Neuroradiology Flashcards
Enlarged perivascular (virchow robin) spaces?
- Cryptococcus (gelatinous pseudocyts, do not enhance) - Mucopolysaccharidoses (hunters, Hurlers) - Atrophy VR don’t contain CSF
Myelination pattern?
Progression: inferior to superior, posterior to anterior, central to peripheral Subcortical white matter is last to myelinate Brainstem and posterior limb of internal capsule are myelinated at 36 weeks
Corpus Callosum Development?
Front to back (but the rostrum is last)
Immature Myelin Appearance?
Higher water content- brighter on T2 and darker on T1 Mature myelin- bright on T1 and T2 dark T1 (1 yo) changes proceed T2 changes (2yo)
Paranasal sinus formation?
Maxillary -> Ethmoid -> Sphenoid ->Frontal
Foramen Ovale
CN V3, accessory meningeal artery
Foramen Rotundum
CNV2 (R2V2)
Superior Orbital Fissure
CN 3,4, V1, and CN 6
Inferior orbital fissure
CN V2
Foramen Spinosum
Middle meningeal artery (spine contains meninges)
Jugular foramen
Jugular vein, CN 9, CN 10, CN 11
Hypoglossal canal
CN12
Optic canal
CN 2 and opthalmic artery
What runs in the cavernous sinus
CN 3, 4, V1, V2, CN 6 (CN 2 and CN V3- do not run in)
What nerve is adjacent to the carotid artery in the cavernous sinus and is not within the wall?
CN6
Branches of external carotid?
Some administrators like fucking over poor medical students Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior Auricular Maxillary Superficial temporal
Internal Carotid Artery Branches?
C2- petrous C3 - Lacerum C4- Cavernous (site of CC fistulas) C5- Clinoid ( aneurysm can compress the optic nerve at this level) C6-Ophthalmic (origin at the dural ring- intrdural) C7- Communicating terminal (aneurysm can cause CN III palsy)
Fetal PCA?
PCOM is as large or bigger then the P1 segment PCOM is superior and lateral to CN 3 (as opposed to superior and medial in normal anatomy)
Deep Cerebral Veins
Basal Vein of Rosenthal Vein of Galen Inferior Petrosal Sinus
Superficial Cerebral Veins
Vein of Trolard (drains into superior sagittal sinus) Vein of Labbe (drains into the transverse sinus) Superficial Middle Cerebral Veins Superior Cerebral Veins
CN III Palsy
Terminal Aneurysm Aneurysm of the PComm Artery
CN 6 palsy
Increased intracranial pressure
Intacranial hypotension
Sagging of midbrain meningeal enhancement distension of dural venous sinuses
Intracranial Hypertension
Empty Sella Optic Hydrops Papilledema
Vasogenic Edema
Extracellular
Cytotoxic edema
Intracellular Na/K pump
Hydrocephalus
Obstructive: Non-communicating- involves the ventricular system Communicating-Involves the villi/arachnodi granulations Non-obstructive: Increased production of CSF- choroid plexus papilloma
Transtentorial Herniation
Effaces ipsilateral suprasellar cistern first Duret hemorrhage from basilar artery perforators
Multiple Sclerosis
- Relapsing and remitting is most common type - Acute plaques should restrict diffusion - Tumefactive- incomplete ring enhancement Marburg- childhood variant, fulminant, rapid demise
ADEM
Post-viral/vaccination T2 bright lesions, which enhance in a nodular/ring like fashion Typically don’t involve the collosal septal interface
Hurst Disease/ Acute Hemorrhagic Leukoencephalitis?
Fulminant from of ADEM, hemorrhage on seen on autopsy
Wenick’e Encephlopathy
Enhancing mammillary bodies Edema in the medial thalami and periaqueductal gray matter
Carbon monoxide
T2 bright globus palladi
Marchiafava-Bigmani
Demylination and Necrosis of the CC- T2 hyperintense signal in the corpus callosum, which starts in the central CC Associated with alcoholism and chronic nutritional deficiencies
What is preserved on FDG-PET in dementia?
Motor strip
Mimics of vascular dementia?
Lyme disease, HIV, Vasculitis
First sign of alzheimer’s?
Hippocampal atrophy (temporal atrophy > 3 mm is suggestive)
Crossed Cerebellar Diaschisis
contralateral cerebellum has decreased uptake
Binswangers
Small vessel vascular dementia spares subcortical U-fibers
TORCH- CMV
Most Common TORCH infection - Periventricular calcifications - Highest association with polymicrogyria
TORCH- Toxoplasmosis
Associated with hydrocephalus Basal ganglia calcifications
TORCH- HSV
HSV-type 2 Thrombus and hemorrhagic infarctions
HIV- Intrauterine
Atrophy of the frontal lobes
PML
JC virus Involves the subcortical U fibers CD4 count typically less than 50 T2 lesions out of proportion to mass effect
Toxoplasmosis
Most common opportunistic infection in HIV T2 bright, ring enhancing lesion, lots of edema, NO RESTRICTION Cold on thallium (lymphoma is hot on thallium)
Hydrocephalus and nodular enhancement of the basilar meninges?
