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Neuroradiology Flashcards

1
Q

Name 3 findings of neurosarcoidosis

A

Pachy and leptomeningeal enhancement

Periventricular high T2 signal

Facial, optic nerve and pituitary stalk enhancement

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2
Q

What does reversed flow in ECA mean?

A

CCA occlusion (steal phenomenon via collateral circulation)

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3
Q

Name 2 Cxs of subfalcine and trans-tentorial (uncal) herniation

A

Subfalcine: ACA infarct and contralateral hydrocephalus

Trans-tentorial: PCA infarct and CN III palsy

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4
Q

What’s Kernohan’s notch and Duret haemorrhages associated with?

A

Trans-tentorial herniation

KN: focal impression on contralateral cerebral peduncle

DH: ventral paramedian mid-brain haemorrhage

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5
Q

Name 3 features of the BBB. What substances can cross?

A

Continuous capillaries (no fenestrations)

Endothelial cells connected by tight junctions

Continuous basement membrane + astrocyte foot processes wrapping around

Lipophilic substances can cross BBB: caffeine, alcohol, heroin

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6
Q

Name 3 intracranial structures with fenestrated capillaries

A

Choroid plexus

Midline organs: pineal gland and pituitary stalk

Dura

These enhance post contrast unlike normal brain parenchyma which is protected by the BBB

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7
Q

Subcortical WM infarcts that cross many territories?

A

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)

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8
Q

Difference b/w cavernoma and capillary telangiectasia in the brain?

A

Both consist of abnormal dilated vascular channels, but cavernoma has NO intervening brain tissue

Cavernoma association: DVA
CT assoc: HHT, XRT

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9
Q

3 common locations for DAI and what % haemorrhagic?

A

GWM junction (mild)

Posterior body and splenium of CC (moderate)

Dorsolateral pons (severe)

Only 20% haemorrhagic

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10
Q

What is obliterative endarteritis in TB meningitis?

A

Affects arteries running through the subarachnoid space: ischaemia of BG and internal capsule in 20-40%

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11
Q

3 main patterns of fungal CNS infection?

A

Basal meningitis (hydrocephalus)

Vasculitis (mucormycosis, aspergillosis)- thrombosis and haemorrhagic infarctions

Parenchymal invasion

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12
Q

How does cryptococcal and candida CNS infections present?

A

Cryptococcal: gelatinous pseudocysts in VR spaces

Candida: multiple micro-abscesses

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13
Q

Difference b/w CJD and variant CJD?

A

CJD: rapidly progressive dementia

vCJD: young adults with slower dementia and extensive cortical plaques

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14
Q

What’s ADEM and how does it differ from MS?

A

Demyelinating disease with relative preservation of axons following viral infection

In contrast to MS, the lesions are monophasic

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15
Q

What is Devic disease (NMO) and who gets it?

A

Synchronous bilateral optic neuritis and spinal cord demyelination

Occurs in Asians

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16
Q

McDonald’s criteria for the Dx of MS?

A

Dissemination in space (at least 2 different locations)

Dissemination in time (at least 2 separate attacks)

CSF oligoclonal bands

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17
Q

Name 4 microscopic features of Alzheimer?

A

Neuritic (senile) plaques in hippocampus and amygdala: beta-amyloid core and positive stain with Congo red

Neurofibrillary tangles: filaments in cytoplasm of neurones

Amyloid angiopathy: beta-amyloid deposition in SA vessels

Hirano bodies: eosinophilic bodies in hippocampus

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18
Q

Triad of Parkinsonism and pathophysiology?

A

Rigidity, bradykinesia and tremor

Damage to the striatonigral dopaminergic system

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19
Q

Name 2 parkinson plus syndromes:

A

Parkinson + other features and more rapid progression

MSA and PSP

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20
Q

Name 3 types of MSA

A

MSA-P: Parkinson dominant but resistant to L-dopa (atrophy of striatum)

MSA-C: Cerebellar dysfunction (atrophy of cerebellum/pons etc)

MSA-A: Autonomic neuropathy (Shy-Drager: hypotension, ED)

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21
Q

What is PSP associated with?

