RITE Images 2004 Flashcards
Congenital toxoplasmosis –
periventricular and cortical calcifications in premature brain
L5/S1 herniated disc, displacing a left nerve root
Right parietal watershed infarction
NOT colloid cyst b/c it would be hypodense ->it’s a calcified pineal gland
Pantothenate kinase deficiency (PKAN), AKA NBIA 1 (Hallervorden-Spatz disease).
EYE of the TIGER sign – globus pallidus
can also be seed in
Cortico basal ganglionic degeneration
PSP
Proximal ICA occlusion from ulcerated plaque.
NOT dissection or total occlusion of L ICA -> No surgery
Arrow is pointing at substantia nigra
Receives fibers from caudate & putamen
R M1 branch of MCA occlusion
Chronic infarct of R cerebral hemisphere
Enlarged vascular structure = venous angioma
Sag T1 – linear hypointense flow void
Accoustic neuroma / neurinoma
Small R enhancing intracanalicular lesion
Air in the right frontal lobe due to loss of brain substance from a prior focal hemorrhagic contusion ; caused by fracture of skull (through frontal sinus)
Left MCA occlusion; hyperdense left MCA sign.
Subdural hematoma; caused by disruption of the bridging veins
Early subacute blood from rupture of an AVM
Deoxyhemoglobin centrally & intracellular methemoglobin
Subarachnoid blood (B) from rupture of MCA aneursym seen in image A.
Embolization of the pulmonary venous circulation by microspheres occluding some of the thin arterial perforators in the brain.
Spinal cord with syringomyelia
Muscle atrophy with vibratory, position, & touch senses spared
Bithalamic mass L>R. tumor, NOS.
Tumor causing mass effect in a young 17YO patient
Duchenne’s muscular dystrophy
Young patient with
Degenerating fibers undergoing phagocytosis
Hypercontracted fibers
Excessive fibrosis and varitation in fiber size
Multicystic encephalopathy or multicystic encephalomalacia.
Circulatory disturbances during the latter ½ of pregnancy or neonatal period
LEMS
Patient presents with weakness & dry mouth with
Increase in CMAP after brief exercise
meningioma
Herpes encephalitis
Low signal on T1 and high signal on T2
Post gad in acute/subacute setting – cortical & leptomeningeal enhancement
Subacute subdural hematoma
Chordoma
Most common neural crest derived tumor of sacrum & arises within bone
Cortical dysplasia
@ posterior extent of L sylvian fissure as thick cortical ribbon
Lissencephaly / agyria
Due to arrest of neuronal migration leading to thick cortex w/ improper layering
Moyamoya
Dark foci in axial T1 representing flow void in collateral vessels due to occluded distal ICAs and collateral circulation
MRA – lack of flow in distal ICA & multiple collateral vessels in region of flow void seen in axial T1 weighted image
Cortical tuber = tuberous sclerosis
Broad pale gyrus w/ loss of G/W matter delineation
Hydrocephalus and meningomyelocele; DISCUSSION BOOK says Chiari II.
Holoprosencephaly
Assoc w/ midline facial defects
Failure of cleavage of prosencephalon
Obstructive hydrocephalus secondary to aqueductal stenosis.
Enlarged 3rd & lateral ventricles w/ normal 4th ventricle
NOT communicating hydrocephalus
Bacterial brain abscess
Aspergillus (multiple septate fungi with invasion of a blood vessel)
Lipoma superior to a myelomeningocele
Cowdry A inclusion produced by HSV.
CMV can also produce this inclusion but will show cytoplasmic enlargement due to viral particles in the cytoplasm
Alcoholic cerebellar degeneration (atrophy of superior vermis)
Acute bacterial endocarditis with destruction of one leaf of aortic valve.
Brain can contain infarctions, hemorrhages, abscesses.
