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Radiology > Neuroradiology Differentials > Flashcards

Neuroradiology Differentials Flashcards

Comprehensive Differentials for Boards

1
Q

Lesions crossing the corpus callosum

A
  • Glioblastoma multiforme
  • Lymphoma
  • Progressive multifocal leukoencephalopathy
  • Multiple sclerosis
  • Mimic: parafalcine meningioma
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2
Q

Ring-enhancing intracranial lesions

A
  • MAGICAL DR mnemonic:
  • Metastasis
  • Abscess: AIDS, IVDA, immunocompromised state
  • Glioblastoma multiforme, high grade glioma
  • Infarct
  • Contusion/hematoma
  • AIDS (toxoplasmosis)
  • Lymphoma
  • Demyelinating disease
  • Radiation necrosis
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3
Q

Posterior fossa mass, child

A
  • Medulloblastoma
  • Cerebellar pilocytic astrocytoma
  • Ependymoma
  • Pontine glioma
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4
Q

Posterior fossa mass, adult

A
  • Metastasis (most common)
  • Cerebellar pilocytic astrocytoma
  • Hemangioblastoma (von Hippel-Lindau disease
  • Medulloblastoma (cerebellar hemisphere)
  • Hemorrhage (hypertensive)
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5
Q

Extra-axial mass

A
  • Meningioma
  • Arachnoid cyst
  • Epidermoid cyst
  • Dural metastasis
  • Bone lesion with intracranial extension
  • Empyema, subdural or epidural
  • Sarcoidosis
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6
Q

Cerebellopontine angle mass

A 
• Vestibular schwannoma (bilateral,neurofibromatosis-2)
• Meningioma
• Arachnoid cyst
• Epidermoid cyst (most common)
• Other: ependymoma, schwannoma, 
glomus jugulare
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7
Q

Sellar or suprasellar mass

A
  • GATCH MODE mnemonic:
  • Germ cell tumor, Granuloma
  • Adenoma, Aneurysm, Arachnoid cyst
  • Tuber cinerum hamartoma
  • Craniopharyngioma, Rathke’s cleft cyst
  • Hypothalamic glioma
  • Meningioma, Metastasis
  • Optic chiasm glioma
  • Dermoid
  • Epidermoid
  • Lymphoma
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8
Q

Suprasellar mass, adult (common)

A
  • Pituitary adenoma (prolactinoma > GH)
  • Craniopharyngioma (30-40 y/o)
  • Meningioma
  • Chiasmatic/hypothalamic glioma
  • Aneurysm
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9
Q

Suprasellar mass, child (common)

A
  • Craniopharyngioma (4-5 y/o)
  • Chiasmatic/hypothalamic glioma (NF-1)
  • Germinoma
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10
Q

Suprasellar mass, homogeneously enhancing

A
  • Macroadenoma
  • Meningioma (planum sphenoidale, clivus)
  • Aneurysm
  • Germinoma, teratoma
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11
Q

Suprasellar mass, partially calcified

A
  • Meningioma
  • Craniopharyngioma
  • Aneurysm
  • Granuloma
  • Dermoid
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12
Q

Suprasellar mass, high attenuation

A
  • Meningioma
  • Craniopharyngioma
  • Adenoma (hemorrhagic)
  • Aneurysm
  • Glioma
  • Germinoma
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13
Q

Pituitary hemorrhage

A 
adenoma
bromocriptine therapy
pregnancy
XRT
anticoagulation
LP
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14
Q

Suprasellar mass, Hyperintense T1/T2

A
  • Adenoma (hemorrhagic)
  • Craniopharyngioma (cystic, proteinaceous material)
  • Rathke’s cleft cyst
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15
Q

Infundibular mass, child

A
  • Germinoma
  • Eosinophilic granuloma
  • Meningitis
  • Lymphoma
  • Glioma
  • Racemose cysticercosis
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16
Q

Infundibular mass, adult

A
  • Metastasis
  • Sarcoid
  • Germinoma
  • Lymphoma
  • Glioma
  • Choristoma (granular cell tumor)
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17
Q

Cavernous sinus mass

A
  • Meningioma
  • Schwannoma, neurofibroma
  • Aneurysm of ICA
  • Cavernous sinus thrombosis
  • Carotid-cavernous fistula
  • Metastasis
  • Lymphoma, sarcoid
  • Macroadenoma
  • Extension from bone tumors: metastasis, chordoma, chondrosarcoma
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18
Q

Cavernous sinus mass, bilateral

A
  • Macroadenoma
  • Meningioma
  • Lymphoma
  • Metastases
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19
Q