TB (sarcoid generally does not cause hydrocephalus)
HSV infection- Adults
HSV 1 First sign is restricted diffusion May have hemorrhage
Limbic Encephalitis
Paraneoplastic syndrome (ex: small cell carcinoma of the lung) No enhancement
CJD
Diffusion restriction-cortical ribboning, hockey stick sign (medial thalamus)
Stages of Neurocysticercosis
- Vesicular- thin walled cyst, no edema 2. Colloid- Hyperdense cyst with edema 3. Granular- cyst shrinks, wall thickens (less edema) 4. Nodular- calcified lesion, no edema
Cortically Based Tumors?
Dysembryoplastic Neuroepithelial Tumor (DNET) Oligodendroglioma Ganglioglioma
NF1
Optic gliomas/Astrocytomas Plexiform neurofibromas Iris Hamartomas
NF2
Multiple schwannomas Meningiomas Ependymomas
Tuberous Sclerosis Tumors
Subependymal tubors Giant Cell astrocytomas
VHL
hemangioblastomas (cerebellar) Others: Pheochromocytomas Retinal angiomas Choriod plexus papilloma Endolymphatic sac tumor Pancreatic cyst, islet cell tumor, adenocarcinoma RCC- clear cell Renal AML, cysts Liver cysts Cysts of the epididymis
What low grade tumors can enhance?
JPA, gangliogliomas
Restricting lesion in the CP angle?
Epidermoid
Calcified cortically based mass?
Oligodendroglioma 1p/19q deletion have a better prognosis
Hemorrhagic Mets?
RCC Thyroid Melanoma Choriocarcinoma
What is associated with GBM?
Turcot Syndrome- medulloblastoma, intestinal polyposis
Hemangioblastoma?
Associated with VHL Can cause polycythemia (increased epo levels) Cyst with enhancing mural nodule, can have prominent flow voids
Benign choroid plexus mass that restricts diffusion?
xanthogranuloma Do not touch lesion
Most common type of functional pituitary adenoma?
prolactinoma
Pituitary apoplexy is assocaited with?
Bromocriptine use Sheehan Syndrome- post-partum necrosis
Craniopharyngioma?
Calcifications Can have papillary- Solid and capsule (adult) or Adamantinomatous type, cysts which can have protein and hemorrhage (peds)
Meningiomas can be hot on what nuclear medicine studies?
Tc-MDP octreotide
Which CPA mass invades to internal auditory canal?
Schwannoma- widen porus acousticus Meningiomas typically don’t widen IAC
What differentiates ana arachnoid cyst from epidermoid?
Epidermoid restricts diffusion and are mildly bright on FLAIR, both lesions follow CSF signal
Most common dural metastases?
Breast Cancer
Hemangiopericytoma
-Aggressive sarcoma that invades skull, can mimic an aggressive meningioma -Don’t Calcify
Rapidly increasing head circumference in child
Desmoplastic infantile ganglioglioma/ Astrocytoma Typically supratentorial, cystic masses
Most common location of Choroid Plexus Papilloma?
Adults- 4th ventricle Kids- Lateral ventricle (usually trigone)
Where does neuroblastoma like to involve?
Calvarium Dura Postero-lateral aspect of orbits
Dysembryoplastic Neuroepithelial Tumor Characteristic?
Temporal Lobe T2 Bubbly appearance Frequently presents as drug resistant seizures
Pleomorphic Xanthroastrocytoma
Temporal lobe involvement Cyst with nodule
What lesion is in the tuber cinereum and assocaited with gelastic seizures?
Hypothalamic Hamartoma (most common presenting sign is actually precocious puberty)
Medulloblastoma?
Typically arise from vermis and project into 4th ventricle Restrict diffusion, enhance homogenously Drop mets are common Associated with basal nevus syndrome and turcots
What is gorlin syndrome?
Medulloblastoma + dural calcifications + basal cell skin cancers + odontogenic cysts
Pineal mass containing fat and calcifications?
Germinoma- engulf the pineal gland (pineocytoma and pineoblastoma expand the pineal gland) Most commonly seen in boys in the pineal region and girls in the suprasellar region
What can germinomas secrete?
HCG- precocious puberty
What is associated with pineoblastoma?
retinoblastoma (3rd place of retiunoblastoma)
Lhermitte-Duclos is associated with?
Cowden Syndrome
Most sensitive sequence for subarachnoid hemorrhage?
FLAIR
Le Forte 1
lateral nasal aperture
LeFort 2
Inferior orbital rim and floor
LeFort 3
Zygomatic Arch and lateral orbital rim/wall
ZMC fracture
involves the zygoma, inferior and lateral orbit