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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
what are the types of brain herniations
``` cingulate (subflacine) central (trans tentorial) transcalvarial uncal upward cerebellar/ transtentorial downward cerebellar (tonsillar) ```
26
what type of headache should make you think of brain tumour
worse in morning- wakes them up increased with coughing/ leaning forward may be associated with vomiting or symptoms similar to tension headaches/ migraines
27
what do you do if there is scary headache symptoms
always do fundoscopyto look for papilloedema
28
why do tumours cause headaches
raised ICP invasion/ compression of dural/ blood vessels/ periosteum double vision difficulty focusing extreme hypertension (cushings triad of raised ICP) psychogenic
29
what does the parietal lobe do
``` processes sensory input sensory discrimination body orientation primary somatic area secondary somatic area ```
30
what does werknickes area do
language comprehension
31
what does the occipital lobe to
visual reception area | visual interpretation
32
what does the cerebellum do
coordination and control of voluntary movement
33
what does the brainstem do
breathing, digestion, heart control, blood vessel control, alertness
34
what does the temporal lobe do
auditory reception area expressed behaviour receptive speech memory/ information retrieval
35
what does the frontal lobe do
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
what symptoms should make you urgently refer a patient on suspicion of a brain tumour
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
what investigations for suspected brain tumour
``` CT MRI LP PET lesion biopsy EEG evoked potentials angiograms radionucleotide studies ```
38
is papilloedema a late or early sign of a brain tumour
late
39
what is the commonest brain tumour
mets from other areas
40
what type of cells do gliomas arise from
astrocytes
41
what are grade 1 astrocytomas
benign, slow growing- affects children and young adults
42
what are grade 2 astrocytoma like
not benign vascular tend to be in parietal or frontal lobes present with seizures
43
what are the poor prognostic factors for
``` over 50 focal deficit short duration of symptoms raised ICP altered consciousness enhancement on contrast studies ```
44
what is the treatment for a grade 2 astrocytoma
want to do surgery as can become malignant or depending on tumour: serial imaging +/- chemo, radio/ no Tx
45
what are grade 3 astrocytomas like
bad- median survival 2 years
46
what are grade 4 astrocytomas like
really bad- median survival 14 months
47
what is the most common pituitary tumour
astrocytoma
48
what is the treatment for grade 4 astrocytomas
Tx not curative unless present v early with a cyst, surgery- cytoreduction, reduce mass effect, post op radiotherapy
49
can you drive if you have a brain tumour operation
no if seizure risk (all glioblastomas) or if significant visual defect
50
what are the types of chemotherapy
temozolomide, PCV, carmustine wafers
51
what are oligodendrogial
tumour of oligodendrocytes (myelin making cells) | affects frontal lobes, may present with seizures - chem sensitive
52
what does tiptoeing, ataxia and vomiting with headaches in children suggest
BRAIN TUMOUR
53
what are meningiomas like
extra axial commoner in females majority asymptomatic 90% benign
54
what are the aggressive types of meningiomas
clear cell, choroid, rhabdoid, papillary, radiation induced
55
what is the Tx for meningiomas
small- leave, pre op embolisation | surgery, radiotherapy
56
what does recurrence of meningiomas depend on
extent of resection and grade
57
what are the types of nerve sheath tumours
schwanomas, neurofibromas, malignant peripheral nerve sheath tumours
58
what are the symptoms of a vestibular schwannoma
hearing loss (unilateral), tinnitus, dysequilibrium
59
what is the treatment of a vestibular schwannoma
``` 'expectant' hydrocephalus management radiotherpay surgery audiological assessment ```
60
are vestibular schannomas malignant
1% are
61
what are pineal tumours like
present with parinad syndrome, lots of them hormone secreting, often curable with chemo and radio (germ cell tumours)
62
what do you test in any child with a midline tumour
tumour markers- ALP, HCG, LDH | to see if germ tumour and whether it will be chemo/ radio sensitive
63
what procedure treats hydrocephalus
VP shunt
64
what are the symptoms of a pituitary tumour
bitemporal hemianopia, HA, endocrine abnormality
65
what tests for a pituitary tumour
morning cortisol and prolactin
66
which pituitary tumours do you surgically remove
in patients with cushings, acromegaly or if going blind (unless prolactinoma)

Neurology (35 decks)

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