CN 5 foramen

A

Standing Room Only:
V1 - Spinosum
V2 - Rotundum
V3 - Ovale

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20
Q

Pineal region mass

A
  • Pineal cyst (NL <15 mm)
  • Germ cell tumor (germinoma)
  • Pineoblastoma (rare, child), pineocytoma (rare, adult)
  • Metastasis
  • Tectal glioma
  • Meningioma
  • Vein of Galen malformation
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21
Q

Temporal lobe lesion, adult

A
  • GBM, metastasis
  • Ganglioglioma (young adult, also parietal lobe/cerebellum), DNET
  • HSV
  • Trauma
  • Mesial temporal sclerosis
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22
Q

Absent posterior pituitary bright spot

A
  • EG

* Diabetes insipidus

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23
Q

Intraventricular mass

A
  • Meningioma (left atrium)
  • Metastases, lymphoma
  • Ependymoma (4th ventricle)
  • Subependymoma (rare, 4th ventricle or frontal horn)
  • Choroid plexus papilloma (child, left atrium; rare adult, 4th ventricle)
  • Colloid cyst
  • Astrocytoma (giant cell astrocytoma in Tuberous Sclerosis)
  • Central neurocytoma (rare, adult)
  • Medulloblastoma (child, 4th ventricle; adult, cerebellar hemisphere)
  • Racemose cysticercosis (mimics epidermoid cyst, arachnoid cyst)
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24
Q

CSF seeding of tumor

A
  • Germinoma
  • PNET: medulloblastoma, pineoblastoma, retinoblastoma
  • Ependymoma
  • Choroid plexus carcinoma
  • GBM
  • Metastases
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25
Q

Hyperacute blood

A

24 hours
Oxyhemoglobin
“ It Be”
T1 Iso (I) ………T2 Bright (B)

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26
Q

Acute blood

A

1-3 days
Deoxyhemoglobin
“ Id Dee”
T1 Iso ………T2 Dark

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27
Q

Early Subacute Blood

A

3-7 days
Methemoglobin
“BiDee”
T1 Bright ………T2 Dark

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28
Q

Late Subacute Blood

A

7-14 days
Methemoglobin (Extra cell)
“Baby”
T1 Bright ………T2 Bright

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29
Q

Chronic

A

> 1 month
Methemoglobin (Extra cell)
“Doo Doo”
T1 Dark ………T2 Dark

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30
Q

White matter disease (multiple)

A

• Ischemia
• Multiple sclerosis
• Acute disseminated encephalomyelitis: measles, mumps, mononucleosis, varicella; post-vaccination (basal ganglia/thalamus abnormalities differentiate from MS)
• PML (classically occipitoparietal regions)
• Central pontine myelinolysis
• SLE and other collagen vascular diseases
• Sarcoid
• Lyme disease
• Vitamin B12 deficiency
• Radiation injury
• Dysmyelinating disease:
Canavan’s disease (diffuse, macrocephaly)
Krabbe’s disease (diffuse)
Alexander’s disease (anterior)
adrenal leukodystrophy (posterior)
metachromatic leukodystrophy (diffuse)
Pelizaeus-Merzbacher disease (deficient myelin-specific lipids)

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31
Q

Infarct, young adult

A
  • Dissection: post-traumatic, Marfan’s syndrome, FMD, extension of Type A thoracic aortic dissection into common carotid artery
  • Drug abuse: cocaine, amphetamine
  • Vasculitis: giant cell arteritis, PAN, temporal arteritis; sarcoidosis; SLE, Wegener’s disease, Behcet’s disease; methamphetamine, ergotism
  • Basilar meningitis: bacterial, TB, fungal, syphilis
  • Fibromuscular dysplasia
  • Migraine
  • Moyamoya disease (child): idiopathic; mimics include Sickle cell anemia, NF-1, connective tissue disorders (Marfan’s syndrome, Ehlers-Danlos, homocysteinuria), radiation injury, Menke’s kinky hair syndrome, atherosclerosis (uncommon)
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32
Q

Gyriform cortical enhancement

A
  • Stroke
  • Cerebritis
  • Postictal state
  • Hypertensive encephalopathy, eclampsia
  • Drugs: cyclosporine, MTX, FK506 (Tacrolimus)
33
Q

Hypertensive encephalopathy

A 
pregnancy
renal failure
TTP
hemolytic-uremic syndrome
similar in appearance to cyclosporine, FK-506 therapy
34
Q

