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Neuroradiology > Skull base/Temporal bones > Flashcards

Skull base/Temporal bones Flashcards

1
Q

Which structures go through:

  • Foramen ovale
  • Vidian canal
  • Foramen spinosum
  • Foramen rotundum
  • Inferior orbital fissure
A
  • V3
  • Vidian artery and nerve
  • Middle meningeal artery
  • V2
  • Infraorbital artery/nerve
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2
Q

Imaging findings JNA

A

Benign, vascular, locally aggressive; adolescent M
Classic findings: Mass with avid enhancement, originates at medial aspect of pterygopalatine fossa causing expansion of fossa, ant bowing/displacement of post wall of maxillary sinus

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3
Q

Most common intracranial lesion to affect anterior skull base

A

Olfactory groove meningioma

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4
Q

Imaging findings enthesioneuroblastoma

A

Olfactory neuroblastoma
Bimodal age
Aggressive mass, slight hyper on CT, iso T1/T2, may have calcs, characteristic peripheral cysts in intracranial portion

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5
Q

Most common malignant neoplasms of paranasal sinuses and nose

A

SCC - mastoid antrum most common paranasal sinuses -avidly enhancing, destructive

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6
Q

DDx for soft tissue in external auditory canal

A

Narrowed EAC

  • Congenital stenosis/hypoplasia
  • Surfer’s ear (EAC exostosis)

Normal/enlarged caliber EAC

  • Acute otitis externa
  • Malignant otitis externa
  • Cholesteatoma (more common in middle ear)
  • SCC
  • Keratosis obturans
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7
Q

Clinical and imaging findings of glomus tympanicum

A

Extra-adrenal pheo (paraganglioma)
Most common primary middle ear tumour
Red mass behind TM, pulsatile tinnitus and conductive hearing loss
Enhancing post contrast, +/- bony/ossicle destruction

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8
Q

Imaging findings and most common location of facial nerve schwannoma

A

Expansion of facial nerve canal, brisk enhancement

Geniculate>tympanic>labyrinthine

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9
Q

DDx middle ear lesions

A 
Glomus tympanicum (most common) - red mass
Cholesteatoma - white mass
Cholesterol granuloma (cholesterol cyst) - blue mass
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10
Q

Imaging findings cholesteatoma

A

Extra-cranial epidermoid, most commonly middle ear
Acquired (98%) versus congenital
Soft tissue mass, blunting of sputum, erosion of ossicles
Signal same as intracranial mermaids - diffusion destruction, no enhancement

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11
Q

Most common form of cochlear dysplasia

A

Mondini deformity - incomplete development of normal two and half turns of cochlea (middle and apical segments are fused)
Incomplete partition type II
Sensorineural hearing loss
also see enlarged vestibule and vestibular aqueduct

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12
Q

What is Michel aplasia?

A

Complete lack of development of entire inner ear

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13
Q

Ddx cochlear demineralization

A

Retrofenestral otospongiosis, OI, fibrous dysplasia, Paget’s disease

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14
Q

Imaging findings in otosclerosis

A

Primary osteodystrophy of the otic capsule
Increased lucency primary feature
One of leading causes of deafness in adults - can result in both conductive and sensorineural hearing loss
2 subtypes: fenestral (more common) and retrofenestral

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15
Q

DDx for petrous apex lesion

A

ACGME’S MC

  • Apical petrositis
  • Congenital cholesteatoma
  • Granuloma
  • Meningioma
  • EG
  • Schwanomma
  • Mets/Myeloma
  • Chordoma/Chondrosarcoma (arise from clivus, extending into petrous apex)
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16
Q

What is Gradenigo triad

A

Uncommon triad seen in petrous apicitis:
Otomastoiditis
Deep facial pain (trigeminal neuropathy at Meckel’s cave)
Lateral rectus palsy (from 6th CN traversing Dorello’s canal)

17
Q

Imaging finding cholesterol granuloma

A

Petrous apex most common site
Usually expansile, can cause bony destruction
T1 hyperintense d/t cholesterol content
May bleed, and have hemosiderin rim

18
Q

Imaging appearance of LCH

A

Temporal bone most common site in skull base
Well circumscribed, destructive lesion, no sclerotic margins, surrounding marrow edema, marked enhancement (think of this in kids)

19
Q

DDx clival lesions with imaging features

A

Chordoma - microloculated, high T2 signal
Chondrosarcoma
Mets (BREAST CANCER MOST COMMON)

20
Q

Imaging findings on glomus tumours

A

Avidly enhancing, salt and pepper appearance due to flow voids

Occur at jugular foramen, middle ear (tympanicum), carotid body and vagus nerve

Associated with MEN2 and NF1

21
Q

Causes of pulsatile tinnitus

A

Venous

  • IIH
  • aberrant venous course - sigmoid sinus diverticulum with plate dehiscence
  • high riding jugular bulb

Arterial

  • ICA stenosis, dissection, FMD
  • Aberrant internal carotid artery
  • Persistent stapedial artery

Other vascular:
Dural aVF, AVM
Paraganglioma

**Non-pulsatile normally due to cochlear abnormality, best assessed with CT temporal bones

Neuroradiology (15 decks)

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