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Radiology > Neuroradiology > Flashcards

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
Q

Subcortical WM infarcts that cross many territories?

A

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

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26
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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27
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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28
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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29
Q

3 main patterns of fungal CNS infection?

A

Basal meningitis (hydrocephalus)

Vasculitis (mucormycosis, aspergillosis)- thrombosis/ infarct

Parenchymal invasion

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30
Q

Name 2 grade 1 astrocytomas

A

Pilocytic astrocytoma and SEGA

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31
Q

What distinguishes GBM from anaplastic astrocytoma?

A

Necrosis and Neovascularisation

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32
Q

What tumours show these on histology?

  1. Pseudopalisading
  2. Fried-egg appearance
  3. Perivascular pseudo-rosettes
A

GBM

Oligodendroglioma

Ependymoma

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33
Q

DNET: grade, histology and association

A

Mixed glial-neuronal tumour (grade I)

Floating neurons in pool of fluid on histology

Associated with focal cortical dysplasia

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34
Q

What tumour has Flexner-Wintersteiner rosettes?

A

Retinoblastoma (can spread along optic nerve to SAS and brain)

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35
Q

Grade and paraneoplastic syndrome associated with haemangioblastoma

A

Grade I and polycythaemia from EPO secretion

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36
Q

What intracranial lesion is lined by pseudostratified epithelium (respiratory epithelium)?

A

Colloid cyst of 3rd ventricle

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37
Q

Difference between neurofibroma and schwannoma in terms of relationship to peripheral nerve?

A

NF engulf fibres of nerve and cannot be separated

SWN attached to nerve but remains separable

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38
Q

Name 2 growth patterns of Schwannomas?

A

Antoni A- compact elongated cells with Verocray bodies

Antoni B- less densely cellular tissue

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39
Q

Name 2 vascular lesions in the brain post XRT. Do they enhance and can they bleed?

A

Cavernoma and capillary telangiectasia

No enhancement and VERY RARELY bleed- most asymptomatic

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40
Q

Osmotic demyelination vs infarct

A

OD central symmetrical and spares periphery/ corticospinal tracts

May involve BG and mid-brain

Does show diffusion restriction

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41
Q

Symmetrical, high T2 signal within the mamillary bodies, medial thalami and peri-aqueductal region?

A

Wernicke-Korsakoff encephalopathy (thiamine deficiency)

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42
Q

Young female with sudden neck pain, dysarthria, diplopia- normal NECT brain/ neck. Next Ix?

A

Like VA dissection: CTA or MRI

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43
Q

Atlanto-occipital instability-name 4 features

A

Pre-dental interval >3 mm

BAI and BDI >12 mm

Occipital condyle fracture

Note epidural haemorrhage is non-specific

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44
Q

Lateral displacement of C1 on C2 by up to 6 mm in total is normal in kids

A

True: due to disparity between growth of the 2 vertebrae

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45
Q

What structure in the spinal cord normally enhances post contrast?

A

Dorsal root ganglion (devoid of BBB)

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46
Q

Name 3 non-infective causes of optic neuritis

A

Multiple sclerosis (most common)

ADEM, NMO

Sarcoidosis

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47
Q

Name 3 infective causes of optic neuritis

A

Toxoplasmosis

HIV

HSV

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48
Q

Diagnostic criteria for NF-1

A

At least 2 of the following:

NOB-FLC and positive FHx

49
Q

Name 2 mediastinal masses associated with NF-1

A

Lateral thoracic meningocele

Extra-adrenal phaeochromocytoma

50
Q

Name 3 vascular lesions associated with NF-1

A

Aneurysm/AVM

Moya-Moya

Co-arctation

51
Q

Name 3 intracranial lesions associated with NF-1

A

Hamartomas (90%) as UBO

Gliomas: optic nerve, PCA

Plexiform neurofibroma (esp CN V)

52
Q

Name 4 skeletal lesions associated with NF-1

A

SW dysplasia

Dural ectasia and posterior VB scalloping

Rib notching

Gracile long bones and pseudo-arthrosis

53
Q

Name 4 CNS manifestations of TS

A

Cortical and subcortical tubers

Heterotopic GM

Subependymal nodules

SEGA

54
Q

Name 5 non-CNS manifestations of TS

A

Cardiac rhabdomyoma

Renal: AML, RCC, oncocytoma

Osseus: hyperostosis calvaria, HPOA

Pulmonary: LAM

Skin: ash-leaf spots

55
Q

Age and general presentation of VHL?