Dural venous sinus thrombosis

A
  • Infection: otomastoiditis
  • Pregnancy
  • Dehydration
  • Sepsis
  • Neoplasm: falx meningioma
  • Hypercoagulable states
35
Q

Conditions associated with cerebral aneurysms

A
  • AVM
  • ADPCKD
  • Fibromuscular dysplasia
  • NF-1
  • Collagen vascular disease
  • Marfan’s syndrome
  • Coarctation of the Aorta
36
Q

Aneurysm in unusual location

A
  • Mycotic: bacterial endocarditis
  • Vasculitis: PAN, SLE, Wegener’s granulomatosis, Takayasu’s disease
  • AVM
  • Post-traumatic
37
Q

Hemorrhage, intraxial

A
  • Trauma
  • Hypertension (putamen, thalamus, pons, cerebellum)
  • Aneurysm (multiple in 15%)
  • AVM, cryptic vascular malformation (cavernous hemangioma, capillary telangiectasia)
  • Thromboembolic, venous infarct (temporal lobe from transverse sinus thrombosis, parasagittal subcortical white matter from superior sagittal sinus thrombosis, thalami from straight sinus or vein of Galen thrombosis)
  • Hemorrhagic metastasis: melanoma, thyroid carcinoma, choriocarcinoma, adenocarcinoma (breast, lung, renal, colon); GBM, oligodendroglioma
  • Amyloid angiopathy
  • Drugs abuse: cocaine, amphetamine
  • Other: coagulopathy, vasculitis, encephalitis
38
Q

Hemorrhage spontaneous intra-axial, elderly

A
  • HTN
  • Amyloid angiopathy
  • Metastasis
39
Q

Hemorrhage spontaneous intra-axial, young

A
  • AVM
  • Aneurysm
  • Drug abuse: cocaine, amphetamine
  • Neoplasm
40
Q

Hemorrhage multifocal intra-axial

A
  • Trauma
  • Metastases
  • Amyloid angiopathy
  • Vasculitis
  • Venous infarction
  • Coagulopathy
41
Q

Hemorrhage, subarachnoid

A
  • Aneurysm
  • Trauma
  • AVM
42
Q

Hemorrhage, epidural/subdural

A
  • Trauma

* Coagulopathy

43
Q

Leptomeningeal enhancement

A
  • Metastases: lung, breast, melanoma, lymphoma/leukemia, PNETs (child)
  • Meningitis: TB, fungal; otomastoiditis
  • Post-surgical
  • SAH
  • Meningeal (pial) angiomatosis in Sturge-Weber
44
Q

Meningitis bugs

A
  • Group B streptococcus (newborn)
  • H. infuenzae (child)
  • N. meningititis (adolescent)
  • S. pneumonia (adult)
45
Q

Dural enhancement/mass

A
  • Post-craniotomy or LP, CSF diversion
  • Neoplasm: meningioma, metastases (breast, prostate, lymphoma), direct extension of primary intracranial tumor, neuroblastoma (child)
  • Meningitis
  • Post-hemorrhagic: remote SDH, EDH
  • Spontaneous intracranial hypotension (CSF leak from lumbosacral root sleeve cyst)
  • Sarcoidosis
46
Q

Ependymal enhancement

A
  • Neoplasm: lymphoma, glioma, CSF spread of primary intracranial tumor or metastasis
  • Ventriculitis: meningitis, post-shunting; CMV (AIDS)
47
Q

Parenchymal calcifications, neonate

A
  • CMV
  • Toxoplasmosis
  • Rubella infection
  • Herpes Simplex infection
  • HIV (basal ganglia)
  • STARCH mnemonic: Syphilis, Toxoplasmosis, AIDS, Rubella, CMV, Herpes simplex virus-2
48
Q

T1 hyperintensity

A
  • Intracellular/extracellular methemoglobin
  • Fat
  • Proteinaceous fluid
  • Melanin
  • Slow blood flow on certain sequences
  • Calcification (hydrated)
49
Q

T2 hypointensity

A
  • Vascular flow voids
  • Deoxyhemoglobin (acute bleed), intracellular methemoglobin, ferritin, hemosiderin
  • Calcification or ossification
  • Proteinaceous fluid
  • Densely cellular mass: meningioma, lymphoma, PNET (pineoblastoma, medulloblastoma, neuroblastoma)
  • Iron deposition, physiologic (basal ganglia, substantia nigra, red nucleus, dentate nucleus), iron deposition, pathologic
50
Q

