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P3.2 > Neuroradiology > Flashcards

Neuroradiology Flashcards

1
Q

Head CT interpretation

-What is the orientation of a head CT?

A

view from the patient’s feet to the head

-Left side of the image is the right side of the patient

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2
Q

When is contrast used in a head CT?

A

Contrast cannot cross the BBB

-Contrast is used if there is suspicion of tumor, infection, or vascular abnormality

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3
Q

Head CT interpretation pneumonic?

A 
Blood-Blood
Can-Cisterns
Be-Brain
Very-Ventricles
Bad-Bad
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4
Q

What is the appearance of an acute hemorrhage on head CT?

A

Acute hemorrhage-hyperdense (white)

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5
Q

What is the appearance of a chronic hemorrhage on head CT?

A

Chronic hemorrhage-hypodense

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6
Q

Head CT-cisterns

A

Assess for symmetry, collection of blood

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7
Q

Head CT-brain

A

-Symmetry, gray-white differentiation, shift, hypo/hyperdensities

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8
Q

Head CT-ventricles

A

-Asymmetry, dilation, effacement, hemorrhage

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9
Q

Head CT-bone

A
  • Bone windows

- Fractures, tumors

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10
Q

Skull fractures patients can present with?

A
  • CSF rhinorrhea
  • Otorrhea
  • Battle’s sign
  • Raccoon eyes
  • Neurologic signs
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11
Q

With open/depressed skull fractures there is an increased risk of?

A

infection/meningitis due to breached dura

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12
Q

What is the modality of choice for evaluating skull fractures?

A

Non-contrast CT

  • Examine bone and soft tissues
  • Pneumocephalus or bleeding into paranasal sinuses
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13
Q

Skull anatomy

Cribriform plate

A

Cribriform plate-CN I

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14
Q

Optic canal

A

Optic canal-CN II, ophthalmic a

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15
Q

Superior orbital fissure

A

Superior orbital fissure-CN III, IV, V1, ophthalmic vein

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16
Q

Foramen rotundum

A

Foramen rotundum-V2

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17
Q

Foramen ovale

A

Foramen ovale-V3

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18
Q

Foramen spinousum

A

Foramen spinosum-Middle meningeal a

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19
Q

Foramen lacerum

A

Foramen lacerum-Internal carotid a

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20
Q

Internal auditory meatus

A

Internal auditory meatus-CN VII, VIII

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21
Q

Where does CN VII exit the skull?

A

CN VII exits the skull via the stylomastoid foramen

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22
Q

Jugular foramen

A

Jugular foramen-CN IX, CN X, CN XI, internal jugular vein

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23
Q

Hypoglossal canal

A

Hypoglossal canal-CN XII

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24
Q

Foramen magnum

A

Foramen magnum-Spinal cord, CN XI, vertebral aa

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25
Q

Blunt trauma to the eye can produce?

A

Blowout fractures

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26
Q

What are the characteristics of blowout fractures?

A
  • Intraorbital pressure shatters the floor of the orbit (roof of the maxillary sinus)
  • The bone separating the orbit from the maxillary sinus is thin
  • Bleeding into the maxillary sinus can result in blood draining into the nasal cavity
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27
Q

Skull fractures-management considerations

-CT is used to assess?

A
  • CT is used to assess status of underlying TBI
  • Cervical spine assessment
  • Neurosurgical consultation
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28
Q

CT is used to assess status of underlying TBI

A
  • Intracranial hemorrhage
  • Parenchymal injury (cerebral contusion)
  • Type of fracture (linear, depressed, basilar)
  • Angiography to assess artery supply (basilar, petrous portion of temporal bone)
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29
Q

Herniation syndromes

A

Displacement of brain tissue past the rigid dural folds or through openings of the skull
-Increased intracranial pressure (compression of vasculature)
Due to mass effect
-Global (generalized edema)
-Focal (tumors, abscesses, hemorrhages)

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30
Q

3 types of herniation syndromes?

A
  • Cingulate (subfalcine)
  • Uncinate (transtentorial)
  • Tonsillar herniation
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31
Q

Cingulate (subfalcine) herniation

A
  • Herniation beneath falx cerebri

- Can compress anterior cerebral artery

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32
Q

What are the signs/symptoms associated with cingulate (subfalcine) herniation?

