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Neuroradiology > Neuroradiology Review > Flashcards

Neuroradiology Review Flashcards

1
Q

Dense MCA sign

A

early ischemia

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2
Q

Insular ribbon sign

A

early ischemia, insula hypodense

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3
Q

Loss of sulcal effacement

A

early ischemia

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4
Q

obscuration of lentiform nucleus/blurred BG

A

early ischemia

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5
Q

Best MRI sequence for blood?

A

Gradient

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6
Q

Can unilarteral PICA infarcts cross midline?

A

No, because vermian branches do not cross midline

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7
Q

Medial lenticulostriate

A

Supplied by M1

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8
Q

Lateral lenticulostriate

A

Supplied by A1

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9
Q

M2 and M3

A

M2 supplies area of sylvian fissure, M3 supplies cortical patietal region

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10
Q

Cortical border zone infarcts

A

Watershed, between ACA and MCA, or between MCA and PCA

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11
Q

Internal border zone infarcts

A

At the border between the lenticulostriate (A1/M1 tributaries) and the Deep penetrating MCA.

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12
Q

What to look at with Internal border zone infarcts?

A

Carotids

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13
Q

What to look for in border zone infarcts in general?

A

Carotids - makes sence, because this causes hypoperfusion.

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14
Q

“Lacunar”?

A

Lake like, in areas of BG, thalamus, white matter

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15
Q

Virchow-Robin Spaces (VRS)

A

Area where arteries enter brain parenchyma, can look like hypodense lacunes. Will be CSF intense on T2, black on flair.

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16
Q

PRES

A

Posterior Reversible Encephalopathy Syndrome

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17
Q

Is PRES vasgenic or cytotoxic

A

vasogenic

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18
Q

What does PRES look like on MRI

A

Should be PCA but can happen anywhere, hyperintense on FLAIR.

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19
Q

PRES associated with?

A

Hypertension, eclampsia, cyclosporine. Hypoperfusion –> vasogenic edema

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20
Q

Risk factors for venous thrombosis

A

Dehydration, pregnancy, hypercoaguability, mastoiditis

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21
Q

Presentation of venous stroke

A

Often presents as hemmoragic stroke in atypical location

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22
Q

How to find a venous stroke?

A

MRV

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23
Q

Glial

A

Astrocytoma, oligodendroglioma

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24
Q

Non-Glial

A

Meningioma, Schwannoma, Pituitary, Pineal, Lymphoma

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25
Q

Mets

A

Lung, Breast, Melanoma, Renal, Colon

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26
Q

What percentage of each?

A

1/3. 1/3. 1/3

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27
Q

Age under 2

A

Choroid plexus papilloma, Anaplastic astrocytoma, teratomas

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28
Q

Age under 10

A

Medulloblastoma, astrocytomas, ependymomas, craniopharyngiomas, gliomas.

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29
Q

Age adult

A

GBM, astrocytomas, meningiomas, oligodendrgliomas, pituitary, schwannomas

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30
Q

Common intra-axial supratentorial tumors in kids

A

astrocytoma, pleomorphic xanthoastrocytoma, PNET, DNET

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31
Q

Common intra-axial infratumors in kids

A

Juvenile pilocytic astrocytoma, PNET, ependymomas

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32
Q

Common intra-axial supratentorial tumors in adults

A

Gliomas, mets

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33
Q

Common intra-axial infratumors in adults

A

Mets, hemangioblastomas (METS ARE TOP 3 IN DIFFERENTIAL!)

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34
Q

Most adult intraaxial

A

MET

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35
Q

Most adult extraaxial

A

Meningioma, Schwannoma

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36
Q

Signs of extraaxial masses

A

CSF cleft, gray matter between the mass and white matter, brioad dural based, subarachnoid vessels displaced circumfrentially, Bony reaction.

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37
Q

Dural Tail

A

Meningioma, can see with schwannoma, but RARE

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38
Q

Enhancement of Intra/Extra axial

A

Extra axial should enhance, because NO BBB

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39
Q

Primitive neuroectodermal tumours (PNET)

A

Rare, from undifferentiated nerve cells (medullablastoma, pineal tumors)

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40
Q

What tumors cross midline?

A

GBM, meningioma, lymphoma, epidermoid cyst

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41
Q

How does GBM cross midline

A

IT infiltrates the corpus

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42
Q

How does Meningioma cross midline

A

Can spread long the meninges

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43
Q

How does Lymphoma cross midline

A

It is usually near the midline

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44
Q

How does epidermoid cyst cross midline

A

Via the subarachnoid space

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45
Q

Tumors seen in NFI

A

Optic glioma, astrocytoma

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46
Q

Tumors seen in NFII

A

Meningiomas, ependymomas

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47
Q

Tumors seen in Tuberous Sclerosis

A

Subependymal giant cell astrocytoma, ependymomas

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48
Q

Tumors seen in Von-Hippel Lindau

A

Hemangiomas

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49
Q

Tumors that are cotically based

A

Most tumors are white matter based. So cortical ones can be: oligodendroglioma, ganglioglioma, Dysembryoplastic neuroepithelial tumor (DNET)

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50
Q

Fat on CT HU?

