes vasogenic oedema

A

brain tumours and abscesses

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39
Q

what is transependymal oedema

A

due to high intraventricular pressure
causes CSF to move from the ventricle into the extracellular space
usually due to obstructive hydrocephalus
causes high flair signal around the lateral ventricles

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40
Q

which artery might be compressed in subfalcine herniation and what is the clinical manifestation of this

A

anterior cerebral artery = the pericallosal artery
manifesting as contralateral leg weakess

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41
Q

what are the two types of transtentorial herniation?

A

central - where the basal ganglia and thalami are pushed down
lateral (uncal) - where the medial portion of the temporal lobe Is displaced

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42
Q

what affect can transtentorial herniation have ?

A

1) compression of the oculomotor nerve - causing pupillary dilatation
2) compression of the PCA - causing medial temporal/occipital lobe infarction
3) shearing of the perforating arteries from the basilar causing small haemorrhages

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43
Q

on Brain MRI what is T1 hyperintense

A

fat
melanin
proteinaceous material
methemoglobin
minerals - gad

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44
Q

what is T2 hypointense

A

most stages of blood - deoxyhaemaglobin, haemosiderin
calcification
fibrous tissue
highly cellular tumours - lymphoma and medulloblastoma
desiccated secretions into the paranasal sinuses

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45
Q

where does hypertensive microangiopahty affect

A

basal ganglia, thalami, cerebellum and pons

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46
Q

where does cerebral amyloid angiopathy affect

A

lobar in the cortico-subcortical sites , spares the deep structures

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47
Q

in MR spectroscopy what happens with Choline

A

marker of cell turnover and increases with most abnormalities

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48
Q

in MR spectroscopy what happens with NAA

A

marker of neuronal viability and decreases with most abnormalities

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49
Q

which way should hunters angle be pointing in normal Brian

A

normally the angle should be pointed upwards. as the Choline < Creating< NAA in a normal person.

In brain disease the angle point downwards

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50
Q

what might high choline levels distinguish

A

tumour vs edema
radiation induced cnecrosis

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51
Q

what might the prescence of 2-HG on MR Spectroscopy reveal

A

IDH - mutant status in gliomas

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52
Q

in MR spectroscopy, what are prominent lipid/lactate peaks associated with ?

A

high grade gliomas and lymphoma

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53
Q

what is very high on MR spectroscopy in Canavan disease >

A

NAA

this is a autosomal recessive condition where there is a deficiency in the n-acetylasparacylase which is important in myeline synthesis. this results in Increased NAA levels.

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54
Q

which CNS regions do no have a BBB

A

choroid plexus
pituitary and pineal glands
tuber cinereum - circadium rhythm in the inferior hypothalamus
area postream - controls vomiting and in the inferior aspect of the forth ventricle

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55
Q

which areas are typically affected in herpes encephalitis ?

A

medial temporal lobes and cingulate gyrus will show gyral enhancement with restricted diffusion

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56
Q

what are the key imaging features of a cerebral abscess

A

reduced diffusivity
hypointense rim on T2 weighted images

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57
Q

in MR, what is dural enhancement a sign of

A

dural edema due to a pathology

to see enhancement there must be both water and gad present. however the dural layer doesn’t usually have water. so only pathologies with water will show dural enhancement

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58
Q

which pathologies demonstrate dural enhancement ?

A

intracranial hypotension
post operatively
post lumbar puncture
meningeal neoplasm - meningioma

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59
Q

what does the leptomeninges include?

A

the Pia and arachnoid

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60
Q

what is the primary cause of leptomeningeal enhancement >

A

meningitis

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61
Q

which metastatic cancers cause leptomengieal enhancement

A

lymphoma and breast cancer

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62
Q

what does infarction of the artery of perchon result in

A

bilateral thamali infarction - as one artery supplies both

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63
Q

what does the recurrent artery of heubner supply?

A

the head of the caudate lobe and the anterior limb of the internal capsule

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64
Q

what’s the most common complication of a subarachnoid haemorrhage

A

vasospasm

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65
Q

what is the gold standard for diagnosisng vasospasm

A

DSA

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66
Q

what is the treatment of vaspasms.

