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Neurology > Neuroradiology and Brain Tumours > Flashcards

Neuroradiology and Brain Tumours Flashcards

1
Q

what can cause a headache due to raised ICP

A

mass, bleed, hydrocephalus, venous thrombosis, infection, oedema

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2
Q

what is CT good for

A

bony detail
spatial resolution
good with emergency/ ICU equipment
fast

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3
Q

what is CT bad for

A

soft tissue
detail
contrast not as good as MRI
high radiation

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4
Q

what is dark and light on CT

A

white things more dense

darkest thing is air

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5
Q

what is MRI good for

A

contrast
soft tissue resolution
depiction of anatomy
marrow and cord pathologies

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6
Q

what is MRI bad for

A

less bony detail
less spatial resolution
not compatible with equipment/ implants
not as quick- need patient cooperation

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7
Q

what are the different types of MRI

A

T1 and T2

T1
-fat, methemoglobin (subacute haematoma), mineral deposition, melanin, contrast material = bright/ hyperintense
-water, air= dark/ hypointense
GREY MATTER WILL BE DARK

T2
(two W's= water white)
-water, air= bright 
-fat and 4 m's= dark 
GREY MATTER WILL BE LIGHT

T2 flare
form of T2 (grey matter bright) that removes brightness of CSF in the image to look for oedema in the brain
GREY MATTER BRIGHT, CSF DARK

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8
Q

does white or grey matter have more myelin

A

white matter- will be dark in T2, bright in T1 MRI

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9
Q

what scan if you suspect an infarct in the brain

A

MRI (if blood vessel not flowing will show up white)

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10
Q

what scan for a brain haemorrhage

A

CT sensitive for acute haemorrhage but sensitivity lessens with time

time doesn’t matter in MRI

if haemorrhage look for aneurysm with CT angiography

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11
Q

what vascular abnormality has a popcorn appearance on imaging

A

cavernoma (cluster of abnormal blood vessels)

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12
Q

what scan is used in acute stroke

A

CT- shows loss of distinction between grey and white matter

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13
Q

what imaging is used in all strokes

A

diffusion weight image

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14
Q

what is the hallmark for trauma imaging

A

CT

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15
Q

what can a haematoma in the brain cause

A

mid line shift, herniation

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16
Q

what type of dural haematoma will affect the shape of brain more

A

extra dural- sub dural can spread further across the brain, extra will create a convex shape

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17
Q

when will a tumour enhance with contrast

A

if vascular in brain only when high grade or if arises from dura (BBB)

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18
Q

what does low density around hydrocephalus on imagine mean

A

oedema in brain

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19
Q

what does demyelination look like on CT (T2 and flare)

A

predominantly affects white mater, inflammation around small venules and veins, lesions on the white matter. CT T2 and flare

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20
Q

what is an example of an non infective imflammatory brain condition

A

demyelination- MS

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21
Q

what are intrinsic or extrinsic brain tumours

A

within our outside of brain parenchyma

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22
Q

what are the most common presentations of brain tumours

A

progressive neurological deficit
motor weakness
headache
seizures

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23
Q

how can a tumour increase ICP

A

mass
oedema mass effect
blockage of CSF flow
haemorrhage

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24
Q

what symptoms does raised ICP cause

A

headache, vomiting, mental changes, seizures

if uncal herniation can cause blown pupil if compresses on oculomotor nerve

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25
Q

what are the types of brain herniations

A 
cingulate (subflacine)
central (trans tentorial)
transcalvarial 
uncal 
upward cerebellar/ transtentorial 
downward cerebellar (tonsillar)
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26
Q

what type of headache should make you think of brain tumour

A

worse in morning- wakes them up
increased with coughing/ leaning forward
may be associated with vomiting or symptoms similar to tension headaches/ migraines

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27
Q

what do you do if there is scary headache symptoms

A

always do fundoscopyto look for papilloedema

28
Q

why do tumours cause headaches

A

raised ICP
invasion/ compression of dural/ blood vessels/ periosteum
double vision
difficulty focusing
extreme hypertension (cushings triad of raised ICP)
psychogenic

29
Q

what does the parietal lobe do

A 
processes sensory input 
sensory discrimination 
body orientation 
primary somatic area 
secondary somatic area
30
Q

what does werknickes area do

A

language comprehension

31
Q

what does the occipital lobe to

A

visual reception area

visual interpretation

32
Q

what does the cerebellum do

A

coordination and control of voluntary movement

33
Q

what does the brainstem do

A

breathing, digestion, heart control, blood vessel control, alertness

34
Q

what does the temporal lobe do

A

auditory reception area
expressed behaviour
receptive speech
memory/ information retrieval

