Neuroradiology

Question 1

What are common indications to perform a CT scan?

Answer 1

Head trauma 
Acute stroke 
Headache : red flags for suspected tumour or subarachnoid haemorrhage 
Cancer 
Post surgical

Question 2

Reasons not to perform a CT scan?

Answer 2

Ð If the patient is GCS 15,

• no suspected open or depressed skull fracture,
• no haemotympanum,
• no ‘panda’ eyes,
• no CSF leakage from ears or nose,
• no post-traumatic seizure,
• no focal neurological deficit,
• <2 episodes of vomiting,
• no amnesia, age < 65 years,
• no coagulopathy,
• not struck by a motor vehicle,
• not ejected from a motor vehicle,

Question 3

What is the imaging technique of choice for seizures?

Answer 3

MRI

Question 4

Is complete recovery after a seizure epilepsy?

Answer 4

No

Need to have recurrent

Question 5

What are indications to perform an MRI?

Answer 5

Demyelination for example MS diagnosis 
CNS tumours 
Spine for intervertebral disc prolapse 
TIA 
Epilepsy 
Paediatric neurology 
Headache

Question 6

When do you not do an MRI?

Answer 6

Implanted electronics  (most cardiac pacemakers, implantable defibrillators, cochlear implants)
Aneurysm clips 
Heart valves 
Claustrophobia 
Pregnancy 
Tattoos

Question 7

What is angiography used for in neurological pathology?

Answer 7

Aneurysm
Arteriovenous malformation
Carotidocavernous fistula
Unstoppable epistaxis

Question 8

What is perfusion?

Answer 8

Defined as the volume of blood passing through a defined volume of tissue per unit time

Question 9

What are neurological disorders of abnormal perfusion?

Answer 9

Stroke

Tumour

Question 10

What is a PET scan usually used for?

Answer 10

To map out glucose usage
To see where there is increased metabolism in cells
Useful for cancer staging

Question 11

What colour are bones in plain radiographs?

Answer 11

White

Question 12

What are the advantages of a plain radiograph?

Answer 12

Almost universally available
Fast
Sequential images in subtraction angiography

Question 13

What are the disadvantages of plain radiograph?

Answer 13

Lacks soft tissue detail

Question 14

What are the advantages of CT?

Answer 14

Rapid
Metal and pacemaker tolerance
Good for demonstrating acute haemorrhage

Question 15

What are the disadvantages of CT?

Answer 15

Radiation exposure

more expensive cumbersome equipment

Question 16

What are the two types of MRI?

Answer 16

T1

T2

Question 17

What are the advantages of MRI?

Answer 17

No radiation
Soft tissue differentiation
Physiological information

Question 18

What are the disadvantages of MRI?

Answer 18

• Poor tolerance of metalwork
• Magnetic sensitive electronics may fail or are contraindicated
  Pacemakers
  Cochlear implants absolutely contraindicated
• Least movement tolerance
• Slow, must limit sequences
• Most expensive equipment
• Danger of metallic object becoming projectiles

Question 19

What are the advantages of US?

Answer 19

No radiation
Less expensive equipment
Can be performed in the neonatal unit
Movement intolerant

Question 20

What are the disadvantages of US?

Answer 20

Requires a wide enough open fontanelle

Image quality and interpretation based on operator skill

Question 21

What are the advantages of radionuclide radiology?

Answer 21

Physiological information
Glucose metabolism
Perfusion
Dopamine reuptake receptors

Question 22

What are the disadvantages of radionuclide radiology?

Answer 22

Unclear anatomical information
Medium cost equipment
Radiotracers can be expensive

Question 23

What are important neurological emergencies?

Answer 23

Trauma
Acute stroke
Cauda equina syndrome
Subarachnoid haemorrhage