Calvarial button sequestrum

A
  • O ME mnemonic:
  • Osteomyelitis
  • Metastases
  • EG
51
Q

Solitary lytic defect in skull

A
  • MT HOLE (“empty hole”) mnemonic:
  • Metastasis, multiple myeloma
  • TB, trauma
  • Histiocytosis, hemangioma
  • Osteomyelitis
  • Leptomeningeal cyst
  • Epidermoid
52
Q

Loss of lamina dura

A
  • CHOMP mnemonic:
  • Cushing’s disease
  • Hyperparathyroidism
  • Osteomalacia, osteoporosis
  • Multiple myeloma
  • Paget’s disease
53
Q

Calcifications in brain

A
  • PINEAL mnemonic:
  • Physiologic: pineal gland, choroid plexus, basal ganglia
  • Infections: Cysticercosis, toxoplasmosis, TB, CMV
  • Neoplasm: craniopharyngioma, oligodendroglioma, meningioma, chordoma
  • Endocrine: hypervitaminosis D, hypoparathyroidism, hyperparathyroidism, Fahr’s disease
  • Arterial: atherosclerosis, aneurysm
  • Lipoma, dermoid
54
Q

Calcified intracranial mass

A
  • Ca++ COME mnemonic:
  • Craniopharyngioma
  • Astrocytoma, aneurysm
  • Choroid plexus papilloma
  • Oligodendroglioma
  • Meningioma
  • Ependymoma (25%)
55
Q

Basal ganglia calcification

A
  • Idiopathic
  • Hypoparathyroidism, hyperparathyroidism
  • Fahr’s disease (familial idiopathic cerebral ferrocalcinosis)
  • Post-inflammatory, post-anoxia
  • AIDS
  • Cockayne’s syndrome
56
Q

Intramedullary lesion

A
  • Neoplasm: ependymoma (adult, conus medullaris/filum, can be cystic or calcified or bloody), astrocytoma (child), hemangioblastoma, metastasis (rare)
  • Infarct, ischemia
  • Hematoma
  • Demyelinating disease: MS
  • Transverse myelitis: post-viral, inflammatory, ischemia, MS, ADEM, SLE, XRT
  • Cryptic vascular malformation: cavernous hemangioma, capillary telangiectasia
  • Syrinx
  • Contusion
  • Abscess
57
Q

Syringomyelia

A
  • Trauma (myelomalacia)
  • Neoplasm
  • Chiari 1 or 2 malformation
  • Infarct (myelomalacia)
  • Arachnoiditis: meningitis, back surgery
58
Q

Intradural, extramedullary lesion

A
  • Meningioma (posterolateral)
  • Nerve sheath tumor (anterolateral): schwannoma, neurofibroma
  • Metastases (drop): germ cell tumors, ependymoma, PNET; adenocarcinoma, melanoma, lymphoma/leukemia
  • Dermoid, epidermoid
  • Lipoma
  • MANDELIN mnemonic: meningioma, metastasis (drop), arachnoiditis, arachnoid cyst, AVM, neurofibroma, dermoid, epidermoid, ependymoma, lipoma, infection (TB, cysticercosis) NL but tortuous nerve roots
59
Q

Extradural lesion

A
  • Degenerative disease: disc protrusion, osteophyte, synovial cyst
  • Metastases to vertebrae: lung, breast, prostate, lymphoma
  • Other tumors: myeloma, chordoma, aneurysmal bone cyst, giant cell tumor, lymphoma/leukemia, osteoblastoma, eosinophilic granuloma, schwannoma, neurofibroma, ganglioneuroma, ganglioneuroblastoma, neuroblastoma
  • Epidural abscess: discitis, osteomyelitis
  • Hematoma
60
Q

Epidural lesion, child

A
  • Extension of paraspinal or vertebral tumor: neuroblastoma, ganglioneuroblastoma, ganglioneuroma; neurofibroma, schwannoma
  • Abscess
  • Ewing’s sarcoma
  • Lymphoma/leukemia
  • Eosinophilic granuloma
  • Other vertebral body tumors (above)
61
Q

Epidural extension over many levels

A
  • Abscess
  • Hematoma
  • Metastases
  • Lymphoma
62
Q

Destructive midline, skull-base lesion

A
  • Metastases
  • Myeloma
  • Nasopharyngeal carcinoma
  • Chordoma (midline)
  • Chondrosarcoma (off midline)
  • Meningioma
  • Macroadenoma
  • Lymphoma
  • Esthesioneuroblastoma (cribiform plate)
  • Aggressive sinusitis: aspergillus, mucormycosis
  • Mucocele, polyposis
63
Q