A

20-30 years

Multi-organ cysts and neoplasms

Skin is NOT involved

56
Q

Name 3 diagnostic criteria for VHL

A

More than 1 haemangioblastoma of CNS

1 haemangioblastoma and visceral manifestation

FHx and 1 manifestation

57
Q

Name 4 non-CNS manifestations of VHL

A

Renal: cysts, bilateral RCC

Adrenal: phaeochromocytoma (bilateral)

Pancreatic: cysts, serous cystadenoma

Endolymphatic sac tumour

58
Q

Inheritance patterns of the 5 major phakomatoses

A

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
Q

What condition should you think of when u see acoustic schwannoma and/ or spinal ependymoma? Typical age?

A

NF-2

20-40 years

60
Q

Name the 4 most common intramedullary spinal lesions

A

Ependymoma (adults: think NF-2)

Astrocytoma (kids: think NF-1)

Metastases (adults: lung most common foll by breast, lymphoma, melanoma)

Haemangioblastoma (think VHL)

61
Q

Difference b/w schwannoma and neurofibroma?

A

Schwannoma haemorrhage, cyst formation and fatty degeneration

62
Q

Why follow up optic neuritis?

A

Exclude tumour

63
Q

Important DDx for macroadenoma

A

Optic chiasm glioma

64
Q

Most common primary CNS tumour in kids (also most common posterior fossa tumour)?

A

Juvenile pilocytic astrocytoma

65
Q

Most common malignant CNS tumour in kids?

A

Medulloblastoma

66
Q

Calcification in posterior fossa tumours in kids?

A

JPA very rare

MB 20%

Ependymoma: 80%

67
Q

Typical location of PML (progressive multifocal leukoencephalopathy)

A

Typically frontal and parietal regions

Involves subcortical U-fibres

Involves brainstem and basal ganglia

68
Q

Name 3 structures that are spared in PML

A

Cortex and deep GM

Optic nerve

Spinal cord

69
Q

Name 4 other causes of PRES apart from HTN

A

HUS

TTP

SLE

Drugs: cyclosporin, interferon, azathioprin

70
Q

Commonest 2 sites for VA dissection

A

V2: pars transversaria
V3: atlas loop

71
Q

Name most common sites for ICA dissection

A

Extracranial most common: cervical ICA

Intracranial: supraclinoid ICA midway between cavernous and bifurcation (may extend into ACA or MCA)

72
Q

Name 3 intracranial cysts that commonly calcify

A

Choroid plexus cyst (>50%)

Pineal cyst

Dermoid/ epidermoid cyst

73
Q

When is CEA recommended?

A

Symptomatic patients

ICA diameter reduced by >70% on imaging or >50% on DSA

74
Q

Where does MB arise in Adults?

A

Lateral cerebellar hemispheres (usually better Px than in kids)

75
Q

Is Chiari type 1 associated with CC agenesis?

A

No, syrinx and craniocervical junction anomaly.

Chiari 2 is associated with CC agenesis

76
Q

Clinical presentation of spontaneous intracranial hypotension vs BIH

A

SIH: postural headache that improves when lying down (similar to post LP headache)

BIH: headaches, visual symptoms and papilloedema

77
Q

Is BIH associated with CN palsy?

A

Yes, CN VI palsy: visual loss/ diplopia

78
Q

Not associated with dilated VR spaces?

A

Muscular dystrophy

79
Q

Most common location for spontaneous dissections

A

ICA (68%)

VA (27%)

Both (5%)

80
Q

MRS: significance of Cr, NAA and Cho

A

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
Q

What does increased tumour grade show on MRS?

A

NAA and creatine decrease

Choline, lipids and lactate increase

82
Q

Myelination of optic nerve and optic radiations

A

Optic nerve: 1 month

Optic radiation: 3 months

83
Q

Name 3 intraorbital lesions that can be both intra and extra-conal

A

Pseudotumour

Lymphoma

Metastases (e.g. Breast)

84
Q

Where do drop mets from MB occur in the spinal cord?

A

Posterior spinal canal more than anterior (due to direction of flow of CSF as it leaves cisterna magna)

85
Q

Name 3 features of MS in the spinal cord

A

30% involve spinal cord only

Plaques parallel to long axis of cord

Less than 2 VB

86
Q

Name 3 intraorbital lesions that can be both intra and extra-conal

A

Pseudotumour

Lymphoma

Metastases (e.g. Breast)

87
Q

Where do drop mets from MB occur in the spinal cord?

