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Radiology > Neuroradiology > Flashcards

Neuroradiology Flashcards

1
Q

Third ventricle recesses

A

Chiasmatic (Supra optic)
Infundibular
Suprapineal
Pineal

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2
Q

Massa intermedia

A

Gray and white matter
Passes 3rd ventricle
Connects bilateral thalami

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3
Q

Ventricles connection

A

Lateral—>3rd : Monro
3rd —> 4th: cerebral aqueduct
4th—> spinal canal: obex
4th —> subarachnoid and basal cisterns: Luschka and Magendie

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4
Q

Choroid plexus locations

A

Body and temporal horn of lateral

Roof of 3rd and 4th

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5
Q

CSF absorption

A

Arachnoid granulation (evaginations into dural venous sinuses)
Lymphatic
Cerebral veins

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6
Q

Cytotoxic vs vasogenic vs interstitial edema

A

Cytotoxic: involves both gray and white matter/ due to cell death(infarct)

Vasogenic: primarily in white matter ( neoplasm, infection)

Interstitial: obstructive hydrocephalus/ periventricular fluid ( transependymal flow of CSF)

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7
Q

Subfalcine herniation

A

Cingulate gyrus under the falx
Compression of ACA
Foremen of Monroe obstruction—> contra lateral hydro

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8
Q

Transtentorial(uncal) herniation

A

Downward: inferomedial uncus displacement—> ipsilateral CN 3(oculomotor) eye is down and out
Ipsilateral PCA: medial temporal/ occipital infarct
Duret hemorrhage
Contra lateral cerebral peduncle compression against Kernohan’s notch—> ipsilateral hemiparesis

Upward: superior tentorial of cerebellar vermis( posterior fossa mass effect) —> obstructive hydro

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9
Q

Cerebellar tonsillar herniation

A

Compression of medulla

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10
Q

Hydrocephalus types

A

Communicating:
Subarachnoid hemorrhage
Normal pressure hydrocephalus (lateral and 3rd)

Noncommunicating:
Obstruction
3rd colloid cyst
Posterior fossa mass

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11
Q

Basal or perimesencephalic cisterns

A 
Suprasellar
Prepontine
Interpeduncular
Ambient
Quadrigeminal
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12
Q

Disc bulge vs herniation

A

Broad based bulge: >180 of disc circumference
Greater than 2mm

Herniation: <90 of disc circumference
Protrusion: neck>dome
Extrusion: neck

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13
Q

Nerve root exit site

A

Thoracic and lumbar: below
Cervical: above
C8 below C7 vertebral body

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14
Q

Position of herniation

A

Medial(Central, Paracentral):descending nerve root / L4-5 herniation—> Descending L5

Lateral(Foraminal, Far lateral):exiting nerve root/ L4-5–> exiting L4

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15
Q

Disc degeneration on imaging

A

Hypo on T2
Loss of height
Osteophytes
Schmorl’s node: superior or inferior disc herniation ( hyper on T2)

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16
Q

Modic changes

A

Modic 1: hyper T2 hypo T1/ inflammation/active back pain/ better surgery outcome

Modic 2: hyper on both/ fatty proliferation/ chronic ischemia/ no symptom

Modic 3: hypo on both/ sclerosis

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17
Q

Ligamentum flavum hypertrophy

A

Posterior of spinal canal
Infolding/ inward buckling
Stenosis

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18
Q

Facet Arthropathy

A

Medial to neural foramina
Can cause neural foraminal narrowing
Associated with synovial cyst ( hyper T2, variable T1)

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19
Q

Tarlov cyst

A

Perineural cyst in sacrum/ within nerve root sheath

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20
Q

High intensity zone

A

Hyper T2 in annulus fibrosus
Fissure or tear /can cause pain
Due to disc degeneration

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21
Q

Diffuse idiopathic skeletal hyperostosis

A

Anterior osteophytes extending at least four levels
Disc spaces are preserved

Spinal fx with small trauma (like AS)
Associated with OPLL

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22
Q

Ossification of Posterior Longitudinal Ligament

OPLL

A

Spinal canal stenosis
Compression on anterior cord

Low signal on MRI
Begins in cervical spine

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23
Q

Scar vs recurrent disc

A

Both hypo on T2
Scar enhances throughout
Disc enhances peripherally

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24
Q

Pyogenic disc it is/ osteomyelitis

A

Hematogenous source
Staph aureus

Adults: starts from subchondral bone then disc
Pets: starts from disc then end plates

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25
Q

Discitis/osteomyelitis on imaging

A

Marrow hypo on T1, both sides of abnormal disc which is hyper on T2
Loss of height
Loss of definition
Vertebral collapse

Adjacent soft tissue infection

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26
Q

Tuberculous osteomyelitis

Pot disease

A

Discs are spared

Wedge shaped compression anteriorly/ gibbus deformity

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27
Q

Gibbus deformity

A

Acutely angled kyphosis

Compression fracture
Achondroplasia
Mucopolysaccharidoses(Hunter and Hurler)