A

the 3 Hs
hypertension
hypervolaemia
hemodilution

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67
Q

what drug is given to prevent vasospasm

A

oral nimodipin

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68
Q

what causes superficial siderosis and how does it present

A

iron overload of pial membrane due to repeated SAH.
Presents with sensorineural deafness and ataxia

69
Q

what is classified as a giant saccular aneurysm ?

A

> 2.5cm

70
Q

what nerve does a PCOM aneurysm compression

A

the oculomotor nerve

71
Q

where do aneurysms formed from hypertension commonly occur

A

in the basal ganglia - known as Charcot-bouchard aneurysms

72
Q

which diseases increase the risk of aneurysms

A

marfans, ehlers-danlos, PCKD, neurofibromatosis

73
Q

what is the most common source for mycotic aneurysms ?

A

bacterial endocarditis

74
Q

what is the gold standard for mycotic aneurysms ?

A

DSA

75
Q

what is an oncotic aneurysm and what is It caused by?

A

tumour - usually left atrial myxoma

76
Q

what is the venous angle a landmark for on cerebral angiography

A

foramen of munro

77
Q

what does a venous infarction of the superior saggital sinus cause

A

infraction of the parasagittal cortex

78
Q

what does a venous infarction of the deef venous system cause

A

infarction of both thalami

79
Q

what does venous infarction of the transverse sinus cause

A

infarction of the posterior temporal lobe

80
Q

what does extracellular methemoglobin look like

A

bright on T1 and T2

81
Q

where does hypertensive haemorrhage typically occur

A

basal ganglia, thalamus and cerebllum

82
Q

what is cerebral amyloid angiopathy

A

amyloid accumulates into the vessel walls of small and medium arteries, this causes vessel weakness and increased risk of haemorrahge

83
Q

where do cerebral amyloid angiopahy haemorrhages occur

A

cortically within the lobes - parietal or occipital

84
Q

what is moyamoya disease

A

non-atherosclerotic vasculopathy caused by progessive stenosis of the intracranial internal carotid arteries and their proximal branches.
this results in the formation of fragile collateral vessels, - looking like puff of smoke on MRA/DSA

85
Q

what does scirrhous carcinoma look like ?

A

leather bottle appearance - abnormal thickening of the stomach and smaller size due to fibrosis. it is a subtype of gastric cancer.

86
Q

what does abdominal tuberculosis commonly affect ?

A

the ileo-caeca valve - it becomes thickened resulting in narrowing of the terminal ilium

is is associated with ascitis - unlike chrons which never has ascites

87
Q

what is lateral medullary syndrome caused by?

A

thrombus/atheroscerloss in the vertebral artery or PICA

88
Q

what are the symptoms of lateral medullary syndrome

A

vestibular signs - falling tot he side of the lesions
Autonomic signs - hiccups. Horners

89
Q

an anerysm where will cause oculomotor nerve palsy

A

one at the junction of the PCOM and ICA

90
Q

on MRI what would a superior saggital sinus thrombus appear like ?

A

static blood gives a high signal on T1

91
Q

what type of haemorrhages are specific for superior saggital thrombus

A

parasaggital haemorrahge

92
Q

what is the common location for a venous epidural haematoma

A

the vertex
the anterior portion of the middle crania fossa
the occipital portion of the posterior cranial fossa

93
Q

what is the characteristic locations of DAI

A

grey-white matter junctions of the cerebral hemisphere
corpus callosum
midbrain (dorsolateral)

94
Q

which are the most common brain mets to bleed ?

A

melanoma
rcc
thyroid
choriocarcinoma

95
Q

which lesions occur at the cerebellar pontine angle

A

vestibular schwannoma
meningioma
epidermoid cyst

96
Q

which tumours arise at the pineal region?

A

pineoblastoma
germinoma

97
Q

which tumours involve the corpus callosum

A

lymphoma and glioblastom

98
Q

what is the most common central skull base tumour ?

A

chordoma , chondrosarcoma

99
Q

what’s the most common suprasella tumour in an adult and then child?

A

adult - pituitary adenoma
child- craniopharngimoa

100
Q

what is the most common posterior fossa tumour in adults

A

haemangioblastoma, and mts

101
Q

what the most common posterior fossa tumours in children

A

pilocytic astrocytoma, medulloblastoma, ependymoma

102
Q

most common mass in the foramen of munro? adults and children

A

colloid cyst - adults
subependymal giant cell astrocytoma

103
Q

what is an IDH wild type tumour ?