A

Posterior spinal canal more than anterior (due to direction of flow of CSF as it leaves cisterna magna)

88
Q

Name 3 features of MS in the spinal cord

A

30% involve spinal cord only

Plaques parallel to long axis of cord

Less than 2 VB

89
Q

How does Wernicke syndrome present? MRI findings?

A

Ophthalmoplegia, nystagmus and ataxia

MRI findings:
High T2 signal in the medial thalami, periaqueductal grey matter and mammillary bodies

90
Q

What is Marchiafava Bignami syndrome?

A

Disease in alcoholics due to deficiency of all B vitamins

Presents with non-specific dementia

Necrosis and demyelination of corpus callosum

91
Q

How does Korsakoff syndrome present?

A

Amnesia and confabulation

92
Q

Most common cause of cerebral abscess in adults?

A

Strep and staph

93
Q

What infection gives owl-eye appearance on histology?

A

CMV: enlarged cell with distended nucleus containing eosinophilic viral inclusions.

94
Q

Paravertebral mass in child: neural elements and Schwann cells not attached to nerve?

A

Ganglioneuroma (well-differentiated tumour comprised of ganglion cells and Schwann cells)

95
Q

What are Rosenthal fibres?

A

Eosinophilic bodies within the astrocyte processes

Present in: pilocytic astrocytoma, glioma, pineal tumour

96
Q

FNA thyroid: what lesions contain Hurthle cells and fibrosing nodules?

A

Hurthle cells: hashimoto and follicular adenoma

Fibrosing nodules: Reidel thyroiditis

97
Q

Paediatric tumour: NOT small round blue cell tumour

A

Wilms tumour: 3 types of cells

Blastemal cells (undifferentiated)

Stromal cells (immature spindle cells: skeletal, cartilage, osteoid)

Epithelial cells (glomeruli and tubules)

98
Q

Triad of Freidreich ataxia

A

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
Q

Name 2 features of pilocytic astrocytoma associated with NF1

A

Affects optic nerve

Better prognosis

100
Q

Most common cause of herpetic meningitis?

A

HSV 2

HSV 1 is the most common cause of herpetic encephalitis (usually adolescents and young adults)

101
Q

Most common location for PCA?

A

Midline or near midline structures

Cerebellar hemisphere (60%)

Hypothalamus

Optic nerve (NF1)

102
Q

What 2 things you should look for when you see tethered cord?

A

Associated meningocele or lipomeningocele

Chiari 2 malformation

103
Q

Aggressive, rapidly growing head and neck soft tissue mass- name 2 DDx

A

Rhabdomyosarcoma

Lymphoma

104
Q

Differences between the 3 major dementia on PET?

A

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
Q

Metachromatic leukodystrophy and perivascular spaces?

A

Spares perivascular/ perivenular spaces

106
Q

What are Rosenthal fibres associated with?

A

Pilocytic astrocytoma

When JPA associated with NF1, better prognosis

107
Q

What sequence is most sensitive for HIE in neonate?

A

Low ADC (DWI can take 24 hrs to become positive)

108
Q

Most common cause of SAH? Delayed complication?

A

Trauma most common cause

Can cause delayed remote brain infarcts from vasospasm

109
Q

Pick’s disease

A

Asymmetrical frontal and temporal lobe atrophy

110
Q

Cerebral venous thrombosis- what type of haemorrhage?

A

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
Q

2 patterns of uveal melanoma?

A

Iris: related to UV light and better prognosis (indolent)

Ciliary body and choroid: not related to UV and worse Px (ciliary body worst)

112
Q

Spread of uveal melanoma?

A

NO lymphatic spread

Direct haematogeneous spread to liver

113
Q

What tumour is never in the posterior fossa?

A

PXA

114
Q

Name 3 metals that are T1 hyperintense in the BG

A

Calcium (Fahr’s disease)

Copper (Wilson’s disease)

Manganese

115
Q

Which vitamin deficiency does not cause neurological symptoms?

A

B2

116
Q

Cowdry intranuclear inclusion bodies in neurons and glia?

A

HSV-1 encephalitis

117
Q

Name 2 synucleinopathies (alpha-synuclein in cytoplasm)

A

Lewy body dementia or Parkinson with Lewy bodies

MSA

118
Q

Name 2 taupathies

A

Fronto-temporal dementia

PSP

119
Q

What gene is related to Alzheimer?

A

Apolipoprotein E on chr 19

Radiology (16 decks)

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