A

It is -100

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51
Q

Fat on MRI?

A

Should have signal on both T1 and T2, however check fat sat and out of phase!

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52
Q

Fat satted tumors?

A

Lipoma, Dermoid Cysts, teratomas

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53
Q

What shows up high intensity on T1 that is not fat?

A

Melanin, Slow flow (IE hemangioma), blood (IE hematoma)

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54
Q

Calcified intraaxial tumors

A

Oligodendrogliomas almost always have calcification. However since astrocytomas are vastly more common, most calcified masses are astrocytomas (even though a small fraction have calcifications)

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55
Q

Calcifieed extraacxial tumors

A

Craniopharyngioma - Slow growing. Suprasellar, cystic squamous sell, in kids, rathke’s pouch

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56
Q

Cystic CNS lesions

A

Epidermoid, dermoid, arachnoid, neuroenteric. All are cystic. VRS can mimic

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57
Q

Appearance of cystic lesions on MRI

A

Intense on T2, isointense to CSF on most sequences because fluid.

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58
Q

High intensity on T1

A

Methhemoglobin, high protein, fat, cholesterol, melanin, slow flow.

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59
Q

What tumors show low intensity on T2

A

Dense tumors with high NC ratio: LYMPHOMA

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60
Q

Why does a lymphoma show up low intensity on T2

A

Becauese it has a high NC ratio

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61
Q

Melanoma metastesis

A

High T1, Low T2

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62
Q

When is restricted diffusion seen?

A

Abcesses, acute infarct, epidermoid cyst

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63
Q

What do tumors looks like on DWI

A

Most tumors do not cause restricted diffusion even in necrotic components. So most of the time the tumor will look hypointense.

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64
Q

Which type of tumors enhance?

A

Extra axial, because contrast does not have to cross the BBB.

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65
Q

What are some exaples of typical enhancing tumors

A

Meningioma, Schwannoma, Pituitary, Pineal

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66
Q

Does the pituitary have a BBB?

A

NO

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67
Q

Does the Ppineal gland have a BBB?

A

NO (Pineocytoma enhances!)

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68
Q

When will an intraaxial tumor enhance?

A

When the BBB is destroyed

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69
Q

What is an example of a tumor that breaks BBB?

A

GBM high grade, if it breaks BBB then it can enhance

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70
Q

What are some non-tumoral enhancing lesions

A

MS, infarctions

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71
Q

What lesions are expected to NOT enhance

A

Dermoid, Epidermoid, arachnoid cysts, low grade astrocytoma

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72
Q

What lesion has limited mass effect even when large, patchy enhancement, edema.

A

GBM - large infiltrative growth beyond MRI finidings

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73
Q

Ring enhancement

A

Mets, GBM, abcess (MAGIC DR)

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74
Q

Tumor arising from the Clivus

A

Chordoma

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75
Q

Tumors arising from the skull base

A

Chordoma, chondrosarcoma, fibrous dysplasia

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76
Q

Chordoma vs Chondrosarcoma

A

Chordoma midline, chondrsarcoma off-midline

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77
Q

Sellar and suprasellar lesions

A

Pituitary, cranio, meingio, chiasmatic glioma, any cyst, schwannoma, met

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78
Q

Name: Supracellar cystern, calcifications on CT, cystic component that shows no enhacement

A

craniopharyngioma

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79
Q

Common tumors in CP angle

A

Schwannoma, meningioma, cysts, mets

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80
Q

Intraventricular Tumors

A

Ependymoma, subependymoma, choroid plexis papilloma, central neurocytoma, colloid cyst, meningioma, giant cell astrocytoma

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81
Q

4th ventricular tumors in kids

A

Astrocytoma (pilocytic?), medulloblastoma, ependymoma

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82
Q

What do the saggital sinuses drain into?

A

Straight sinus

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83
Q

What does the vein of Galen Drain?

A

Drains deep central veins: thalamostriate, internal cerebral into straight sinus

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84
Q

What does the vein of Labbe drain?

A

temporal lobe into transverse sinus

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85
Q

What does the vein of Trolard drain?

A

Drains cortical to superior saggital sinus

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86
Q

Cause of venous thrombosis in neonate?

A

Shock, dehydration

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87
Q

Cause of venous thrombosis in children?

A

Sinusitis, mastitis

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88
Q

Cause of venous thrombosis in adults?

