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CLASP > Radiology: Neuro > Flashcards

Radiology: Neuro Flashcards

1
Q

what is first line imaging for neuro presentations?

A
  • CT

well tolerated
with or without contrast
specialist ix including angiography, venography

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2
Q

MRI pros and cons in neuro imaging?

A
  • better soft tissue resolution, specialist IX and sequences
  • longer duration, CI for some and can be poorly tolerated
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3
Q

babies what can you use before fontanelle closes?

A
  • ultrasound
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4
Q

diagram of lobes of brain CT

A
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5
Q

what do fissures of the brain do and what do they contain?

A
  • they separate structures of the brain
  • CSF filled clefts

interhemispheric - seperates cerebral hemispheres - 2 halves of brain
sylvian fissures - separate frontal and temporal lobes - good to look for early strokes

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6
Q

name a) herniation?

A

a) Subfalcial (cingulate) herniation

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7
Q

name b) and c) herniation

A

b) uncal herniation
c) downward (central, transtentorial) herniation

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8
Q

name d) and e) herniation

A

d) external herniation
e) tonsillar herniation

types a), b) and e) are usually caused by focal, ipsilateral SOL i.e. tumour or axial or extra-axial haemorrhage

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9
Q

study these structures

A

cover and answer

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10
Q

study suprasellar cistern and quadrigeminal cistern on this image

A
  • suprasellar cistern is an expansion of SAS above sella turcica, and above pit fossa
  • common location for blood to collect in SAH
  • can be obliterated in cases of raised intracranial pressure
  • quadrigeminal cistern
  • CSF filled subarachnoid cisters
  • extends from 3rd ventricle to great cerebral vein
  • contains vessels and nerves (post cerebral arteries, trochlear nerve etc)
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11
Q

study

A

cover and answer

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12
Q

what are the 3 parts of the brainstem?

A
  • midbrain
  • pons
  • medulla oblongata
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13
Q

on MRI what colour is CSF

A
  • dark
  • cortex is white and white matter is grey…
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14
Q

what is an ischaemic stroke

A
  • sudden cessation of adequate amouts of blood reaching parts of brain - deprivation of o2 and glucose
  • cascade of events - cell death -> mostly through liquefactive necrosis
  • typically presents w rapid onset neuro deficit, determined by area of brain involved
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15
Q

describe some types of ischaemic stroke?

A

depends on territory affected/mechanism

embolism
- cardiac embolism - AF, Ventricular aneurysm, endocarditis
- paradoxical embolism - septal defect - go into R heart and into arterial circulation
- atherosclerotic embolism - aortic arch
- fat embolism - long bone fractures
- air embolism - brought about by injecting

thrombosis
- perforator thrombosis: lacunar infarct
- acute plaque rupture w overlying thrombosis

arterial dissection - traumatic or atherosclerotic

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16
Q

name 3 vascular territories?

A
  • ACA - anterior cerebral artery
  • MCA - middle cerebral artery
  • PCA - posterior cerebral artery
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17
Q

arterial supply

A
  • provided by circle of willis

posterior
- 2 vertebral -> basilar artery -> PCA

anterior
- internal carotid -> MCA and ACA

communication
- anterior communicating
- posterior communicating

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18
Q

stroke location and symptoms

A
  • neuro deficit a patient presents w depends on ANATOMICAL site of insult to brain parenchyma
  • e.g. referring to homunculus - hand is bigger as it controls many diff movements etc
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19
Q

why do we image strokes?

A
  • exclude intracranial haemorrhage
  • confirms ischaemia
  • exclude other intracranial pathologies - mimicking a stroke - e.g. tumour
  • permit rapid tx e.g. thrombolysis or mechanical thrombectomy
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20
Q

what imaging do we use for a stroke?

A
  • non-contrast CT scan
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21
Q

early findings of ischaemic stroke?

A
  • earliest CT finding is a hyperdense segment of vessel - intravasc thrombus/embolus and as such is visible immediately
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22
Q

first few hours of thrombus on CT?

A
  • loss of grey-white matter differentiation
  • hypoattenuation of deep nuclei
  • cortical hypodensity w assoc parenchymal swelling w resultant gyral effacement
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23
Q

with time stroke on CT?

A
  • hypoattenuation and swelling becomes more marked - significant mass effect
  • more time… gliosis occurs eventually appearing as a region of low density w volume loss i.e. in lateral ventricles
24
Q

reasons for intracranial haemorrhage and how it appears on CT?

A
  • trauma or atraumatic
  • can be due to underlying lesion
  • acute blood appears WHITE on unenhanced scan
  • pattern/shape of blood collection is determined by anatomical location
25
Q

intra-axial haemorrhage is defined as?

A
  • haemorrhage occurring within the brain substance
26
Q

extra-axial haemorrhage is defined as? and its 3 divisions?

A
  • outwith brain parenchyma but inside the skull
    1. extradural
    2. subdural
    3. subarachnoid
27
Q

intra-axial haemorrage

A
  • acute haematoma in right occipto-parietal region
  • lobar haemorrage
  • midline shift to left and blood in posterior horn of left lateral ventricle - can also leak into extra-axial component areas - e.g. subdural
28
Q

haematoma in left basal ganglia occurs usually w what?

A
  • typical appearance of a hypertensive bleed
  • note blood in posterior horns of left lateral ventricles

tx: watch swelling, reverse warfarin if on warfarin

29
Q

extradural haemorrage

A
  • collection of blood between inner surface of skull and outer layer of dura
  • usually trauma assoc w skull fracture
  • bleeding is usually arterial, most commonly from a torn middle mengineal artery - i.e. golf - hit in temple
  • biconvex in shape, can cause mass effect w herniation - tx prompt evacuation and stop bleed
  • limited by cranial sutures
  • less common than subdurals
30
Q

how does extra dural haemorrhage appear on CT?

