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CORE: Neuro > Stroke > Flashcards

Stroke Flashcards

1
Q

goal of stroke imaging

A

who benefits from therapy

hemorrhage precludes tPA

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2
Q

goal of stroke therapy

A

restore perfusion

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3
Q

AHA guidelines for stroke therapy

A

IV tPA within 3 hours of stroke onset

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4
Q

goal of perfusion imaging

A

characterize ischemic penumbra

perhaps predict area of vulnerable brain vs infarct core

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5
Q

insular ribbon sign

A

loss of gray-white differentiation

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6
Q

hyperdense artery sign

A

visualization of acute IV thrombus, typically in MCA

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7
Q

stroke MRI

A

restricted diffusion > mass effect/T2 and FLAIR hyperintensity > white matter changes > gyral enhancement/resolution of mass effect&raquo_space; encephalomalacia

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8
Q

reason for restricted diffusion

A

shift from extracellular to intracellular water due to NA/K ATPase pump failure

increase viscosity of infarcted brain

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9
Q

AVM

A

congenital high flow vascular malformation

typically with seizures and bleeding

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10
Q

Spetzler Martin scale

A

evaluate AVM for surgical resection

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11
Q

AVM imaging characteristic

A

vascular nidus with multiple flow voids; adjacent gliosis, dystrophic calcifications and blood products (blooming)

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12
Q

vein of galen malformation

A

vascular malformation characterized by AV fistula from thalamoperforator branches

most common cause of extracardiac high output cardiac failure in kids

may cause parinaud in adults

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13
Q

dAVF

A

complex high flow lesions due to AV shunts between meningeal arterioles and dural venules

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14
Q

cognard classification

A

describes lesions with progressively increased risk of bleeding for dAVF

presence of cortical venous drainage and risk of hemorrhage

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15
Q

type V cognard classification

A

spinal dAVF; may cause myelopathy

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16
Q

carotid cavernous fistula

A

CCF; type of dAVF caused by trauma between cavernous carotid artery and cavernous sinus

enlargment of superior orbital vein and shunting within cavernous sinus; proptosis and CN palsy

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17
Q

low flow lesions

A

cavernous malformation/cavernoma; developmental venous anomaly; capillary telangiectasia

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18
Q

caput medusa morphology

A

developmental venous anomaly ; radially oriented vein

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19
Q

cavernoma

A

vascular hamartoma; small but definite bleed risk

can cause seizures

can be induced by radiation treatment

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20
Q

familial cavernomatosis

A

multiple cavernous malformations

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21
Q

cavernoma imaging manifestations

A

CT: hyperattenuating lesion (microcalcification within cavernoma)

MRI: popcorn like lobular mixed signal due to blood products of varying age; peripheral rim of hemosiderin (GREdark); no enhancement

CTA: occult

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22
Q

developmental venous anomaly/venous angioma

A

abnormal vein that provides functional venous drainage to normal brain

DO NOT TOUCH lesion; can cause venous infarct

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23
Q

capillary telangectasia

A

asymptomatic vascular lesion composed of dilated capillaries interspersed with normal brain

DO NOT TOUCH lesion

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24
Q

capillary telangectasia imaging

A

MRI: brush stroke like enhancing lesion in brainstem/pons; no mass effect or edema

GRE blooming

CTA/MRA: occult

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25
Q

SAH

A

commonly from trauma then aneurysm

thunderclap headache/meningismus

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26
Q

subarachnoid space hyperattenuation DDX

A

SAH, meningitis, leptomeningeal carcinomatosis, prior intrathecal contrast administration

also DDX increased FLAIR in subarachnoid space + recent oxygen/propofol administration

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27
Q

SAH work-up

A

noncontrast CT; lumbar puncture for xanthochromia if suspicion high despite negative CT

28
Q

SAH locations/aneurysms

A

anterior interhemispheric fissure: ACA

suprasellar cistern: Pcomm

sylvian fissure: MCA

perimesencephalic cistern: basilar tip aneurysm or nonaneurysmal perimesencephalic SAH

29
Q

grading scales for SAH

A

Hunt and Hess (clinical; no imaging/headaches)

Fisher: thickness of SAH

30
Q

compliciations of SAH

A

vasospasm (peak 7 days after ictus)

acute hydrocephalus due to arachnoid granulations&raquo_space; vetriculostomy

supericial siderosis: iron overload of pial membranes to to repeat bleeds; sensorineural deafness/ataxia

31
Q

perimesencephalic SAH

A

nonaneurysmal SAH; occult venous bleeding

sandard care is to perform catheter angiography 2x, 1 week apart

mild to moderate vasospasm, better prognosis

32
Q

reversible cerebral vasoconstriction syndrome

A

nontraumatic nonaneurysmal SAH and ischemia

thunderclap headache; prolonged but reversible vasoconstriction

33
Q

saccular aneurysm

A

focal outpouching of arterial wall; typically at branch points; neck:body ratio affects treatment

sizes: small <1 cm, medium <2.5; giant >2.5 cm

may be caused by Takayasu/giant cell arteritis, HTN, marfan, ehlers-danlos, PCKD, NF1 (connective tissue diseases)

34
Q

fusiform aneurysm

A

segmental arterial dilation without neck; due to atherosclerosis

do not occur at branch points

35
Q

mycotic/infectious aneurysm

A

septic emboli; form in distal arterial circulation beyond circle of Willis

fragile; high risk of rupture

36
Q

oncotic aneurysm

A

aneurysm caused by neoplasm

benign left atrial myxoma may peripherally embolize and cause distal oncotic aneurysm