A
  • Paraparesis
  • Urinary incontinence
  • Frontal release signs (primitive reflexes)
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33
Q

Uncinate (transtentorial) herniation

A
  • Medial aspect of the temporal lobe compressed against free tentorium
  • Oculomotor nerve
  • Posterior cerebral a
  • Compression of Kernohan notch
  • Duret hemorrhages in midbrain and pons
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34
Q

Impingement of the oculomotor nerve by an uncinate hemorrhage results in?

A

Impingement of the oculomotor nerve by an uncinate hemorrhage results in fixed dilation and impairment of ocular movements

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35
Q

Compression of the posterior cerebral artery by an uncinate hemorrhage results in?

A

contralateral homonymous hemianopsia

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36
Q

Compression of the Kernohan notch by an uncinate process results in?

A

ipsilateral limb weakness

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37
Q

Tonsillar herniation

A
  • Displacement of cerebellar tonsils through foramen magnum

- Brainstem compression compromises respiratory and cardiac centers in medulla

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38
Q

What are the signs and symptoms associated with tonsillar herniation?

A
  • Decreased level of consciousness
  • Flaccid paralysis
  • Blood pressure instability
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39
Q

What are the characteristics of a CT of a cingulate herniation?

A

CT of a cingulate herniation

  • Midline shift of septum pellucidum
  • Ventricle compression/dilation
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40
Q

What are the characteristics of an MRI of an uncal herniation?

A
  • Displacement of uncus and medial temporal lobe
  • Encroachment of suprasellar cistern
  • Aquaduct compression -> increased lateral ventricle pressure
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41
Q

What are the characteristics of an epidural hematoma?

A
  • Rupture of middle meningeal a (fx of temporal bone)
  • Lucid interval
  • Rapid expansion of epidural space under arterial pressure
  • Herniation
  • Biconvex (lens) shaped
  • Does not cross suture lines
  • Can cross falx, tentorium
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42
Q

What are the characteristics of a subdural hematoma?

A
  • Rupture of bridging veins
  • Slow venous bleeding
  • Manifestation of symptoms within 48 hours
  • Herniation/compression symptoms
  • Crescent shaped
  • Crosses suture lines
  • Does not cross falx, tentorium
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43
Q

What are the characteristics of subarachnoid hemorrhage?

A
  • Aneurysm rupture of cerebral a (saccular), arteriovenous malformation
  • Ehlers-Danlos syndrome, ADPKD
  • Rapid loss of consciousness
  • “Worst headache of my life”
  • Bloody or yellow lumbar puncture
  • Intracerebral extension, subarachnoid blood in sulci on CT
44
Q

What are common complications of subarachnoid hemorrhage?

A

Complications of subarachnoid hemorrhages

  • Vascular spasm 2-3 days due to blood breakdown
  • Rebleeding
45
Q

Vascular spasm caused by subarachnoid hemorrhage should be treated with?

A

Tx vascular spasm caused by subarachnoid hemorrhage with Nimodipine-dilates vessels

46
Q

What are the characteristics of intraparenchymal hemorrhage?

A
  • Systemic HTN
  • Amyloid angiopathy, vasculitis, neoplasm
  • Mid-to-late adults
  • Hyperdensity in basal ganglia, internal capsule on CT
  • Ventricle infiltration, edema, herniation
  • Sudden onset of neurological symptoms (stroke)
47
Q

emorrhagic cerebrovascular disease/stroke

A

Hemorrhagic CVD/stroke

  • Subarachnoid hemorrhage
  • Intracerebral hemorrhage
48
Q

Hemorrhagic cerebrovascular disease/stroke

-What are the characteristics of intracerebral hemorrhage?

A
  • HTN, anticoagulation, cancer
  • Basal ganglia = most common site
  • Can occur secondary to ischemic stroke due to vessel fragility
49
Q

Ischemic cerebrovascular disease/stroke

A
  • Acute blockage of vessels
  • Thrombotic
  • Embolic
  • Hypoxic
50
Q

Thrombotic ischemic cerebrovascular disease/stroke

A
  • Clot at site of infarction

- Atherosclerotic plaque

51
Q

Embolic ischemic cerebrovascular disease/stroke

A
  • Embolus from distant location obstructs vessel

- A-fib, DVT with patent foramen ovale

52
Q

Hypoxic ischemic cerebrovascular disease/stroke

A
  • Hypoperfusion or hypoxemia

- Watershed areas

53
Q

MR angiography is used to detect?