A

Coagulopathy, in women its OCP/pregnancy as highest risk factors

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89
Q

What is the dense clot sign?

A

Sometimes the clot shows up hyper dense on CT. Can see in straight, transverse, sigmoid, etc

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90
Q

What is the cord sign, and the dense vessel sign?

A

Same as dense clot sign

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91
Q

What is the empty delta sign?

A

Contrast CT scan shows a contrast void in the superior sagital sinus on axial. Looks like a delta with hypersense contrast around the central clot

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92
Q

First sign of venous thrombosis?

A

Edema, then possibly hemorrhagic conversion

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93
Q

What type of edema will VT cause?

A

Vasogenic

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94
Q

What is the distribution

A

Bilateral often

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95
Q

What does vasogenic edema look like

A

Finger-like

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96
Q

What if you see some vasogenic edema in temporal

A

Vein of Labbe

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97
Q

What if you see intensity on flair in thalamus and basal ganglia bilaterally? What does it mean?

A

BL means venous possibly, intensity is edema, location is Galen, or one of the other deep veins that Galen drains.

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98
Q

MR venograph types

A

Time of flight, phase contrast, contrast enhanced

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99
Q

Time of Flight venography

A

Uses the phenomenon of flow void, to create a signal intensity

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100
Q

Phase contrast venography

A

Development of phase shift due to flow, created an angio…

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101
Q

Contrast enhanced MRV

A

Uses T1 shortening of gado

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102
Q

What can mimic a venous clot?

A

Aracnoid granulation

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103
Q

Does MRV have pitfalls?

A

Lots. CTV is more reliable. Contrast MRV is better than the phase contrast or TOF MRV.

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104
Q

What does the quadragemial Cistern look like

A

Smiley face

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105
Q

What does the suprasellar cistern look like

A

Star of david

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106
Q

What are the three parts of the extradural ICA?

A

Cervical, petrous, cavernous

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107
Q

What is the Torcula?

A

Confluence of the sinuses

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108
Q

What structure pass through the optic canal

A

CNII, opthalmic artery, and vein

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109
Q

What structures pass through SOF

A

CNIII, IV, V1

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110
Q

What structures pass through IOF

A

V2

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111
Q

What are the three compartments of Orbit

A

Intraconal space, conal space (muscles), extraconal space

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112
Q

What is the blood supply to the globe

A

central retinal artery

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113
Q

What is more lateral, ICA vs IJV?

A

IJV

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114
Q

What are the divisions of the neck?

A

Supra, and infra hyoid neck

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115
Q

What are the four muscles of mastication

A

Medial/lateral pterygoid, masseter, temporalis

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116
Q

What term is used for cystic cavitation of an old infarct?

A

encephalomalacia

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117
Q

What looks like beads on string on CTA?

A

FMD

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118
Q

Five common causes of intraparenchymal hemmorage?

A

Amyloid, tumor, coagulopathy, venous infarct, AVM.

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119
Q

Where does spontaneous hemmorage occur

A

External capsule and basal ganglia and pons and cerebellum

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120
Q

Acute blood on CT? HU?

A

forty five

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121
Q

MAGICAL DRS

A

Mets, Abcess, Glioblastoma, Infarct, Contusion, AIDS, Lymphoma, Demylination, Resolving hematoma, Septic embolus

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122
Q

What are the two most common causes of SAH?

A

Trauma, Ruptured Berry aneurysm

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123
Q

What does an AVM look like on angiogram?

A

One large vessel feeding a tangle of abnormal vessels.

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124
Q

Two most common brain mets

A

lung and breast

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125
Q

What is the mnmonic for mets causing intracranial hemorrhage?

A

MRI CT

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126
Q

MRICT

A

Melanoma, RCC, insulinoma, choriocarcinoma, thyroid carcinoma

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127
Q

What is the treatment for a solitary met

A

surgical removal

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128
Q

What is the characteristic bony change for meningioma?

A

hyperostosis

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129
Q

What does meningioma look like on CT?

A

isodense, with homogenous enhacement and possible calcs, with hyperostosis

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130
Q

What does meningioma look like on MRI?

A

Isointense with bright enhancement

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131
Q

What is DISH

A

diffuse idiopathic skeletal hyperostosis. Anterior fusion flowing dyndesmophytes

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132
Q

Pineal region differential

A

Germ cell tumor, pinealocytoma, pinealblastoa, tecta glioma, meningioma, metastesis, aneurysm of the vein of galen.

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133
Q

What is an empty sella? How?

A

Defect in the diaphram sella that allows CSF pulsations to flatten the pituitary.

134
Q

Cerebellar tumors?