A

Abnormal tau accumulation

Opthalmoplegia, pseudobulbar palsy, dementia

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22
Q

Tigroid MRI appearance

A

Metachromatic leukodystrophy (most common inherited leukodystrophy)

Myelin loss and gliosis

Sparing of subcortical U-fibres

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23
Q

Calcium deposition in basal ganglia

A

Fahr disease (cerebrovascular ferrocalcinosis)

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24
Q

Iron deposition in globus pallidus

A

Hallervorden-Spatz disease

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25
Subcortical WM infarcts that cross many territories?
CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) Involves anterior temporal lobes (spared in CSVI) Notch 3 gene (skin biopsy) and family Hx of early strokes
26
Difference b/w cavernoma and capillary telangiectasia in the brain?
Both consist of abnormal dilated vascular channels, but cavernoma has NO intervening brain tissue Cavernoma association: DVA CT assoc: HHT, XRT
27
3 common locations for DAI and what % haemorrhagic?
GWM junction (mild) Posterior body and splenium of CC (moderate) Dorsolateral pons (severe) Only 20% haemorrhagic
28
What is obliterative endarteritis in TB meningitis?
Affects arteries running through the subarachnoid space: ischaemia of BG and internal capsule in 20-40%
29
3 main patterns of fungal CNS infection?
Basal meningitis (hydrocephalus) Vasculitis (mucormycosis, aspergillosis)- thrombosis/ infarct Parenchymal invasion
30
Name 2 grade 1 astrocytomas
Pilocytic astrocytoma and SEGA
31
What distinguishes GBM from anaplastic astrocytoma?
Necrosis and Neovascularisation
32
What tumours show these on histology? 1. Pseudopalisading 2. Fried-egg appearance 3. Perivascular pseudo-rosettes
GBM Oligodendroglioma Ependymoma
33
DNET: grade, histology and association
Mixed glial-neuronal tumour (grade I) Floating neurons in pool of fluid on histology Associated with focal cortical dysplasia
34
What tumour has Flexner-Wintersteiner rosettes?
Retinoblastoma (can spread along optic nerve to SAS and brain)
35
Grade and paraneoplastic syndrome associated with haemangioblastoma
Grade I and polycythaemia from EPO secretion
36
What intracranial lesion is lined by pseudostratified epithelium (respiratory epithelium)?
Colloid cyst of 3rd ventricle
37
Difference between neurofibroma and schwannoma in terms of relationship to peripheral nerve?
NF engulf fibres of nerve and cannot be separated SWN attached to nerve but remains separable
38
Name 2 growth patterns of Schwannomas?
Antoni A- compact elongated cells with Verocray bodies Antoni B- less densely cellular tissue
39
Name 2 vascular lesions in the brain post XRT. Do they enhance and can they bleed?
Cavernoma and capillary telangiectasia | No enhancement and VERY RARELY bleed- most asymptomatic
40
Osmotic demyelination vs infarct
OD central symmetrical and spares periphery/ corticospinal tracts May involve BG and mid-brain Does show diffusion restriction
41
Symmetrical, high T2 signal within the mamillary bodies, medial thalami and peri-aqueductal region?
Wernicke-Korsakoff encephalopathy (thiamine deficiency)
42
Young female with sudden neck pain, dysarthria, diplopia- normal NECT brain/ neck. Next Ix?
Like VA dissection: CTA or MRI
43
Atlanto-occipital instability-name 4 features
Pre-dental interval >3 mm BAI and BDI >12 mm Occipital condyle fracture Note epidural haemorrhage is non-specific
44
Lateral displacement of C1 on C2 by up to 6 mm in total is normal in kids
True: due to disparity between growth of the 2 vertebrae
45
What structure in the spinal cord normally enhances post contrast?
Dorsal root ganglion (devoid of BBB)
46
Name 3 non-infective causes of optic neuritis
Multiple sclerosis (most common) ADEM, NMO Sarcoidosis
47
Name 3 infective causes of optic neuritis
Toxoplasmosis HIV HSV
48
Diagnostic criteria for NF-1
At least 2 of the following: | NOB-FLC and positive FHx
49
Name 2 mediastinal masses associated with NF-1
Lateral thoracic meningocele Extra-adrenal phaeochromocytoma
50
Name 3 vascular lesions associated with NF-1
Aneurysm/AVM Moya-Moya Co-arctation
51
Name 3 intracranial lesions associated with NF-1
Hamartomas (90%) as UBO Gliomas: optic nerve, PCA Plexiform neurofibroma (esp CN V)
52
Name 4 skeletal lesions associated with NF-1