A

occlusion or stenosis

-Images taken before contrast injection and during first pass of contrast through arteries

54
Q

Anterior cerebral artery

A
  • Paralysis of contralateral foot and leg
  • Cortical sensory loss over toes, foot, and leg
  • Urinary incontinence
  • Impairment of gait and stance
55
Q

Middle cerebral a

A
  • Paralysis and sensory impairment of contralateral face and arm
  • Motor aphasia
  • Homonymous hemianopsia (optic radiation in temporal lobe)
  • Hemineglect
56
Q

Posterior cerebral artery

A
  • Occipital cortex, visual cortex

- Homonymous hemianopsia with macular sparing (upper quadrant)

57
Q

Lenticulo-striate artery

A
  • Striatum, internal capsule
  • Contralateral hemiparesis/hemiplegia (UMN)
  • Corticospinal tract
58
Q

Anterior spinal artery

A
  • “Medial medullary syndrome”
  • LCST, ML, CN 12
  • Contralateral hemiparesis (UE and LE)
  • Decreased contralateral proprioception
  • Ipsilateral hypoglossal dysfunction
59
Q

Posterior inferior cerebellar artery

A
  • “Lateral medullary syndrome”
  • Vestibular nuclei (vertigo, nystagmus)
  • Spinothalamic tract/spinal trigeminal nucleus
  • Nucleus ambiguus
  • Sympathetics (ipsilateral Horner syndrome)
  • Inferior cerebellar peduncle
60
Q

PICA -> vestibular nuclei -> symptoms?

A

PICA -> vestibular nuclei -> symptoms -> Vertigo, nystagmus

61
Q

PICA -> spinothalamic tract/spinal trigeminal nucleus -> symptoms?

A

PICA -> spinothalamic tract/spinal trigeminal nucleus -> symptoms -> decreased pain and temp sensation ipsilateral face, contralateral body

62
Q

PICA -> nucleus ambiguus -> symptoms?

A

PICA -> nucleus ambiguus -> symptoms -> dysphagia, hoarseness, decreased gag reflex

63
Q

PICA -> inferior cerebellar peduncle -> symptoms?

A

PICA -> inferior cerebellar peduncle -> symptoms -> ataxia, dysmetria

64
Q

List all symptoms of PICA on previous cards

A
  • Vertigo, nystagmus
  • Decreased pain and temp sensation ipsilateral face, contralateral body
  • Dysphagia, hoarseness, decreased gag reflex
  • Ataxia, dysmetria
65
Q

Anterior inferior cerebellar artery

A
  • “Lateral pontine syndrome”
  • Vestibular nuclei
  • Facial nucleus
  • Spinal trigeminal nucleus/spinothalamic tract
  • Cochlear nuclei
  • Middle and inferior cerebellar peduncles
66
Q

AICA -> facial nucleus -> symptoms?

A

AICA -> facial nucleus -> symptoms -> paralysis of face, decreased lacrimation/salivation

67
Q

AICA -> cochlear nuclei -> symptoms?

A

AICA -> cochlear nuclei -> symptoms -> deafness, tinnitus

68
Q

Basilar artery

A
  • “Locked in syndrome”
  • Pons, medulla, lower midbrain
  • Corticospinal/bulbar tracts
  • Ocular cranial nerve nuclei
  • Paramedian pontine reticular formation
69
Q

What are the symptoms of “Locked in syndrome” (basilar a)?

A
  • Preserved consciousness/blinking
  • Quadriplegia
  • Loss of voluntary facial, mouth, and tongue movements
70
Q

CVD/stroke radiology

-Initial imaging?

A
  • Initial imaging-non-contrast CT to exclude hemorrhage (tPA therapy)
  • Hyperdensity
71
Q

CVD/stroke radiology

-Detection of ischemic changes via CT?

A

CT detects ischemic changes in 6-24 hours

  • Cortical hypodensity, parenchymal swelling
  • Loss of grey-white matter differentiation
72
Q

Diffusion weighted MRI can detect ischemia within?