A

Mets, hemangioma, astrocytoma, medulloblastoma, lymphoma, abcess

135
Q

What is the mnmonic for VHL

A

HIPPEL RR

136
Q

HIPPEL RR

A

Hemangioblastoma, islet cell tumors, pheo, pacreatic cystadenoma, epididymal cysts, liver cysts, retinal angioma, RCC (and cysts)

137
Q

What does a hemangioblastoma look like on CT?

A

Cystic mass with enhancing mural nodule

138
Q

Posterior fossa masses in child? Mnmonic

A

GAME

139
Q

GAME

A

Glioma, Astrocytoma, medulloblastoma, ependymoma

140
Q

What does a juvenile pilocytic astrocytoma look like on MRI

A

Cystic t2 bright lesion with mural enhancing nodule usually located in the cerebellum.

141
Q

Where are ependymomas usually located?

A

Floor of the fourth ventricle

142
Q

What is the appearance of ependymoma on MRI?

A

Tooth paste squeezing from the fourth ventricle and out the foramen of magendie and luschka

143
Q

Two common congenital abnormalities of CNS

A

Arnold-chiari and Dandy-Walker

144
Q

What is arnold-Chiari 1

A

Downward displacement of cerebellar tonsils through foramen magnum, small fourth ventricle, syringomyelia, fusion of c1 with cranium. Treatment can be removal of posterior part of c1 and cranium to allow for space.

145
Q

What is arnold-chiari 2

A

inferiorly placed tentoria, small posterior fossa, large foramen magnum, meningomylocele, agenesis of corpus callosum, stenogyria, inferiorly displaced brainstem, elongated medulla, vermian peg

146
Q

Dandy-walker

A

enlarged fourth ventricle, agenesis of vermis, varying degrees of hypoplasia of cerebellar hemispheres, high confluence of sinuses

147
Q

What tumor is associated with TS

A

Supepedymal Giant cell astrocytoma

148
Q

What are four characteristics of TS

A

Adenoma sebaceum, multiple subependymal hamartomas, renal angiomyolipomas, tubers (high t2 intensity)

149
Q

What is encephalofacial angiomatosis called?

A

Sturge Webber

150
Q

What are five features of sturge webber

A

Vascular facial nevi, vascular malfomations involving meninges, calcs along gyri, cerebral atrophy, glaucoma.

151
Q

Described aging blood - Acute, sub, chron?

A

Dense, Iso, hypo

152
Q

What does subfalcine herniation look like?

A

Midline shift and distortion of the horns of the lateral ventricles

153
Q

What does transtentorial herniation look like?

A

Obliteration of the quadrageminal plate cisterns with hydrocephalus via compression of the cerebral aqueduct

154
Q

What will you see with meningitis?

A

Leptomeningeal enhancement

155
Q

How would you differentiate an abcess from another ring enhancing lesion on MRI?

A

DWI

156
Q

What does it look like on that image sequence?

A

Bright on DWI because of restriction.

157
Q

What does bilateral asymmetric white matter lesions in an immunocompromised person represent?

A

Possible multifocal leukencephalopathy

158
Q

Best imaging sequence for MS?

A

Flair

159
Q

Where are the lesions in MS characteristically located and what are they called?

A

Dawson’s fingers are located periventricularly

160
Q

Patients with metabolic derangement and white matter lesions in the brainstem suggest what pathology?

A

CPML

161
Q

What is the most common cause of cerebellar atrophy

A

Alcoholism affects the anterior and superior vermis

162
Q

When people have complex seizure disorders you expect to see what radiologic finding?

A

Mesial temporal sclerosis, you will see gliosis of the hippocampus and parahippocampal regions.

163
Q

What does MTS look like on MRI

A

abnormal T2 intensity on this area

164
Q

What are the two types of hydrocephalus

A

COmmunicating and non-communicating

165
Q

What are four causes of CHC?

A

Infection, post SAH, DVT, NPH

166
Q

What are three causes of NCHC?

A

Aqueductal stenosis, mass, congenital

167
Q

What tumor causes hydrcephalus by over production

A

Choroid plexus papilloma

168
Q

Hydrocephalus can be mimicked in appearance by general brain atrophy, called?

A

HYdrocephalus ex vacuo

169
Q

Age changes in vertebral discs is called? What does it look like?

A

Disc dessication, Looks like decreased T2 signal.

170
Q

What are the two parts of the IV disc?

A

Nucleus pulposus, nucleus fibrosis

171
Q

What is it called when a disc herniated into an adjacent body?

A

Schmorl’s Node

172
Q

What is a disc bulg?

A

Greater than 180 degrees

173
Q

What is a disc protrusion?

A

less than 180 degrees

174
Q

What is a disc extrusion?

A

Focal protrusion with extruded part wider than the base. Pedunculated almost.

175
Q

How do you localize a disc herniation?

A

Central, paramedian, foraminal, extraforaminal

176
Q

What are some things you expect to see with DJD of the spine?