SW dysplasia Dural ectasia and posterior VB scalloping Rib notching Gracile long bones and pseudo-arthrosis
53
Name 4 CNS manifestations of TS
Cortical and subcortical tubers Heterotopic GM Subependymal nodules SEGA
54
Name 5 non-CNS manifestations of TS
Cardiac rhabdomyoma Renal: AML, RCC, oncocytoma Osseus: hyperostosis calvaria, HPOA Pulmonary: LAM Skin: ash-leaf spots
55
Age and general presentation of VHL?
20-30 years Multi-organ cysts and neoplasms Skin is NOT involved
56
Name 3 diagnostic criteria for VHL
More than 1 haemangioblastoma of CNS 1 haemangioblastoma and visceral manifestation FHx and 1 manifestation
57
Name 4 non-CNS manifestations of VHL
Renal: cysts, bilateral RCC Adrenal: phaeochromocytoma (bilateral) Pancreatic: cysts, serous cystadenoma Endolymphatic sac tumour
58
Inheritance patterns of the 5 major phakomatoses
NF 1: AD and most common phakomatosis (Chr-17) NF 2: AD (Chr-22) TS: majority sporadic (50-86%) from TSC1-2 mutation. Remainder AD (Chr-9) VHL: AD (Chr-3) SWS: sporadic and NO hereditary component
59
What condition should you think of when u see acoustic schwannoma and/ or spinal ependymoma? Typical age?
NF-2 20-40 years
60
Name the 4 most common intramedullary spinal lesions
Ependymoma (adults: think NF-2) Astrocytoma (kids: think NF-1) Metastases (adults: lung most common foll by breast, lymphoma, melanoma) Haemangioblastoma (think VHL)
61
Difference b/w schwannoma and neurofibroma?
Schwannoma haemorrhage, cyst formation and fatty degeneration
62
Why follow up optic neuritis?
Exclude tumour
63
Important DDx for macroadenoma
Optic chiasm glioma
64
Most common primary CNS tumour in kids (also most common posterior fossa tumour)?
Juvenile pilocytic astrocytoma
65
Most common malignant CNS tumour in kids?
Medulloblastoma
66
Calcification in posterior fossa tumours in kids?
JPA very rare MB 20% Ependymoma: 80%
67
Typical location of PML (progressive multifocal leukoencephalopathy)
Typically frontal and parietal regions Involves subcortical U-fibres Involves brainstem and basal ganglia
68
Name 3 structures that are spared in PML
Cortex and deep GM Optic nerve Spinal cord
69
Name 4 other causes of PRES apart from HTN
HUS TTP SLE Drugs: cyclosporin, interferon, azathioprin
70
Commonest 2 sites for VA dissection
V2: pars transversaria V3: atlas loop
71
Name most common sites for ICA dissection
Extracranial most common: cervical ICA Intracranial: supraclinoid ICA midway between cavernous and bifurcation (may extend into ACA or MCA)
72
Name 3 intracranial cysts that commonly calcify
Choroid plexus cyst (>50%) Pineal cyst Dermoid/ epidermoid cyst
73
When is CEA recommended?
Symptomatic patients ICA diameter reduced by >70% on imaging or >50% on DSA
74
Where does MB arise in Adults?
Lateral cerebellar hemispheres (usually better Px than in kids)
75
Is Chiari type 1 associated with CC agenesis?
No, syrinx and craniocervical junction anomaly. Chiari 2 is associated with CC agenesis
76
Clinical presentation of spontaneous intracranial hypotension vs BIH
SIH: postural headache that improves when lying down (similar to post LP headache) BIH: headaches, visual symptoms and papilloedema
77
Is BIH associated with CN palsy?
Yes, CN VI palsy: visual loss/ diplopia
78
Not associated with dilated VR spaces?
Muscular dystrophy
79
Most common location for spontaneous dissections
ICA (68%) VA (27%) Both (5%)
80
MRS: significance of Cr, NAA and Cho
Creatine (NOT creatinine): reference metabolite NAA: neuronal marker (myelin sheath of nerve fibres) Cho: from components of cell membrane (elevated in neoplasm, demyelination and gliosis)
81
What does increased tumour grade show on MRS?
NAA and creatine decrease Choline, lipids and lactate increase
82
Myelination of optic nerve and optic radiations
Optic nerve: 1 month Optic radiation: 3 months
83
Name 3 intraorbital lesions that can be both intra and extra-conal
Pseudotumour Lymphoma Metastases (e.g. Breast)
84
Where do drop mets from MB occur in the spinal cord?
Posterior spinal canal more than anterior (due to direction of flow of CSF as it leaves cisterna magna)
85
Name 3 features of MS in the spinal cord
30% involve spinal cord only Plaques parallel to long axis of cord Less than 2 VB
86
Name 3 intraorbital lesions that can be both intra and extra-conal
Pseudotumour Lymphoma Metastases (e.g. Breast)
87
Where do drop mets from MB occur in the spinal cord?