A

Diffusion weighted MRI can detect ischemia within 3-30 mins

  • diffusion of water molecules
  • Increased ratio of intracellular to extracellular water volume in ischemic brain cells
73
Q

CVD/stroke: global ischemia

A
  • Hypoperfusion or hypoxemia states
  • Drowning, cardiac arrest, cardiovascular surgery
  • Hippocampus, watershed areas
  • Difficulty forming new memories, acquiring new info
  • Cortical blindness-weakness of shoulders, thighs with sparing of face, hands, feet
74
Q

Watershed areas

-Anterior cortical border zone?

A

Anterior cortical border zone-Between ACA and MCA

75
Q

Internal border zone?

A

Internal border zone-Between LCA and MCA

76
Q

Posterior cortical border zone?

A

Posterior cortical border zone-between MCA and PCA

77
Q

Multiple sclerosis

A
  • AI inflammation and demyelination of the CNS
  • HLA-D2 association
  • Disease is initiated by Th1 and Th17 cells reacting against myelin
  • Demyelination is caused by wbcs (Th17 cells)
78
Q

Clinical presentation of multiple sclerosis?

A
  • 20-30 y/o female
  • Relapsing, remitting symptoms
  • Unilateral optic neuritis
  • Intranuclear ophthalmoplegia
  • Hemiparesis
  • Hemisensory symptoms
  • Bladder, bowel incontinence
79
Q

Multiple sclerosis diagnosis

A

-Increased IgG levels in CSF (oligoclonal bands are diagnostic)

80
Q

Multiple sclerosis radiology

A
  • MRI (gold standard)
  • Periventricular plaques (oligodendrocyte loss, reactive gliosis)
  • White matter lesions separated by space and time
81
Q

Multiple sclerosis-internuclear ophthalmoplegia

-Lesion of what structure?

A

Internuclear ophthalmoplegia-> Lesion of MLF (highly myelinated to coordinate both eyes)

82
Q

Multiple sclerosis

-Conjugate horizontal gaze palsy

A

Multiple sclerosis-Conjugate horizontal gaze palsy

  • CN VI nucleus activates to abduct, contralateral CN III nucleus does not retract
  • Opposite medial rectus does not fire, CN VI over-fires to stimulate CN III (nystagmus)
83
Q

Adult brain tumors (MGM studios)

-Metastases

A

Metastases

  • Most common CNS tumor
  • Junction of gray and white matter, round shape
  • Single or multiple
  • Lung, breast, kidney, colorectal cancer, melanoma
84
Q

Adult brain tumors (MGM studios)

-Glioblastoma multiforme (grade IV astrocytoma)

A
  • Highly malignant - 1 year survival
  • Cerebral hemispheres
  • Can cross corpus collosum (butterfly glioma)
  • GFAP+ astrocytes
  • Pseudopalisading necrosis and hemorrhage
85
Q

Adult brain tumors (MGM studios)

-Meningioma

A

Meningioma

  • Typically benign
  • Parasagittal region
  • Arises from arachnoid cells, may have dural attachment
  • Seizures or focal neuro signs
  • Spindle cells concentrically arranged, psammoma bodies
86
Q

Adult brain tumors (MGM studios)

-Schwannoma

A
  • Cerebellopontine angle
  • Schwann cell origin (S100+)
  • Can be localized to CN VIII (vestibular schwannoma)
  • Bilateral schwannomas found in NF2
87
Q

Adult brain tumors

-Oligodendroglioma

A

Oligodendroglioma

  • Slow-growing
  • Frontal lobes
  • “Chicken wire” capillary pattern
  • Oligodendrocyte origin (fried-egg cells)-round nuclei with clear cytoplasm
88
Q

Adult brain tumors

-Pituitary adenoma

A

Pituitary adenoma

  • Slow-growing
  • Commonly prolactinoma
  • Bitemporal hemianopia (pressure on optic chiasm)
  • Hyper or hypo pituitarism
89
Q

Childhood brain tumors (“Animal Kingdom, Magic Kingdom, Epcot”)
-(Pilocytic) astrocytoma