A

Disc space narrowing, osteophyte formation, sclerosis, vacuum disc phenomenon

177
Q

List the three places a spinal tumor can be located

A

Extradural, intradural extramedullary, intramedullary. Try to describe how these look.

178
Q

If you have enlargement of the spinal cord what type of lesion do you suspect?

A

Intramedullary

179
Q

What changes on MRI will a patient s/p radiation have on MRI on T1?

A

Increased signal because of fatty replacement

180
Q

Mnemonic for vertebral column tumors?

A

COAG

181
Q

What does this stand for?

A

Chordoma, osteoblastoma, aneurysmal bone cyst, giant cell tumor

182
Q

Pterion

A

Suture

183
Q

What is transependymal flow?

A

edema associated with hydrocephalus

184
Q

What is a persistent metopic suture?

A

Can be see as a sagital suture line that extends through the frontal bone

185
Q

What does the vidian canal go to?

A

vidian canal is aka pterygoid canal, it connects the middle cranial fossa to the pterygopalantine fossa

186
Q

What does Uncal herniation look like and what is the management?

A

effacement of the quadrageminal cistern. Surgical management

187
Q

What is a Duret hemmorhage?

A

Linear density of the region of the pons indicating a bleed. Duret hemmorhages can expand

188
Q

what happens in an orbital blowout fracture?

A

direct blow to the eye: fracture of the floor of the orbit, can pooch into the maxillary sinus

189
Q

What components are involved in a zygomaticomaxillary complex fracture (ZMC).

A

Sometimes called the tripod fracture because it has at least three fractures involved. It can involve the lateral or medial walls of the orbit, (can also involve the orbital floor like a blowout fracture), as well as the zygomatic arch.

190
Q

What are lefort fractures?

A

Fractures that are either vertical or horizontal involving the maxilla.

191
Q

Old Elephants Age Gracefully

A

For calcified masses: Oligo, Epend, Astro, Glioblastoma

192
Q

What shows up as FLAIR intensity that looks like an infiltrative process of the white matter with thickening of the corpus callosum and possible extension into the cortical white matter.

A

Gliomatosis cerebri

193
Q

This shows up as a T2 bright lesion that has a complete rim. A GRE (gradient) will show marked susceptibility

A

Cavernous malformation

194
Q

When will a stroke show up on CT scan (number of hours?)

A

longer than 4 hours. Use DWI

195
Q

What is the appearance of AVM on a contrast study

A

Early opacification of the veins on an angiogram

196
Q

What genetic condition presents with subcortical infarcts and leukencephalopathy?

A

CADASIL (cerebral AD subcortical infarcts and leukencephalopathy)

197
Q

When does this usually present?

A

30-50

198
Q

What is the difference between Moyamoya disease and regular moyamoya?

A

The disease is idiopathic whereas Moyamoya can be secondary to primary diseased like NF1 and Sickle cell.

199
Q

The presence of what factor is highly specific for an abcess on MRI?

A

restricted diffusion

200
Q

What would MR spectroscopy tell you if there was a lactate/lipid peak?

A

Likely abcess

201
Q

In an immunocompromised individual with scattered white mattered lesions on MRI what would your diagnosis be?

A

PML

202
Q

What would you see cortical ribboning and thalamic restricted diffusion in? Along with progressive dementia?

A

CJD

203
Q

What does imbrication mean?

A

Normal overlap of the apophyseal joints

204
Q

What is the Harris ring?

A

The normal lateral appearance of C2

205
Q

What does a burst fracture look like?

A

Lateral radiograph: bowing of posterior vertebral line, and disruption of the spinolaminar line.

206
Q

What should you not see with a burst?

A

dislocation of the facet joints

207
Q

What does a dislocation look like?

A

Facet joint locking, listhesis.

208
Q

What are good studies for herniated nucleus pulposis?

A

MRI, myelogram

209
Q

What are the seven projections that attach to the vertebral arch?

A

one spinous, two transverse, four articular.

210
Q

Spinous points down where?

A

Cervical

211
Q

Spinous points up where?

A

Thoracic and lumbar

212
Q

What is another name for the articular joints?

A

Joints of luschka

213
Q

What is a common finding in older people in the joints of luschka

A

Uncovertebral hypertrophy

214
Q

What is spondylolyses?

A

Shearing off of the pars interarticularis, common, and looks like a collar on the scotty dog

215
Q

Which lubar transverse processes are usually longest?

A

L3

216
Q

What are some components of spondolytic change?

A

Facet hypertrophy, ligamentum flavum hypertrophy, disc bulge

217
Q

Osteophyte vs syndesmophyte

A

Osteophyte is horizontal spikes that accentuate the endplates. Syndesmophytes are arching connections between two endplates of adjacent vertebrae. Ostephytes = calcs of annulus fibrosis. Syndes = calcs of Sharpey fibers at margins of the disc

218
Q

DISH has which?

