Neuroradiology Info

Question 1

Amyloid beta-related angiitis

(a) Mechanism of disease
(b) Clinical presentation
(c) Definitive diagnostic test
(d) tx

Answer 1

Amyloid beta-related angiitis

(a) Vasculitis of small and medium-sized leptomeningeal arteries
- immune response to beta-amyloid in BV walls

(b) Subacute dementia, seizures, focal neurologic signs, HA
(c) Brain biopsy
(d) Tx w/ immunosuppressants

Question 2

What is considered a chronic (vs. episodic) headache

Answer 2

Chronic headache = 15 or more headache days per month

Question 3

Distinguish the type of hemorrhage seen 2/2 HTN vs. amyloid angiopathy

Answer 3

HTN => lacunar stroke

• deep structures: basal ganglia, brainstem
• presents w/ contralateral motor/sensory deficit

Amyloid angiopathy => lobar stroke = in lobes (occipital and parietal) adjacent to the cortex, more superficial
-p/w headache and sudden progression of focal neurologic deficit

Question 4

Brain mets w/ highest propensity to hemorrhage

Answer 4

Melanoma, renal cell, choriocarcinoma (uterus), and thyroid cancer have highest propensity to hemorrhage

-but breast and lung are the most common overall => hemorrhagic mets most likely due to breast and lung

Question 5

Common size cuttoff for hematomas that should be assessed for neurosurgical evaluation

Answer 5

Generally hematomas larger than 3cm in diameter

b/c highest risk of neurological decline

Question 6

76 yo F p/w headache and right visual field deficits

Localize the lesion

Answer 6

Right visual field deficits localizes lesion to the left parietal lobe

Question 7

2nd MC location for hypertensive hemorrhagic stroke

Answer 7

1st- basal ganglia

2nd- cerebellar hemisphere

Question 8

Describe the appearance of new, subacute, and old bleed on T1 vs T2WI

Answer 8

New bleed (0-1 days)

• isointense on T1
• hyperintense on T2

Acute (1-3 days)

• isointense on T1
• hypointense on T2

Subacute (4-7 days)

• hyperintense on T1: so becomes visible on T1 in about 4-7 days
• hypointense on T2

Chronic (2+ wks)
-hypointense on both T1 and T2

Question 9

Most typical/classic presentation of intraparenchymal hemorrhage

Answer 9

Most commonly in the basal ganglia => presents w/ contralateral hemiplegia (motor findings) and sensory deficits

ex: pt w/ RUE and RLE weakness w/ h/o chronic HTN

Question 10

3 MC sites for intracranial aneurysm

Answer 10

• posterior communicating artery (connects ICA and PCA)
• anterior communicating artery (connects ACAs)
• bifurcation of the middle cerebral artery

Question 11

71 yo F s/p tPA infusion for ischemic stroke develops seizure and obtundation

(a) Dx
(b) Tx

Answer 11

(a) Hemorrhagic conversion of ischemic stroke
- risk of about 6% w/ tPA use, increases as you deviate from the standard tPA protocol

(b) Tx = supportive measures
- decrease ICP measures

minimize risk of further bleed or expansion
-keep BP under tight control

Question 12

Pituitary apoplexy

(a) What is it?
(b) Presentation
(c) Mgmt

Answer 12

Pituitary apoplexy = bleeding into or impaired blood supply of the pituitary gland at the base of the brain

(b) Presents w/ sudden onset HA and rapidly worsening visual symptoms (visual field defect or diplopia)
(c) Mgmt often includes emergency surgical decompression and replacement of pituitary hormone deficiencies