35
Q

what does the frontal lobe do

A

premotor cortex- storage of motor patterns

prefrontal area- concentration, elaboration of though, judgement, inhibition, personality, emotional traits

brocas area language production

motor cortex- voluntary motor activity

36
Q

what symptoms should make you urgently refer a patient on suspicion of a brain tumour

A

adults- progressive sub acute loss of central neurological function
children- newly abnormal cerebellar or other central neurological function

new onset seizures 
headaches 
mental changes 
cranial nerve palsy
unilateral sensioneural deafness

headaches with symptoms of raised ICP

  • vomiting
  • drowsiness
  • posture relates
  • pulse synchronous tinnitus
37
Q

what investigations for suspected brain tumour

A 
CT 
MRI
LP
PET
lesion biopsy 
EEG
evoked potentials 
angiograms 
radionucleotide studies
38
Q

is papilloedema a late or early sign of a brain tumour

A

late

39
Q

what is the commonest brain tumour

A

mets from other areas

40
Q

what type of cells do gliomas arise from

A

astrocytes

41
Q

what are grade 1 astrocytomas

A

benign, slow growing- affects children and young adults

42
Q

what are grade 2 astrocytoma like

A

not benign
vascular
tend to be in parietal or frontal lobes
present with seizures

43
Q

what are the poor prognostic factors for

A 
over 50 
focal deficit 
short duration of symptoms 
raised ICP 
altered consciousness 
enhancement on contrast studies
44
Q

what is the treatment for a grade 2 astrocytoma

A

want to do surgery as can become malignant
or depending on tumour:
serial imaging +/- chemo, radio/ no Tx

45
Q

what are grade 3 astrocytomas like

A

bad- median survival 2 years

46
Q

what are grade 4 astrocytomas like

A

really bad- median survival 14 months

47
Q

what is the most common pituitary tumour

A

astrocytoma

48
Q

what is the treatment for grade 4 astrocytomas

A

Tx not curative unless present v early with a cyst, surgery- cytoreduction, reduce mass effect, post op radiotherapy

49
Q

can you drive if you have a brain tumour operation

A

no if seizure risk (all glioblastomas) or if significant visual defect

50
Q

what are the types of chemotherapy

A

temozolomide, PCV, carmustine wafers

51
Q

what are oligodendrogial

A

tumour of oligodendrocytes (myelin making cells)

affects frontal lobes, may present with seizures - chem sensitive

52
Q

what does tiptoeing, ataxia and vomiting with headaches in children suggest

A

BRAIN TUMOUR

53
Q

what are meningiomas like

A

extra axial
commoner in females
majority asymptomatic
90% benign

54
Q

what are the aggressive types of meningiomas

A

clear cell, choroid, rhabdoid, papillary, radiation induced

55
Q

what is the Tx for meningiomas

A

small- leave, pre op embolisation

surgery, radiotherapy

56
Q

what does recurrence of meningiomas depend on

A

extent of resection and grade

57
Q

what are the types of nerve sheath tumours

A

schwanomas, neurofibromas, malignant peripheral nerve sheath tumours

58
Q

what are the symptoms of a vestibular schwannoma

A

hearing loss (unilateral), tinnitus, dysequilibrium

59
Q

what is the treatment of a vestibular schwannoma

A 
'expectant'
hydrocephalus management 
radiotherpay 
surgery 
audiological assessment
60
Q

are vestibular schannomas malignant

A

1% are

61
Q

what are pineal tumours like

A

present with parinad syndrome, lots of them hormone secreting, often curable with chemo and radio (germ cell tumours)

62
Q

what do you test in any child with a midline tumour

A

tumour markers- ALP, HCG, LDH

to see if germ tumour and whether it will be chemo/ radio sensitive

63
Q

what procedure treats hydrocephalus

A

VP shunt

64
Q

what are the symptoms of a pituitary tumour

A

bitemporal hemianopia, HA, endocrine abnormality

65
Q

what tests for a pituitary tumour

A

morning cortisol and prolactin

66
Q

which pituitary tumours do you surgically remove

A

in patients with cushings, acromegaly or if going blind (unless prolactinoma)

Neurology (35 decks)

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