A

Syndesmophytes

219
Q

What are some high risk factors for spinal injury?

A

GCS 65, dangerous mechanism, parasthesias, Ank spond or DISH

220
Q

What are some low-risk factors for spinal injury?

A

None of the above, simple accidents, ambulatory, absence of midline neck tenderness,no focal findings, no intox, normal GCS

221
Q

What do anterior disc herniations cause?

A

Limbus deformities, which appear as anterior opacities, without the jigsaw sign, and with sclerotic margins indicating that it’s not a fracture. The sclerotic margins indicate a schmorls node.

222
Q

How do you describe listhesis?

A

You say “Antero/retro of TOP over BOTTOM”

223
Q

Benign tumors of the spine?

A

COAG: osteoid osteoma, osteoblastoma, aneurysmal bone cyst, giant cell tumor

224
Q

Malignant tumors of the spine?

A

Chordoma, chondrosarc, mets, multiple myeloma, lymphoma,

225
Q

MRI features of osteomyelitis/discitis?

A

Loss of disc height, endplate edema, abnormal disc space fluid.

226
Q

What are the posterior elements

A

Pedicle, lamina, spinous processes

227
Q

How many vertebrae in each set?

A

7, 12, 5, 5

228
Q

How many cervical nerves?

A

eight

229
Q

Where do cervical vs. Lumbar exit?

A

Lower vs upper

230
Q

Where is the conus?

A

T12

231
Q

What are common features of facial fracture?

A

Cortical disruption, fragment displacement, asymmetry, opacification or air fluid levels in the sinus, orbital emphysema, STS

232
Q

What is the best radiographic view for nasal fracture?

A

water’s view

233
Q

What is a FIZL fracture the same as?

A

ZMC, Frontozygomatic suture, infraorbital rim, zygomatic arch , lateral maxillary wall

234
Q

What structure is always involved in Le Fort fractures?

A

Pterygoid plate (fractures are floating palate, maxilla, and face.

235
Q

What is the ADI? normal measurement?

A

Atlantodental interval - should be less than 3 mm in adults

236
Q

What is the BDI?

A

Basion to dens interval should be less than 12mm

237
Q

What is a hangman’s fracture and what motion is it associated with?

A

Hyperextension. C2 pars fracture.

238
Q

What are radiographic features of hangmans?

A

Pars fracture of C2, POsterior displacement of spinolaminar line, anterior inferior avulsion fracture with anterior longitudinal ligament rupture, prevertebral soft tissue swelling

239
Q

What is a flexion tear drop injury?

A

Severe flexion injury. Bad outcome because very unstable

240
Q

What does a teardrop refer to/look like

A

The anterior vertebral body fracture resembles a tear drop, there is subluxation of the posterior vertebral body, prevertebral hematomas, cord compression

241
Q

What is SCIWORA

A

Spinal cord injury without radiographic abnormality

242
Q

What test to order if you cannot evaluate traumatic nerve root injury with MRI?

A

CT myelogram

243
Q

What is the radiographic appearance of a compression fracture vs a burst fracture?

A

Compression fracture will look like disc wedging on laterals, burst fracture has comminution and may have retropulsion of fragments into spinal canal

244
Q

What is a “Chance” injury?

A

Unstable injury perpendicular to spinal axis which extends through intervertebral disc. These injuries typically happen as “seat” belt injuries” where the point of fixation is at a point anterior to the fracture.

245
Q

Name: medial lobe temporal atrophy, and parietal atrophy

A

Alzheimers

246
Q

Frontal lobe and atrophy of the temporal pole

A

FTLD

247
Q

global atrophy, with diffuse white matter lesions, lacunes

A

vascular dementia

248
Q

How is medial temporal lobe atrophy scored?

A

0-4, 4 being the worst, with severe volume loss of the hippicampus

249
Q

If you saw a MTA (medial temporal lobe atrophy) score of 4 what is usually the diagnosis? then second?

A

Alzheimers, then vascular

250
Q

What scale is used to grade white matter disease on FLAIR?

A

Fazekas: 0 is no, or a single lesion, 3 is large confluent lesions.

251
Q

What scale is used to grade parietal atrophy?

A

Koedam: 0 is normal, 3 is extreme widening of the posterior cingulate and parieto-occipital sulci

252
Q

What will you see with Cerebral amyloid angiopathy?

A

Multiple peripheral punctate microhemorrhages

253
Q

What type of dementia will give you the characteristic hummingbird sign?

A

Progressive supranuclear palsy, the midbrain atrophies and gives this characteristic appearance

254
Q

What type of dementia will give you the characteristic Hot Cross Bun sign?