37
Q

traumatic pseudoaneurysm

A

do not contain all 3 layers of vessel wall; abnormal luminal narrowing proximal

occur distally

arteries close to bony structures (basilar/vertebral) prone to dissecting

38
Q

dural sinuses

A

superior sagittal sinus > torcular herophili/confluence of sinuses

transverse sinus (left is usually hypoplastic)

sigmoid sinus < jugular bulb

39
Q

deep cerebral veins

A

internal cerebral veins, basal vein of rosenthal, vein of galen

venous angle: septal/thalamostriate vein intersection (foramen of Monro)

40
Q

superficial cerebral veins

A

vein of Trolard (superficial cortical to SSS)

vein of Labbe(drains temporal convexity to transvers/sigmoid sinus)

41
Q

risk factors for venous thrombosis

A

pregnancy, OCP, thrombophilia, malignancy, infection

42
Q

more common cause of stroke in younger patients

A

cortical vein thrombosis/deep venous sinus thrombosis

43
Q

empty delta sign, cord sign, findings on MR venogram

A

cord sign: increased density in thrombosed sinus/cortical vein

empty delta sign: filling defect in SSS

MR venogram: lack of flow in thrombosed vein/dural venous sinus

44
Q

thrombosis in SSS, deep venous system, transverse sinus&raquo_space; venous infarction

A

superior sagittal sinus thrombosis: infarction of parasagittal high convexity cortex

deep venous system thrombosis: infarction bilateral thalami

transverse sinus thrombosis: infarction posterior temporal lobe

45
Q

stages of iron in hemoglobin

A

intracellular oxyhemoglobin -> deoxygenation –> intracellular deoxyhemoglobin –> oxidation –> intracellular methemoglobin –> cell lysis –> extracellular methemoglobin –> chelation –> hemosiderin/ferritin

46
Q

risk of posterior fossa hemorrhage >3cm

A

brainstem compression or hydrocephalus from 4th ventricular obstruction

47
Q

hyperacute hematoma: blood product stage, T1/T2 signal

A

0-6 hrs
intracellular oxyhemoglobin
T1 isointense, T2 iso/hyperintense
peripheral rim on GRE

48
Q

acute hematoma: blood product stage, T1/T2 signal

A

6-72 hrs
intracellular deoxyhemoglobin
T1 isointense, T2 dark

49
Q

early subacute hematoma: blood product stage, T1/T2 signal

A

3 days -1 week
intracellualr methemoglobin
T1 hyperintense, T2 dark

50
Q

late subacute hematoma: blood product stage, T1/T2 signal

A

1 week - months
extracellular methemoglobin
T1/2 bright

51
Q

chronic hematoma: blood product stage, T1/T2 signal

A

extracellular iron/ferritin/hemosiderin

T1/2 dark

52
Q

most common cause of spontaneous hemorrhage

A

chronic hypertension

53
Q

common locations for hypertensive hemorrhage

A

basal ganglia, thalamus, cerebellum

54
Q

imaging findings suggestive of hypertensive microangiopathy

A

periventricular white matter disease, prior lacunar infarcts

microhemorrhages on T2* in basal ganglia/brainstem

55
Q

cerebral amyloid angiopathy

A

amyloid in small and medium artery walls that cause vessel weakness –> hemorrhage; can also cause occlusion and contribut to microangiopathy

exclusively in elderly adults (whites)

56
Q

primary imaging feature of cerebral amyloid angiopathy

A

hematoma: lobar/cortical (parietal/occipital lobes)

multiple microhemorrhages seen on T2*; seen in cortex, not basal ganglia

57
Q

aneurysmal hemorrhage

A

most common cause of nontraumatic SAH

58
Q

AVM malformation hemorrhage

A

rupture of AVM; parenchymal hematoma
congenital abnormal high flow AV connection without intervening normal brain

tends to affect younger patients

59
Q

dural AV fistula hemorrhage

A

fistulous connection between meningeal artery and venous sinus/cortical vein

most common types: cavernous-carotid fistula or posterior fossa dAVF

60
Q

venous thrombosis hemorrhage

A

thrombosis of cortical veins/deep venous sinuses lead to venous hypertension which can cause infarction and parenchymal hemorrhage

61
Q

hemorrhagic neoplasms in the brain

A

glioblastoma, mets (choriocarcinoma, melanoma, thyroid carcinoma, RCC; breast/lung based on most common)

pts treated with bevacizumab (Avastin)

62
Q

cavernous malformation

A

vascular hamartoma that consists of low-flow endothelial lined blood vessels; no intervening brain

popcorn like lobular mixed high T1/2 signal; dark hemosiderin rim

however, once it bleeds hematoma is nonspecific

63
Q

hemorrhagic transformation of infarct: risk factors

A

thrombolytic therapy, large region of hypoattenuation, dense artery sign

64
Q

vasculitis hemorrhage

A

vasculitis typically causes cerebral ischemia, less likely frank emorrhage

65
Q

moya moya

A

nonatherosclerotic vasculopathy; progressive stenosis of intracranial ICA –> proliferation of fragile lenticulostriate collaterals

susceptible to aneurysms in posterior circulaton; decreased flow in affected vascular regions

66
Q

puff of smoke, ivy sign

A

puff of smoke: enlarged basal perforating arteries

ivy sign: FLAIR MRI; tubular branching hyperintense structures within sulci

67
Q

types of intraparenchymal hemorrhage in elderly

A

hypertensive hemorrhage, amyloid angiopathy

CORE: Neuro (21 decks)

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