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28
Q

Dural AV fistula

A

Older males
Back pain and progressive myelopathy

Cognard type 5

MRI: flow voids surrounding the cord
Swollen cord

Myelogram: serpiginous filling defects in subarachnoid

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29
Q

Spinal cord infarction

A

Upper thoracic and thoracolumbar

Bowel bladder incontinency, loss of perineal sensation
Motor and sensory loss of legs

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30
Q

Blood supply to distal cord

A

Artery of Adamkiewicz

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31
Q

Risk factors for spinal cord infarction

A 
Aortic surgery
Aortic aneurysm
Arthritis
Sickle cell
Vascular malformation
Herniation
32
Q

Spinal cord infarction on imaging

A

Hyper on T2
Enlarged cord
Restricted diffusion

Concomitant vertebral body infarction: sickle cell and steroid use

33
Q

Tethered cord syndrome

A

Back and leg pain
Gait spasticity
Decreased lower sensation

Conus should end superior to inferior of L2
If below—> tethered

Thickened film or lipoma

34
Q

Diastematomyelia

A

Congenital
Split spinal cord
Cause of scoliosis

35
Q

Fatty film

A

Fat within film terminals
Associated with diastematomyelia, Tethered cord

Hyper on T1

36
Q

Orbital cavity bones

A 
Frontal
Ethmoid
Nasal
Zygomatic
Maxilla
37
Q

Optic foremen

A

Optic nerve

Ophthalmic artery

38
Q

Superior orbital fissure

A

CN III: superior, medial, inferior, inferior oblique
CN IV: superior oblique (SO4)
CN V1: sensory upper face
CN VI: lateral rectus (LR6)
Superior ophthalmic vein: valveless/ infection to brain

39
Q

Inferior orbital fissure

A

CN V2: sensory inferior eyelid, upper lip, nose

Infraorbital artery

40
Q

CN V2 course

A

Cavernous sinus—> foramen rotardum—>inferior orbital fissure

41
Q

Orbits compartments

A

Septum : orbit margin—> Tarsus of eyelid

Presentable/postseptal: infection

Postseptal
Extra conal: lacrimal gland, fat, bone
Conal: extraocular muscles
Intraconal: optic nerve-sheath complex, sensory motor of orbit, LNs, fat
Globe
42
Q

Optic nerve-sheath complex

A

Optic nerve
Surrounding CSF
Leptomeningeal and dural coverings

43
Q

Extraocular muscles origin

A

Inferior oblique: medial floor

Rest: annulus of Zinn, apex of orbit at optic foramen and medial superior fissure

44
Q

Orbital infection causes

A

Paranasal sinuses
Trauma
Foreign body
Odontogenic

45
Q

Preseptal infection

A

Swelling and erythema of eyelid

46
Q

Orbital cellulitis

A

Not yet organized or peripherally ring enhancing

47
Q

Subperiosteal abscess

A

Organized at periosteum
Exophthalmos
Visual impairment
Surgical emergency

48
Q

Orbital abscess

A

Severe form of subperiosteal
Ophthalmoplegia
Exophthalmous
Visual impairment

49
Q

Cover outs sinus thrombosis

A

Multiple CN palsy

Orbital abscess

50
Q

Orbital hemangioma

A

Cavernous: in adults, most common, progressive proptosis
Imaging: CT—>intraconal,ovoid, enhancing
MRI—>iso T1/ hyper T2, early patchy enhancement with progressive filling
Capillary: first year of life, rare
With port-wine stain and strawberry hemangioma
Enlarges first year then involuted

51
Q

Orbital lymphoma

A 
With systemic disease
Lacrimal gland involvement—> painless downward proptosis
CT: hyper dense 
MRI: hypo on T1 and T2
Mold the globe

DDx: pseudotumor/ painful

52
Q

Orbital Lymphangioma

A 
Hamartomatous
In peds
Extra conal
Multilocular cystic mass, complex, fluid level
Peripheral and septal enhancement
53
Q

Orbital Schwannoma/ neurofibromas

A

Schwannoma more common
Sensory of V1–> superior orbit

MRI: hypo T1, hyper T2 with enhancement

54
Q

Orbital metastasis

A

Breast, lung, thyroid, renal, melanoma

Metastatic breast cancer: no exo sometimes endophthalmous

Peds with Neuroblastoma: sunburst type Periosteal reaction

55
Q

Lacrimal gland lesion

A

Epithelial salivary and lymphoid tissue

Epithelial: 50% benign poleomorphic adenoma
Malignant: adenoid cystic and mucoepidermoid carcinoma