Posterior spinal canal more than anterior (due to direction of flow of CSF as it leaves cisterna magna)
88
Name 3 features of MS in the spinal cord
30% involve spinal cord only Plaques parallel to long axis of cord Less than 2 VB
89
How does Wernicke syndrome present? MRI findings?
Ophthalmoplegia, nystagmus and ataxia MRI findings: High T2 signal in the medial thalami, periaqueductal grey matter and mammillary bodies
90
What is Marchiafava Bignami syndrome?
Disease in alcoholics due to deficiency of all B vitamins Presents with non-specific dementia Necrosis and demyelination of corpus callosum
91
How does Korsakoff syndrome present?
Amnesia and confabulation
92
Most common cause of cerebral abscess in adults?
Strep and staph
93
What infection gives owl-eye appearance on histology?
CMV: enlarged cell with distended nucleus containing eosinophilic viral inclusions.
94
Paravertebral mass in child: neural elements and Schwann cells not attached to nerve?
Ganglioneuroma (well-differentiated tumour comprised of ganglion cells and Schwann cells)
95
What are Rosenthal fibres?
Eosinophilic bodies within the astrocyte processes Present in: pilocytic astrocytoma, glioma, pineal tumour
96
FNA thyroid: what lesions contain Hurthle cells and fibrosing nodules?
Hurthle cells: hashimoto and follicular adenoma Fibrosing nodules: Reidel thyroiditis
97
Paediatric tumour: NOT small round blue cell tumour
Wilms tumour: 3 types of cells Blastemal cells (undifferentiated) Stromal cells (immature spindle cells: skeletal, cartilage, osteoid) Epithelial cells (glomeruli and tubules)
98
Triad of Freidreich ataxia
Most common hereditary ataxia: AR spinocerebellar degenerative disorder Ataxia Cardiomyopathy Spinal posterior column degeneration: loss of sensation, vibration and proprioception. Pain and temperature preserved.
99
Name 2 features of pilocytic astrocytoma associated with NF1
Affects optic nerve Better prognosis
100
Most common cause of herpetic meningitis?
HSV 2 HSV 1 is the most common cause of herpetic encephalitis (usually adolescents and young adults)
101
Most common location for PCA?
Midline or near midline structures Cerebellar hemisphere (60%) Hypothalamus Optic nerve (NF1)
102
What 2 things you should look for when you see tethered cord?
Associated meningocele or lipomeningocele Chiari 2 malformation
103
Aggressive, rapidly growing head and neck soft tissue mass- name 2 DDx
Rhabdomyosarcoma Lymphoma
104
Differences between the 3 major dementia on PET?
Alzheimer: symmetrical involvement of temporo-parietal lobes (spares occipital lobes, BG and cerebellum) Lewy body: similar to AD but pronounced occipital involvement Multi-infarct: asymmetrical cortical uptake defects but involving BG
105
Metachromatic leukodystrophy and perivascular spaces?
Spares perivascular/ perivenular spaces
106
What are Rosenthal fibres associated with?
Pilocytic astrocytoma When JPA associated with NF1, better prognosis
107
What sequence is most sensitive for HIE in neonate?
Low ADC (DWI can take 24 hrs to become positive)
108
Most common cause of SAH? Delayed complication?
Trauma most common cause Can cause delayed remote brain infarcts from vasospasm
109
Pick's disease
Asymmetrical frontal and temporal lobe atrophy
110
Cerebral venous thrombosis- what type of haemorrhage?
Initially subcortical white matter haemorrhage Venous infarct: involves WM, leptomeninges and cortex Deep GM: ICV, temporal lobe: TS or vein of Labbe, parasagittal: SSS
111
2 patterns of uveal melanoma?
Iris: related to UV light and better prognosis (indolent) Ciliary body and choroid: not related to UV and worse Px (ciliary body worst)
112
Spread of uveal melanoma?
NO lymphatic spread Direct haematogeneous spread to liver
113
What tumour is never in the posterior fossa?
PXA
114
Name 3 metals that are T1 hyperintense in the BG
Calcium (Fahr's disease) Copper (Wilson's disease) Manganese
115
Which vitamin deficiency does not cause neurological symptoms?
B2
116
Cowdry intranuclear inclusion bodies in neurons and glia?
HSV-1 encephalitis
117
Name 2 synucleinopathies (alpha-synuclein in cytoplasm)
Lewy body dementia or Parkinson with Lewy bodies MSA
118
Name 2 taupathies
Fronto-temporal dementia PSP
119
What gene is related to Alzheimer?
Apolipoprotein E on chr 19

Radiology (16 decks)

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