A

Glioblastoma

104
Q

what does gliomatosis cerebri mean

A

if affects more than 3 lobes

105
Q

IDH mutant gliomas include

A

oligodendrogliomas and astrocytomas

106
Q

what is the FLAIR mismatch sign specific for

A

astrocytomas (IDH-mutant Ip19q non-codeleated)

107
Q

where are oligodendrogliomas typically found

A

cortically based mass found in the frontal and temporal regions with gyriform calcification

108
Q

The pneumonic P-DOG MD is for Supratentorial tumours - low grade -what does it stand for ?

A

Pleomorphic xanthoastrocytomas
Dysembryoplastic neuroepithelial tumour
Oligodendroglioma
Ganglioglioma
Multinodular and vacuolating neuronal tumour
Desmoplastic infantile astryocytoma and ganlioglioma

109
Q

what gene mutation is seen in PXA

A

BRAF V600E

110
Q

what do PXA’s look like

A

enhancing mass
cyst formation
plaial tail

111
Q

which tumours are associated with focal cortical dysplasia

A

DNET and ganglioglioma

112
Q

where do gangliogliomas arise ?

A

temporal lobes

113
Q

what lesion is a small cluster of bubbles in the cortical/subcortical region within the temporal lobe?

A

Multinodular and vacuolating neuronal tumour

114
Q

when is imaging follow up required for pineal cysts ?

A

> 10mm

115
Q

what type of optic nerve disease are seen in NF1 and NF2

A

NF1 - optic nerve gliomas
NF2 - optic sheath meningiomas

116
Q

what symptoms does colloid cysts present with ?

A

usually arise at the formanen of munro in the 3rd ventricles, resulting in intermittent obstructive hydrocephalus. This causes a thunderclap headache - often positional

117
Q

what is cowden syndrome

A

multiple harmatomas in the body

118
Q

classic imaging finding of a pilocytic astrocytoma ?

A

large cystic mass centred in the cerebellum with an enhancing nodule
if found in the optic pathway - associated with NF1

119
Q

what is the classic imaging finding of a medulloblaystom

A

large solid mass usually in the midline of the posterior fossa
avidly enhancing
low ADC values
leptomeningeal enhancement is common - icing sugar

120
Q

if a patient has medulloblastoma, what needs to be imaged ?

A

drop metastasis are common so the whole spine needs to be imaged

121
Q

if a patient has medulloblastoma, what needs to be imaged ?

A

drop metastasis are common so the whole spine needs to be imaged

122
Q

what syndrome is lhermitte-duclos associated with ?

A

cow dens syndrom
(multiple harmatomatous disease)

123
Q

what is the classic features of a haemangioa

A

large cystic mass with surrounding oedema and an enhancing nodule
posterior fossa = cerebellum

124
Q

what syndrome are haemangiomas associated with

A

von hippel lindau

125
Q

where doe pleomorphic xanthastrocytomas occur and what do they look like ?

A

usually occur in the temporal lobe
cystic lesion, may have haemorrhage

126
Q

what do DNETs look like ?

A

temporla lobe lesion, soap bubbly appearance with a bring rim with enhancement

127
Q

what do gangliogliomas look like

A

temporla lobe lesions with cystic mass and an enhancing nodule with calcification

128
Q

what do desmoplastic infantile astrocytoma and gangliogliomas look like

A

present as infants with rapidly enlarging head
large multipcystic and solid mass - the solid mass enhances

129
Q

where else might patients with a rhabdoid tumour in the brain get a problem

A

the kidney

130
Q

where do Intraventricular meningiomas commonly occur

A

in the trigones of the lateral ventricles - they homogeneously enhance

131
Q

what tumour commonly arises from the septum pellucidium

A

central neurocytoma

132
Q

what condition are subependymal giant cell astrocytomas associated with

A

tuberous sclerosis

133
Q

what is the characteristic features of a chord plexus tumor

A

cauliflower like Intraventricular mass that avidly enhances
entirely Intraventricular

134
Q

what is the most common cause of a ring-enhancing brain mass in a patient with HIV

A

lymphoma
toxoplasmosis

135
Q

what are the most common cancers to metastasis to the brain

A

lung
breast
melanoma

136
Q

what are the most common haemorrhagic metastases to the brain

A

melanoma
renal cell carcinoma
chroicarcinoma
thyroid cancer

137
Q

what condition predisposes to meningiomas

A

neurofibromatosis type 2

138
Q

what do meningiomas look like.

