RITE Images 2007 Flashcards
Multicystic encephalopathy or multicystic encephalomalacia
Disturbances during latter half of pregnancy
NPH
Cerebral abscesses (endocarditis 2ndary to IVDA)
TORCHES
Aicardi syndrome – X-linked dominant; lethal in males
Agenesis of corpus callosum, retinal lacunae, development abnormalities, infantile spasms
Focal polymorphic delta – nonspecific in infarct or tumor; seen in white matter processes
Spinal infection
Loss of distinction btw endplates, disks, 7 adjacent vertebral bodies on T1 & increased T2
Check T2!
oligodendroglioma
Lipoma – hyperintense on both T1 & T2!; do not need further workup! No Neurosurgery or Rad Onc consultation, LP or blood cx
Displaced optic chiasm
Hemangioblastoma
Capillary rich neoplasm w/ abundant foamy cells w/ lipid; can be seen w/ Von-hippel lindau
Usually seen in cerebellum or SC
Neurocysticercosis
Neurosarcoidosis – look for leptomeningeal ehancement esp @ pituitary stalk/hypothalamus; if pt
FTD – see decrease in glucose metabolism in frontal & anterior temporal areas
- Alzheimer’s – parietotemporal association*
- Lewy Body – occipital regions*
GBM – see mass effect & extension across corpus callosum
Abnormal contrast enhancement suggests tumor has abnormal vessels w/ marked permeability – another finding in GBM
Cryptococcus – likes to hang out in the BG!
Pathology – “soap bubble” abscesses
Chiari II – deformity of tectum of mesencepahlon, caudalization of cerebellar vermis into cervical spinal canal, deformity of medial aspect of cerebral hemisphere w/ absent posterior corpus callosum
Heterotopia – migrational arrest of affected neuroblasts
Aneurysm of vein of Galen
Time of flight – blood backing up into the posterior region of SSS which is dilated
Autosomal dominant cerebral Cavernous angioma (malformation) (CCM1) syndrome
Usually in hispanics, intraparenchymal cavernous malformations that can produce seizures, impairment of fxn, & hemorrhage
necrotizing vasculitis – “WARP”
W – wegener’s
A – amphetamine induced
R – rheumatoid
P - PAN
Diastematomyelia – spinal dysraphism;
Pts – have neuro defects in LE – gait d/o, sphincter disturbance, muscle atrophy
infarct
Amyloid angiopathy
Primary or secondary systemic amyloidoses cause amyloid deposits
ACA infarct
Hemorrhagic conversion – subacute hematoma c LMCA infarct
Pachygyria – occurs during neuronal migration
Syringohydromyelia –
See dilation of cord around a central cystic cavity; inferior cerebellum has herniated à Chiari
Can be seen in both chiari I or II
Central temporal spikes – benign rolandic epilepsy of childhood
MS
Olivopontinecerebellar atrophy
NOT Dandy-Walker
Hypoxic injury – anoxia causes increased T2 signal to
GP deep sulci superior cerebellum
Necrotic GP enhances p GAD
Dural venous fistula
Vascular disease Right carotid does NOT show flow void
Anencephaly – most common of neural tube closure defects; need FOLATE
Anti-folate receptor antibodies?
SDH
Recurrent artery of Heubner infarct;
-comes off A1 segment of ACA
Supplies:
anteroinferior portion of caudate
putamen
anterior limb of IC
Wakefulness
- Anterior eyeblinks (first second of page)*
- Facial muscle EMG artifact (throughout)*
- Occiptial dominant alpha rhythm*
Triphasic waves
SDH
Syringomyelia
Muscle atrophy results
Vibratory, position, & touch senses spared
Colloid cyst – low signal in T2
Purulent leptomeningitis -
Hx of alcohlism & asplenism -> pneumoccocal meningitis
Pleomorphic xanthoastrocytoma – usually arises in temporal or parietal areas
Minimal hemosiderin rim w/ no edema à excludes abscess & hematoma
Wallerian degeneration w/ shrinkage of 1 medullary pyramid & atrophy of ipsilateral cerebral peduncle
Wallerian degeneration is 2ndary to destruction of corticospinal tract ABOVE this level i.e. infarct in posterior limb of IC
Transverse myelitis –
Spinal tap – lymphocytic predominance & increased protein
Pick’s disease – lobar atrophy of Frontal & Temporal Lobes
Spinal stenosis
Hemorrhage 2ndary to amyloid (congophilic) angiopathy
Friedrich’s Ataxia - Dorsal spinocerebellar columns & posterior columns
Neurofibroma or meningioma -> need SURGERY!