A

(Pilocytic) astrocytoma

  • Well circumscribed
  • Posterior fossa (can be supratentorial)
  • GFAP+
  • Benign, good prognosis
  • Rosenthal fibers (eosinophilic corkscrew fibers)
90
Q

hildhood brain tumors (“Animal Kingdom, Magic Kingdom, Epcot”)
-Medulloblastoma

A
  • Highly malignant
  • Cerebellum (vermis)
  • Primitive neuroectodermal tumor
  • Can compress 4th ventricle-> hydrocephalus
  • “Drop metastases” to spinal cord
  • Homer-wright rosettes
91
Q

Childhood brain tumors (“Animal Kingdom, Magic Kingdom, Epcot”)
-Ependymoma

A

Ependymoma

  • Arise within or adjacent to ependymal lining of ventricular system (4th ventricle)
  • Can cause hydrocephalus
  • Perivascular rosettes
  • Poor prognosis
92
Q

Childhood brain tumors (“Animal Kingdom, Magic Kingdom, Epcot”)
-Craniopharyngioma

A
  • Benign (can be confused with pituitary adenoma)
  • Most common childhood supratentorial tumor
  • Derived from Rathke pouch remnants
  • Calcification common, oil-like fluid
93
Q

Common brain infections

-Bacterial brain abscess

A
  • Focal collection of necrosis and inflammation
  • Local extension from adjacent foci, hematogenous spread
  • Strep and staph most common in healthy patients
94
Q

Signs and symptoms of bacterial brain abscess?

A
  • Headache (not relieved with aspirin), neck stiffness, vomiting (increased ICP)
  • Sinus infections, trauma, hematogenous spread (endocarditis, chronic pulmonary infections, rec. drug use)
95
Q

Where are bacterial brain abscesses usually located?

A

distribution of the MCA

96
Q

What modality is useful in differentiating ring-enhancing lesions due to bacterial infection vs neoplasm?

A

MRI (DWI) is capable of differentiating ring-enhancing lesions due to bacterial infection vs neoplasm

97
Q

Common brain infections

-Mucor and Rhizopus spp.

A
  • Fungi, proliferate in blood vessel walls, penetrate cribriform plate, and enter brain
  • Frontal lobe abscess, cavernous sinus thrombosis
98
Q

Signs and symtoms of mucor and rhizopus spp brain infection?

A
  • Headache
  • Facial pain
  • Black Escher on face
  • CN involvement (does not specify which one)
  • DKA/neutropenic patients
99
Q

Common brain infections

-Signs and symptoms of HSV1 brain infection?

A

Signs and symptoms of HSV1 brain infection

  • Alterations in mood, behavior, memory
  • Only 10% have prior hx of herpes infections
100
Q

What effect does HSV1 infection have on brain tissue (pathology)?

A

HSV1 brain infection -> necrotizing and hemorrhagic (no abscess formation)

101
Q

Where do HSV1 brain infections usually present?

A

HSV1 brain infections usually present in the inferior and medial temporal lobes

102
Q

Common brain infections

-HIV/AIDS

A
  • HIV enters CNS through incoming macrophages causing subacute inflammation
  • Brain atrophy
  • Memory and psychomotor speed impairment
  • Depressive symptoms
  • Movement disorders
103
Q

HIV/AIDS associated infections (CD4 less than 200)

A

HIV/AIDS associated infections (CD4 less than 200)

  • Toxoplasmosis
  • Primary CNS lymphoma
  • Cryptococcal meningitis
  • JC virus (progressive multifocal encephalopathy)
  • CMV encephalitis (CD4 less than 50)
104
Q

HIV/AIDS associated infections (CD4 less than 200)

-Toxoplasmosis

A
  • Reactivation from prior infection
  • Parietal/frontal lobes at corticomedullary junction
  • Ring enhancement
105
Q

HIV/AIDS associated infections (CD4 less than 200)

-Primary CNS lymphoma

A
  • B symptoms (fever, night sweats, weight loss)
  • Large solitary lesion, diffuse ring enhancement
  • Periventricular location
106
Q

HIV/AIDS associated infections (CD4 less than 200)

-JC virus (progressive multifocal encephalopathy)

A
  • Multifocal white matter lesions

- Demyelinating disease

107
Q

HIV/AIDS associated infections (CD4 less than 200)

-CMV encepahlitis (CD4 less than 50)

A
  • Ventricular enlargement

- Increased periventricular signal on T2

P3.2 (11 decks)

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