Destructive skull-base lesion, frontal

A
  • Esthesioneuroblastoma
  • Metastasis
  • meningioma
  • Sinonasal carcinoma
  • Lymphoma
  • Rhabdomyosarcoma
  • Aggressive sinusitis
  • Mucocele, sinonasal polyposis
64
Q

Destructive skull-base lesion, basisphenoid

A
  • Nasopharyngeal carcinoma
  • Chordoma
  • Chondrosarcoma
  • Metastases, myeloma
  • Macroadenoma
  • Meningioma
  • Aggressive sinusitis: aspergillus, mucormycosis
65
Q

J-shaped sella

A
  • Cretinism
  • Idiopathic
  • Hydrocephalus
  • Gargoylism
  • Achondroplasia
  • Optic glioma
  • NF-1
66
Q

Jugular foramen mass

A
  • Glomus jugulare
  • Schwannoma
  • Metastasis
  • Meningioma
  • Asymmetrical or thrombosed jugular vein, ectatic carotid artery, carotid pseudoanuerysm
67
Q

Far lateral disc herniation mimics

A
  • Conjoined nerve root
  • Perineural cyst
  • Neurofibroma
68
Q

Tarlov cyst mimics

A
  • Intrasacral meningocele

* Dural ectasia

69
Q

Arachnoiditis

A
  • Trauma, surgery
  • Intrathecal steroids, anesthesia
  • Myelogram
  • Infection
70
Q

Globe lesions

A
  • Uveal melanoma (lobular), uveal metastases (plaque-like)
  • Choroidal or retinal detachment
  • Vitreous hemorrhage
  • Pseudotumor
  • Retinoblastoma (child)
  • Optic disc Drusen, choroidal osteoma (lateral to optic disc)
71
Q

Optic nerve or nerve sheath enlargement

A
  • Optic glioma (child, NF-1), optic nerve sheath meningioma (adult), lymphoma/leukemia, metastasis
  • Pseudotumor
  • Optic neuritis
  • Sarcoidosis
72
Q

Rectus muscle enlargement

A
  • Thyroid opthalmopathy (inferior>medial>superior>lateral)
  • Pseudotumor
  • Myositis: extension from paranasal sinus infection, pseudotumor
  • Metastasis, lymphoma, others
  • Vascular congestion from mass at orbital apex, carotid-cavernous fistula, cavernous sinus thrombosis, dural AVM
73
Q

Lacrimal fossa mass

A
  • Viral infection
  • Benign neoplasm: dermoid, pleomorphic adenoma
  • Malignant neoplasm: adenoid cystic carcinoma, lymphoma, metastases
  • Pseudotumor
  • Sarcoidosis
  • Sjogren’s syndrome
  • Wegener’s granulomatosis
74
Q

Lacrimal fossa mass, bilateral

A
  • Lymphoma

* Sarcoid

75
Q

Intraconal mass

A
  • Cavernous hemangioma (adult), capillary hemangioma (child), lymphangioma (child)
  • Orbital cellulitis, pseudotumor
  • Varix, carotid-cavernous fistula
  • Lymphoma, rhabdomyosarcoma (child), metastasis (child: neuroblastoma to bone; adult: breast, lung, prostate, melanoma to uvea, rectus muscles, bone)
76
Q

Extraconal mass

A
  • Metastasis to bony orbit
  • Invasion by adjacent primary tumor: paranasal sinus or nasal SCC, sphenoid wing meningioma
  • Lacrimal fossa mass
  • Subperiosteal abscess or hematoma
77
Q

Orbital mass, child

A
  • LO VISHON mnemonic:
  • Leukemia, lymphoma
  • Optic nerve glioma
  • Vascular malformation (capillary hemangioma, lymphangioma)
  • Inflammation (pre-, post-septal)
  • Sarcoma (rhabdomyosarcoma)
  • Histiocytosis
  • Orbital pseudotumor, osteoma
  • Neuroblastoma
78
Q

Middle ear mass

A
  • Cholesteatoma, cholesterol granuloma, inflammatory debris/granulation tissue
  • Vascular: aberrant carotid artery, dehiscent jugular bulb
  • Neoplasm: glomus tympanicum (cochlear promontory, ascending pharyngeal artery embolization), glomus jugulare invading middle ear (glomus jugulotympanicum), hemangioma, others
79
Q

Lesion causing pulsatile tinnitus

A
  • Aberrant carotid artery, high jugular bulb or dehiscent jugular bulb
  • Transverse sinus/internal jugular vein thrombosis, high grade carotid stenosis, dural AVF
  • Glomus tympanicum, glomus jugulare invading middle ear

Radiology (1 decks)

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