A

avidly enhancing
dural tail - due to vasoactive substances related from the tumour

139
Q

what does a cholesterol granuloma typically look like

A

a blue tympanic membrane,
large mass in the petrous part of the temporal bone or middle ear
contains cholesterol and blood so high on T1

140
Q

what are the 3 differentials for a cerebellar pontine angle ?

A

schwanoma
epidermoid
meningioma

141
Q

brain - causes of high T1 signal

A

melanin
fat
protein
contrast
methhaemaglobin (subacute bleed)

142
Q

what is vernet syndrome

A

a lesion at the jugular foramen resulting in :
- loss of taste at the posterior 3rd of the tongue
- vocal chord paralysis
- weakness of sternocleidomastoid and traps
- dysphasia

143
Q

what are the 3 neopaslsm of the pineal region

A

germ cell tumour - germinoma / teratoma
pineal parcenhymal tumours - pineocytoma -> blastoma
pineal glioma

144
Q

what are the 4 main locations of T2 white matter lesions in MS ?

A

juxtacortical
periventricular
spinal - cervical
infratentorial

145
Q

what can happen to the corpus callosum in chronic MS

A

thins

146
Q

what is ADEM

A

acute monophasic demylinating disorder - usually occurs in children after a vaccination

147
Q

what is vasogenic oedema ?

A

affects the white matter mainly
the BBB is disrupted

148
Q

what is PRES

A

neurotoxic state where the posterior circulation fails to autoregulate in response to acute changes in blood pressure
this results in hyperperfusio and resultant vasogenic oedema - which mainly affects the white matter

149
Q

which lobes are more specific to CADASIl

A

anterior temporal lobes or paramedical frontal lobes - especially when associated with migraine

150
Q

what virus causes progressive multifocal leukoencephalopathy ?

A

JC virus

151
Q

what does wernickle encephalopathy present with

A

ataxia, confusion and oculomotor dysfunction

152
Q

where does wernickel encephalopathy usually affect

A

the thalamus, periductal grey matter, hypothalamus, mammillary bodies

153
Q

what does fahrs disease result in

A

idiopathic bilateral basal ganglia calcification

154
Q

what CT findings are typical of hypoxic ischaemic encephalotpahy ?

A

loss of grey white matter differentiation
diffuse cerebral hypoattenuation
sulcal effacement
white cerebellum sign - sparing of the cerebellum which appears relatively hyperlattenuation when compared to the affected supratentorial brain

155
Q

where dose methanol posinionig usually affect

A

causing hemorrhagic necrosis of the putamen - but not affected the globus pallidus

156
Q

what’s the hallmark finding of Carbon monoxide poisoning

A

symmetrical necrosis of the globus pallidi - causing hyperintenseity with a hypointense rim on FLAIR

157
Q

What is the radiological manifestation of huntintons disease?

A

atrophy of the caudate lobe

158
Q

What is polycythemia associated with ?

A

haemgioblastoma

159
Q

in true Parkinson’s disease where will there be loss of uptake on a dopamine scan ?

A

the posterior putamen

160
Q

what is the classic feature of Huntingtons disease?

A

atrophy of the caudate head - resulting in prominence of the lateral ventrciels

161
Q

on PET scan for alzhiemers - where will there be low metabolism?

A

precuenus and posterior aspect of the cingulate gyrus

162
Q

involvement of the middle cerebral peduncle makes you think of MS or small vessel disease ?

A

MS

163
Q

where does ADEM classically invovle/

A

the basal ganglia - thalamus

164
Q

In the brain where does Wilsons disease commonly affect ?

A

basal ganglia and thalami

165
Q

where does herpes encephalitis commonly affect

A

the mesial temporal lobe

166
Q

what should be the first consideration in a patient with fever and mesial temporal lobe enhancement

A

herpes encephalitis

167
Q

where does toxoplasmosis tend to affect

A

the basal ganglia

168
Q

what is the hockey stick and pulvinar sign associated with?

A

CJD - describes Hyperintensity of the dorsomedial thalami

ST2 Radiology (13 decks)

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