Usually due to staph
Hypothalamic hamartoma – nonenhancing
Pontine glioma- heterogeneously enhances
heterotopic grey matter in L frontal region (laminar type);
Caused by migrational arrest of affected neuroblasts; lesion here is destructive
hemangioblastoma
capillary rich neoplasm with abundant foamy cells
can arise independently or in conjunction with von-hippel-lindau disease
most common location is cerebellum > spinal cord
congenital abnormality / syringohydromyelia
Hydromyelia = dilatation of cord around central cystic cavity
Commonly seen with Chiari I and II
Septic emboli from endocarditis
Cerebral abscesses
Pt had hx of endocarditis 2ndary to IV drug abuse
Neurosarcoidosis – intra axial leptomeningeal, parynchymal enhancement with involvement of pituitary stalk/hypothalamic involvement
Tumor – round, enhancing, mass effect
- (NOT abscess or colloid cyst)*
- NOT abscess (b/c it’s not a ring)*
- NOT mesial temporal sclerosis (b/c doesn’t enhance)*
Meningeal carcinomatosis
*ring of enhancement around brainstem, meninges and cerebellar sulci
aneurysm
Basal ganglia hemorrhage – secondary to HTN
Wallerian degeneration w/ shrinkage of 1 medullary pyramid & atrophy of ipsilateral cerebral peduncle;
secondary to destruction of CST above that level (infarction in posterior limb of IC)
Mesial temporal sclerosis
Fahr’s disease
Calcification of basal ganglia and cerebellum – – idiopathic calcification
Patient has no metabolic derangements to explain calcifications (hyperparathyroidism, Wilson’s, amyloid angiopathy)
Radiation necrosis
AVM
Flow void / low signal region
Intracranial hypotension - pachymeningeal enhancement, sagging
Patient presents with orthostatic headache
Can get enhancement of meningeal structures in intracranial hypotension, carcinomatosis or lymphoma
Spondylitis - Osteomyelitis, discitis, epidural abscess – (esp at L4-5)
L4-L5 – active discitis
Active spondylitis at L 4-5
Remote spondylitis at L2-3
Chiari II
Cerebral aqueduct not visualized and ventricles not enlarged -> aqueductal stenosis w/ functioning shunt
Should have lumbar mylomeningocele
They do not have to be mentally retarded
Deformity of tectum of mesencephalon, caudalization of cerebellar vermis into cervical spinal canal & deformity of medial aspect of cerebral hemisphere & absent posterior corpus callosum
Pituitary microadenoma – focal hypointensity, remodeling of sella floor, bowing of cavernous sinus
Myelomeningocele (mostly CSF)
Lipoma is present but it’s located superior to area in question
Fusiform cord enlargement – c/w acute myelitis, nonspecific
Increased intramedullary T2 signal, spinal cord enlargement, and variable enhancement involving several spinal levels
NOT contusion, ependemymoma or astrocytoma
Triphasic waves – metabolic encephalopathy
ACA occlusion
Falcine meningioma
Homogenous enhancement, isointensity on T1
Bilateral remote ACA infarcts from single unpaired ACA
Amyloid – cerebral amyloid angiopathy
Spinal muscular atrophy
Sturge Weber - calcification
Remote infarct
Metastasis – multiple lesions
Most common neoplasm of posterior fossa in adults
Pineoblastoma
Need contrast enhanced imaging of entire spine to look for drop mets - High incidence of subarachnoid seeding
Development venous anomaly (venous angioma)
SSPE – periodic slow wave complexes
Tumefactive MS – open ring enhancement affecting white matter
Purulent leptomeningitis
Pneumococcal meningitis – w/ hx of alcoholism & asplenism
Picks disease – frontal & temporal atrophy (FTD)
GBM – spread
Toxoplasma gondii (bradyzoite form)
AIDS patient
Necrotizing vasculitis
seen in WARP
-Wegener’s granulomatosis
-Amphetamine induced vasculitis
-Rheumatoid vasculitis
-Polyarteritis nodosa
Sleep spindles - infant
3Hz spike and wave – in absence seizures, some can have GTC
Treat with valproate
MS
Lewy body – eosinophilic cytoplasmic inclusion in a neuron with melanin granules
Cocci
What is the structure the arrow points to?
What is the associated neurotransmitter?
Inferior olivary nucleus (origin of climbing fibers)
Glutamate is the NT
Eclampsia
Chiari 1
Near occlusion of superior saggital sinus
Third ventricle colloid cyst (T2)
Arachnoid cyst
Drop metastasis and nodular lesions most commonly seen with medulloblastoma
“PC-GAME”
Pineoblastoma
Choroid Plexus tumors
Germinoma
Anaplastic Gliomas
Medulloblastomas
Ependymomas
Normal
A - Inominate artery
B - External carotid
C - Vertebral
D - Subclavian
E - Basilar
What is 3 pointing to?
What is the function?
3- neurohypophysis – direct extension of neuraxis
Contains axons arising from the supraoptic & paraventricular nuclei
Carries oxytocin & vasopressin (ADH)
Damage to the infundibulum -> diabetes insipidus