A

Multiple system atrophy, atrophy of the pons shows a big + on axial imaging.

255
Q

What shows up on FLAIR and DWI or a combination as neo-cortical ribboning?

A

CJD

256
Q

What disease would cause atrophy of the head of the caudate and subsequent enlargement of the frontal horns of the lateral ventricles?

A

HD

257
Q

What are the two most common causes of epilepsy?

A

Mesialtemporal sclerosis, and focal cortical displasia

258
Q

What are some other cause of epilepsy?

A

Polymicrogyria, SW, TS, cavernous hemangioma, tumors

259
Q

What are the best sequences to visualize MTS?

A

Coronal T2 and FLAIR

260
Q

What if you have hyperintensity on FLAIR and T2 in the mesialtemporal lobe but NO atrophy?!

A

Could be status epilepticus, or a tumor, or encephalitis

261
Q

What does SE look like on MRI?

A

temporal lobe intesity on T2, with possible swelling and DWI restriction because of cytotoxic edema

262
Q

What would show up as a subtle blurred interface between grey and white matter in a focal area?

A

Focal cortical dysplasia, a congenital failed migration of neurons that is second most common cause of epilepsy after MTS

263
Q

What is the transmantle sign?

A

Seen in FCD where white matter extends from the ventricle all the way to the cortex

264
Q

Diagnosis? Focally shrunken cortex with atrophy and gliosis in the underlying white matter

A

Ulegyria: caused by congenital lack of blood supply to an area. Looks like pedunculated gyri on stacks of white matter

265
Q

What will show up on SWI and T2 with blooming artifact and hyperintense appearance?

A

Cavernoma (or cavernous angioma)

266
Q

What characteristically appears as a popcorn ball?

A

Same as above

267
Q

What would be the differential for multiple punctate microbleeds?

A

Cerebral amyloid angiopathy, cavernomas, DAI

268
Q

What disease is characterized by hamartomarous growth of one side of the brain with bony enlargement of the skull, dysplastic thick cortex only on one side?

A

Hemimegalencephaly

269
Q

What disease shows up as hemiatrophy of the brain of unknown origin, with ventriculomegaly and progressive hemiplegia?

A

Rasmussen’s encephalitis

270
Q

What is “Fitz, zitz, nitwitz

A

TS - adenoma sebaceum, epilepsy, MR

271
Q

What disease is characterized by vascular malformation with leptomeningeal enhancement and capillary venous angiomas in the face. Atrophy of the cortex is mainly in the occipital lobes

A

Sturge-Weber

272
Q

What is the pathophysiology behind SW?

A

Venous occlusion causes ischemia and angiomatosis with atrophy and cortical calcium deposits.

273
Q

What is a key feature of the calcifications of SW?

A

Tram-track like calficications because of the calcified venous angiomatosis.

274
Q

What eye finding do you have to worry about in SW?

A

choroidal hemangioma, which shows up as intensity on FLAIR

275
Q

What is a cleft from ventricular space to the subarachnoid space that is lined by polymicrogyric gray matter?

A

Schizencephaly

276
Q

What is the typical distribution of MS White matter lesions?

A

Corpus, periventricular, spinal, U-fibers, enhancement, dawsons

277
Q

What is the typical distribution of vascular white matter lesions?

A

cortical infarctions and BG nuclei lesions

278
Q

What is the distribution of brainstem lesions in MS vs Vascular?

A

MS peripheral, Vascular

279
Q

What are juxtacortical lesions?

A

Could be classified as “periventricular” but these are not abutting the ventricles but close to the cortex.

280
Q

What should be characteristic about the axis of the priventricular lesions?

A

perpendicular to ventricles

281
Q

What do MS spinal lesions look like?

A

Should be small and peripheral not extending past 2 vertebral lengths

282
Q

What is a good sequence for looking at spinal chord lesions in MS?

A

Proton density, because it has good contrast for the structures

283
Q

Do dawson’s fingers enhance?

A

Yes, for about a month after they appear

284
Q

Would enhancing periventrucular lesions mixed with non-enhancing lesions help you make a MS diagnosis? why?

A

Lesions in space and time; lesions for MS will only enhance for about a month

285
Q

What is the “incomplete ring” a sign of?

A

Tumefactive MS, most ring enhancing lesions are circumfrential.

286
Q

What other disease would you think about with bilateral optic neuritis?

A

Neuromyelitis optica (devic’s disease)

287
Q

How would you tell this apart from MS?

A

NMO should have more extensive spinal cord lesions that are longer that in MS (think more than a few segments)

288
Q

What Ab titer will be high in NMP?

A

AQP4-AB

289
Q

How would you differentiate MS from ADEM?