Lymphoid: sarcoidosis, lymphoma, pseudotumor

56
Q

Thyroid ophthalmopathy

A

Lymphocytes—> hyaluronic acid—> fibrosis of muscles

Increases fat—>extraocular muscle enlargement

Inferior rectus—> medial—>superior—>lateral
(I’M SLow)

Bilateral, spares the tendons

57
Q

Orbital pseudotumor

A

Infiltrate of lymphocyte, plasma cell and macrophage
Painful proptosis
DDx: Wegener, sarcoidosis

Lacrimal gland
Imaging: fat stranding, increased ST, enlarged muscles
T2: steroid

58
Q

Tolosa- Hunt syndrome

A

Same as orbital pseudotumor but involves cavernous sinus

59
Q

Optic nerve glioma

A

Peds: low grade astrocytoma with indolent course
NF1/ bilateral
Imaging: fusiform, variable enhancement, cyst and nodule

Adults: anaplastic astrocytoma or GBM
Imaging: enhancing, involves chiasm, any part of optic tract

60
Q

Optic nerve meningioma

A 
Second most
Arachnoid cells
Middle age, female
Slow progressive visual impairment
Preserved central visual field

Imaging: circumferential thickening, uniform enhancement, tram-track sign

61
Q

Optic neuritis

A

Painful subacute vision loss and reduced color perception

MS(most), viral, sarcoidosis, vasculitis, toxins

Imaging: optic enlargement, T2 prolongation, enhancement(active phase)
Chronic: atrophy

62
Q

Devic syndrome

A

Neuromyelitis optica

Optic nerve and spinal cord, worse than MS
NMO-IgG—> Ab to aquaporin 4

Imaging: MS type lesions at optic tract s and spinal cord
Absence of brain lesions

63
Q

Retinoblastoma

A

Most common in globe/ Under 5 years/Leukocoria

Sporadic: unilateral/ Familial: bilateral
Imaging: hyper, enhancing, calcification

Trilateral: bilateral retino with pineoblastoma
Quadrilateral: bilateral retino, pineoblastoma and suprasellar retinoblastoma

64
Q

Coat disease

A

Vascular of retina
Boys
Lipoproteinaceous subretinal exudates—> retinal detachment

Normal size globe with subretinal soft tissue without enhancing

65
Q

Retinopathy of prematurity

A

Prolonged oxygen therapy

Abnormal vascular, hemorrhage, retinal detachment
Bilat microphthalmia, hyper globe

End stage: phthisis bulbs, shrunken nonfunctional globes

66
Q

Persistent hyper plastic primary vitreous

A

Embryonic vasculature within vitreous
Hemorrhage, cataract, detachment
Microphthalmia, hyper vitreous

No calcification

67
Q

Coloboma

A

Incomplete fusion of embryonic intraocular fissure
Elongated globe

Trisomy 13, 18, CHARGE, VATER

IMAGING: cone shaped deformity
Optic nerve coloboma: Posterior out pouching
Iris coloboma: anterior
Uvea: microphthalmous and cyst

68
Q

Sphenoid wing dysplasia

A

NF 1

CSF pulsating through defect , pulsation exophthalmos

69
Q

Septo-optic dysplasia

A

Optic nerve hypoplasia
Agenesis of septum

Associated with Schizencephaly

70
Q

T1 vs T2

A

T1–> longitudinal relaxation
T2–> transverse relaxation

T1 shortening—> hyper
Prolongation—> hypo

T2 shortening—> hypo
Prolongation—> hyper

71
Q

Conventional spin echo T1

A

Most brain lesions hypo on T1

T1 hyper:
Gadolinium, fat,proteinaceous
Paramagnetic stages of blood(methemoglobin)
Melanin
Mineralization ( copper,iron,manganese)
Slow flow blood
Calcium
72
Q

Conventional spin echo T2

A

Most brain lesions are hyper on T2
Water is bright/ edema

T2 hypo:
Paramagnetic stages of blood( except hyper acute,extracellular methemoglobin)
Calcification
Fibrous
Highly cellular ( lymphoma, medulloblastoma)
Vascular flow void
Mucin ( desiccated sinus secretion)

73
Q

FLAIR—> fluid attenuation inversion recovery

A

T2 with suppression of water

T1: WM brighter than GM
FLAIR: WM darker than GM

74
Q

Conventional spin echo proton density

A

Highest signal to noise ratio

MS, demyelination plaques in posterior fossa

75
Q

DWI and ADC

A

DWI: signal loss by increased Brownian motion
T2 weighted, reduced diffusivity—> bright

ADC: without T2
reduced diffusivity—>dark

Higher b-value: more contrast, decreases signal to noise ratio

76
Q

Anisotropic

A

Tendency of water to diffuse along white matter tract

77
Q

Reduced diffusion DDx

A 
Acute stroke
Bacterial abscess
Cellular tumor( lymphoma, medulloblastoma)
Epidermis cyst
Herpes encephalitis
Creutzfeldt-Jakob disease

Radiology (3 decks)

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