Intradural extramedullary
- NO**T Rad Onc b/c neither is radiosensitive*
- Do NOT need further imaging!*
Carotid immediately proximal to takeoff of MCA (to R) & ACA (to L)
HSV – low signal on T1 & high on T2
crosses vascular boundaries à t/f NOT infarct
Spongiform change – prion disease
Also add gliosis & neuronal loss à classic triad
Misfolding may be induced by mutation or exposure of normal cellular prion protein to pathogenic prions; misfolding alters 2ndary structure so that the protein becomes highly resistant to chemical or thermal methods of sterilization.
Prior focal hemorrhagic contusion –
AIR in R frontal lobe w/ Air-fluid level -> air would gain access is if there was a break in the skull, most often in the air containing sinuses of cranial base; in order for air to occupy the space, there would have to be loss of substance at this site
Communicating hydrocephalus –
Dilation of sylvian fissure?
Coronal image – sulci at high parietal convexity are compressed as compared to markedly dilated posterior extent of Sylvian fissure
meningioma
Multiple sclerosis
Large lesion (schilder’s) variety of MS
Enhancement affecting only white matter
Developmental venous anomaly (DVA) or venous angioma
Pt w/ HA, sz
Obstructive hydrocephalus w/ obstruction at aqueduct
Normal 4th ventricle w/ enlarged 3rd ventricle
Near occlusion of superior saggital sinus
No flow in SSS
Spinal Infection
Decreased disk height, disk hypointensity on T1 & hyperintense on T2, disk enhancement, erosion of vertebral endplates, loss of distinction btw endplate & disk, along w/ adjacent vertebral bodies on T1
Atherosclerosis of intracranial vessels
Bilateral remote ACA infarctions – 2ndary to *single unpaired ACA ->B ACA infarctions
apathy, lack of motivational intent, akinetic mutism, weakness of LE, urinary incontinence
Hydrocephalus ex vacuo
Brain abscess
Enhanced ring w/ GAD
Dark rim on FLAIR
GBM – multiple irregular ring enhancing lesions adjacent to & compressing lateral ventricles;
white matter vasogenic edema
spread through both hemispheres
Arachnoid cysts
extraaxial
Positive occipital sharp transients of sleep
POSTS
Occur during drowsiness;
Normal
Metastatic disease – b/c bone is destroyed!
BG hemorrhage w/ rupture into ventricular system; HTN ICH
Cocci
Active Spondylitis L4-L5
Remote spondylitis L2-L3
osteomyelitis, discitis, & epidural abscess formation @ L4-L5
Metastatic disease does NOT X-over disc space
meningioma
Large ulcerate plaque
NOT dissection
SAH
Listeria – prefers brainstem
Subacute process w/ quick worsening
Subacute sclerosing panencephalitis – periodic long interval diffuse discharges recurring q 4-15 secs
Cavernous angioma
Generalized polyspikes & spike-wave D/C –EEG correlate of primary generalized epilepsy syndromes
GTC, generalized myoclonic seizures, absence
Astrocytoma – lesion in L optic nerve; L optic nerve is thickened but DOES NOT ENHANCE
Lesions that enhance – meningioma, schwannoma, neurofibroma
En-plaque variant meningioma
?increased vascular permeability – eclampsia?
Periventricular leukomalacia (PVL) – immature brain c small foci fo dystrophic calcification in white matter
Principal ischemic lesion of prematurity
*REM – mixed frequency EEG & REM, sawtooth pattern; EMG lowest level of recording
*Minimum duration required for respiratory event to be called OSA or hypopnea is 10 secs in adult
*AHI c moderate OSA -> use CPAP
use dental appliance if mild OSA
Sturge Weber Syndrome
Lesions in parietal occipital area; parenchymal calcification, serpentine calcification
Laminar necrosis due to hypoxic/ischemic injury
Pituitary apoplexy – syndrome of infarction or hemorrhage of the pituitary;
HA, opthalmoparesis, visual defects, encephalopathy