A
  • biconvex shape
  • mass effect - sulcal effacement, midline shift
  • worried about coning
31
Q

subdural haemorrhage?

A
  • collection of blood in subdural space - potential space between dura mater and arachnoid mater
  • SDH can happen in any age group - mainly due to head trauma

causes - infants - NAI, young adults - RTA, elderly - falls

32
Q

mainstay IX for SDH

A
  • CT
33
Q

what do you see on CT of SDH

A
  • semilunar shape
  • crosses sutures
  • mass effect
  • early dilatation of posterior horn of R Lateral ventricle - when you block off foramen of munroe opp side of brain - ventricle can no longer empty - resulting in one sided hydrocephalus
34
Q

what is this?

A
  • acute on chronic subdural haematoma
35
Q

subarachnoid haemorrhage

A
  • blood within subarachnoid space
  • majority assoc w berry aneurysms - so found commonly arround circle of willis
  • can be traumatic or other vasc malformations
  • hyperdense material is seen filling SAS
36
Q

what imaging for SAH and what will you see?

A
  • unenhanced (non contrast CT) scan
  • large vol of high attenuation of acute blood in the:
    1. - suprasellar cistern
    2. - sylvian fissures
    3. - sulci
    4. most commonly hyperdense material around circle of willis - hyperdense material is light grey!!!
37
Q

in absence of trauma SAH what other ix will you do on top of unenhanced CT scan

A
  • absence of trauma - cerebral angiography is performed to look for underlying berry aneurysm
38
Q

complications of SAH

A
  • hydrocephalus -> CSF circulates through cisterns and ventricles blood will block arachnoid granulations that reabsorb CSF - build up of CSF in ventricles - you WILL SEE dilatation of temporal horns of lateral horns (bilaterally) - suspect hydrocephalus
  • vasospasm - causing delayed cerebral ischaemia - triple H therapy - haemodilution, hypertension, hypervolaemia, ca channel blockers, endovasc intervention
  • hyponatraemia
  • infarction
39
Q

is primary or metastases more common in intracranial masses?

A
  • mets
40
Q

what are common types of mets to the brain?

A
  • lung
  • breast
  • melanoma
  • renal cell
  • colorectal cancer
41
Q

imaging for intracranial masses?

A
  • CT usually first test
  • hypo or hyperdense - often rounded
  • solitary or multiple
  • useful to determine oedema -> mass effect
  • contrast may make lesions more conspicuous (depends on integrity of BBB)
42
Q

where are mets found

A
  • brain or cerebellum
  • supra or infra tentorial
    -> lots of oedema, lots of mass effect, avidly enhance (as not dependent on BBB) - oedema indicates mets
  • may have known underlying malignancy - sometimes presenting lesion then primary malignancy is then found
43
Q

primary masses are commonly solitary and found where?

A
  • supra or infra tentorial
  • w degree of oedema, mass effect and enhancement depends on grade of tumour(below or above tentorium cerebelli)
44
Q

lesion in intracranial region what happens?

A
  • brain herniation - shift of cerebral tissue from its normal location = mass effect
  • common types of herniations:

below cerebri (subfalcine),

uncal or transtentorial (medial temporal lobe) can press on PCA -> causing stroke,

foramen magnum - tonsillar herniation can compress brainstem - compress clivus altering vital life sustaining functions of pons and medulla (resulting in CV and resp problems) - descent of cerebellar tonsils below foramen magnum - tonsillar herniation is often called coning - fatal if not corrected

45
Q

complication of intracranial mass?

A
  • hydrocephalus
  • flow of CSF becomes impaired either due to anatomical obstruction of normal reservoirs/channels or because it can no longer be reaborbed - blood in subarachnoid space
  • upstream CSF spaces become dilated and CSF breaks out across barriers
46
Q

where is spinal cord found and what is it’s extension?

A
  • spinal cord is found within spinal canal of vertebral column
  • and is contained by thecal sac
  • extends from corticomedullary junction at foramen magnum of skull down to tip of conus medullaris
  • divides into cervical, thoracic and lumbar parts
47
Q

at what level does spinal cord terminate?

A
  • at the conus medullaris - L1 approx in adults
48
Q

what lies anterior to the spinal cord?

A
  • vertebral bodies
49
Q

what lies posterior to the spinal cord?

A
  • spinous processes
50
Q

what is better to visualise spinal cord? CT or MRI?

A
  • MRI
  • CSF is bright on MRI
51
Q

what is spinal cord compression and what is immediate tx?

A
  • surgical emergency
  • requires prompt surgical decompression to prevent permanent neuro damage
  • if spinal roots below conus medullaris are involved -> termed cauda equina syndrome
52
Q

causes of spinal cord compression

A
  • intervertebral disc
    disc protrusion, disc extrusion, discitis, osteomyelitis
  • vertebral
    trauma (vertebral crush fracture -> goes back and impinges on spinal cord), tumour
  • epidural space
    epidural abscess/epidural haematoma
  • dura
    spinal meningioma
  • intradural space
    nerve sheath tumour
53
Q

initial ix imaging for spinal cord compression?

A

MRI spine - as it means you can visualise the spinal cord and conus

54
Q

typical symptoms to look out for in spinal cord compression?

A
  • loss of power in lower limbs
  • loss of sensation
  • saddle anaesthesia
  • urinary retention
55
Q

red flags of back pain?

A
  • hx of malignancy
  • major trauma
  • thoracic/radicular pain
  • constant, progressive, non-mechanical pain
  • systemically unwell
  • widespread neuro signs and symptoms

CLASP (5 decks)

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