A

Acute disseminated encephalomyelitis is similar to ms. The patient could also be younger s/p vaccination or illness

290
Q

What criteria is used for MS grading?

A

McDonald Criteria

291
Q

What are the criteria?

A

Dissemination in space (greater than one lesion in two out of four areas: periventricular, juxtacortical, infratentorial, spinal), Dissemination in time (Either a new enhancing lesion on follow up, or a multiple lesions where at least one isnt enhancing at one time)

292
Q

Tumors from the gland

A

Adenoma, rathkes cleft cyst, craniopharyngioma

293
Q

Tumors from the stalk

A

Rathke’s cleft cyst, craniopharyngioma, herminoma, eosinophilic granuloma, mets

294
Q

Tumors from the optic chiasm

A

Gliomas

295
Q

Tumors from the hypothalamus

A

Gliomas, hamartomas, germinomas, eosinophilic granulomas

296
Q

Tumors/lesions from the Carotids

A

Aneurysm, ectasia, anomalies

297
Q

Tumors/lesions from the cavernous sinus

A

Schwannoma, inflammation, car-cav fistula. Watch for thombosis, and CN VI impingement.

298
Q

Tumors/lesions from cavernous meninges

A

Meningioma, inflammation

299
Q

Tumors/lesions from the sphenoid/skull base

A

SCC, chordoma, sarcoma, mets, inflammation

300
Q

What pathology can cause chemosis, headache, cn IV problems?

A

Cavernous sinus thombosis

301
Q

What signs would be helpful in the diagnosis?

A

opthalmic vein engorgement, swi?

302
Q

Definition of Microadenoma

A

Less than 10mm

303
Q

Definition of macroadenoma

A

greater than 10mm, classic snowman look

304
Q

What does a Rathke’s cleft cyst look like?

A

T2 bright, should be able to see a normal pituitary in the sella on UNENHANCED scan, if the cyst isnt too large

305
Q

Pars interarticularis defect

A

could be congenital. Associated with anterolisthesis of L4 on L5

306
Q

Cerebral palsy, features on MRI

A

Ischemic injury early, could see periventrucular leukomalacia, or cortical disease

307
Q

grading of disc protrusion

A

can be done on sagittals: mild, mod, severe. Mild: keyhole maintained, moderate, keyhole fat disrupted, severe nerve root impingement

308
Q

MS considerations

A

Want to look to see if there are NEW lesions, especially if they are enhancing, this tells the clinicial if the disease is getting worse despite treatment. Look on FLAIRs

309
Q

What classification system is used for MS?

A

McDonald: criteria for where 2/4 gets the dx, locations, time/space

310
Q

What are two types of MS?

A

Relapsing/remitting, progressive

311
Q

What is optic nerve drusen?

A

focal punctate calcification usually bilateral in posterior orbit at the junction of the optic nerve and globe

312
Q

What is a cavum septum pellucidum?

A

Bifircated septum

313
Q

Where would you see a DVA?

A

enhancing in the brain parenchyma

314
Q

What three tumors will uniformly enhance?

A

meningioma, nerve sheath tumors, lymphoma

315
Q

What does posterior longitudinal hypertrophy in the high cervical region look like?

A

Epidural hematoma. But this finding is very common in patients with RA

316
Q

What is a haller cell?

A

seen in 20% of people. Its an infraorbital air cell just of note, usually not associated with pathology.

317
Q

What are some causes of medullary nephrocalc

A

PTH, RTA, sickle, gout

318
Q

What does a left sided IVC empty into?

A

Usually the coronary sinus

319
Q

What are the posterior calcifications on a plain film lateral xray of the cspine?

A

nuchal ligament calcifications

320
Q

What is a toddler’s fracture?

A

lucent line from the tibial plateau extending inferiorly

321
Q

What is the vascular supply to the head of the caudate?

A

Artery of Hubnert. Which is a branch of the ACA

322
Q

What two foramen look like the footprint of a high heel?

A

Ovale and Spinosum

323
Q

Where does the vidian canal go?

A

Pteragopalatine fossa?

324
Q

Where does the urachus go?

A

Umbilicus to the dome of the bladder

325
Q

What is the largest pathologic lymph node in the body?

A

Node of Winslow at 2.5 cm

326
Q

What is the smallest pathologic lymph node in the body?

A

Retrocrural lymph node? at 7mm

327
Q

What does subfalcine herniation look like?

A

midline shift

328
Q

What does uncal herniation look like?

A

effacement of the suprasellar cystern

329
Q

What is the mnemonic for trigeminal nerve holes?

A

SRO: standing room only, S/V1: SOF, R/V2: rotundum, O/V3: ovale

330
Q

Why does the posterior pituitary light up on t1 imaging?

A

ADH is bright (maybe its the protein?) normal.

Neuroradiology (1 decks)

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