Cerebrovascular Neuroradiology

Front 1

How many days after an infarct does edema reach maximum?

Back 1

3 days

Front 2

By when do you see cystic encephalomalacia?

Back 2

6 –8 weeks

Front 3

3 signs of significant stenosis on Doppler?

Back 3

1. high velocity flow
2. turbulent flow
3. luminal narrowing

Front 4

Intraparenchymal hemorrhage – DDx

Back 4

1. Hypertension
2. Trauma
3. amyloid angiopathy
4. venous hypertension/venous sinous occlusion/venous infarct
5. coagulopathy
6. Large infarct territory/reperfusion
7. hemorrhagic metastasis
8. AVM
9. anuerysm dissecting into tissue

Front 5

Most common sites of spontaneous intraparenchymal hemorrhage

Back 5

1. External capsule/basal ganglia
2. cerebellum
3. thalamus
4. pons

Front 6

Intraparenchymal Hematoma
1. How long until isodense to CSF?
2. How long until ring-enhancing?
3. How long remains ring-enhancing?

Back 6

1. 2-3 months
2. 7-10 days
3. 3-4 months

Front 7

SAH
1. 2 most common causes?
2. 5 rarer causes

Back 7

1. Trauma, ruptured anuerysm
2. AVM (dural), pituitary apoplexy, idiopathic mesencephalic hemorrhge, coagulopathy, neoplasm,

Front 8

Aneurysm rupture – major causes of morbidity? (4)

Back 8

1. rerupture
2. vasospasm, infarction
3. hydrocephalus
4. herniation

Front 9

AVM
1. 2 most common clinical presentations?
2. What is common in adjacent brain tissue?

Back 9

1. seizure, intraparenchymal bleed
2. atrophy

Front 10

Carotid-Cavernous Fistula – 2 types

Back 10

1. Direct connection in cavernous sinus
2. Parasellar AVM

Front 11

Birth Trauma – DDx

Back 11

1. Caput succedaneum – soft superficial pitting edema, crosses suture lines
2. Subgaleal hemorrhage – firm fluctuant mass, can dissect into neck, deep to aponeurosis
3. Cephalohematoma – hematoma between outer layer of periosteum, most commonly parietal, firm tense mass, may calcify, thicken diploe, does NOT cross suture line
4. Skull fracture
5. Subdural Hemorrhage
6. Benign subdural effusion

Front 12

Increased Intracranial Pressure

Back 12

1. Intracranial mass
2. Hydrocephalus
3. Malignant hypertension
4. Diffuse cerebral edema
5. Increased Venous Pressure
6. Elevated CSF protein
7. Pseudotumor cerebra – papilledema, enlargement of perioptic nerve subarachnoid space

Front 13

Strokes – Vascular Etiologies/categories

Back 13

Brain Infarction – 80%
a. Occlusive atheromatous disease
i. Extracranial aa. 35%
ii. Intracranial aa – 10%
b. Small vessel dz – lacunar infarct (25%)
c. Cardiogenic emboli
i. Ischemic HD with mural thrombus (AMI, arrhythmia)
ii. Valvular HD – postinflammtory (rheumatic) valvulitis, infective endocarditis, nonbacterial thrombotic endocarditis, MVP, MS, prosthetic valves
iii. A-fib
iv. Left Atrial Myxoma

Front 14

Strokes – Vascular Etiologies/categories

Back 14

Non-atheromatous Disease
i. Elongation, coils, kinks
ii. FMD
iii. Aneurysm
iv. Dissection
v. Cerebral arteritis (takayasu, collagen disease/SLE, lymphoid granulomatosis, termpoal arteritis, behcet dz)
vi. Postenarterectomy thrombosis/embolism, restenosis
e. Coagulation disorder
2. Primary Intracranial Hemorrhage – 15%
f. Hypertensive hemorrhage – 40-60%
g. Amyloid angiopathy – 15-25%
h. Vascular malformation – 10-15%
i. Drugs: eg anticoagulants 1-2%
j. Bleeding diathesis (<1%)
3. Vasospasm due to nontraumatic SAH
k. Ruptured aneurysm 75-80%
l. Vascular malformation 10-15%
m. Nonaneurysmal SAH5

Front 15

CAUSES OF EARLY DRAINING VEIN - (rapid or short "transit time")

Back 15

1. Neoplasms - primary or secondary
2. AVM
3. Inflammatory lesion
4. Trauma (hyperemia)
5. Ischemia
6. Epileptic focus
7. Toxic encephalopathy
COMMENT: Definition is vein seen < 3 sec after beginning of intracerebral contrast - usually veins drain into Sup Sinus from anterior to posterior

Front 16

DEEP VENOUS DRAINAGE

Back 16

1. Anterior septal
2. Thalamostriate
3. Internal cerebral veins (paired)
4. Basal vein(s) of Rosenthal (medial temporal lobe)
5. Great vein of Galen
6. Inferior sagittal sinus (free edge of Falx)
7. Straight sinus
8. Superior sagittal
9. Transverse sinus
10. Sigmoid sinus
11. Internal jugular
COMMENT: Superficial drainage is superficial middle cerebral vein, vein of Trolard and vein of Labbe to superior sagittal sinus

Front 17

Moya Moya – DDx

Back 17

1. Primary (inherited)
2. Secondary
a. Down
b. TS
c. SCD
d. CTD
e. Progeria
f. Midline anomalies (morning glory syndrome)
g. NF1
h. Irradiation
i. Inflammatory: CNS angiitis (of childhood) basal meningitis (TB), leptospirosis, atherosclerosis, local infection (tonsillitis/otitis)
j. Vasculopathies and prothrombotic states: Kawasaki disease, anticardiolipin antibody, Factor V leiden, polyarteritis nodosa, behcet’s, SLE

Front 18

IVY sign (FLAIR) – DDx

Back 18

1. Moya Moya
2. Leptomeningeal mets
3. meningitis
4. Hyperoxygenation

Front 19

Severely Attenuated Circle Of Willis

Back 19

1. Moya Moya
2. SAH
3. Meningitis (basilar)
4. Tumor Encasement

Front 20

DDx of Puctate T2-bright fFoci in basal ganglia

Back 20

1. Moya moya – engorged vessels in punctate foci enhance
2. Cribriform lacunar state: no enhancement

Front 21

Dural Venous Occlusion – DDx (mimics)

Back 21

1. Normal – blood in vessels normal slightly hyperdense on NECT, especially newborn (dense fetal hgb in 1st 14 days
2. Anatomic Variant
a. congenital hypoplastic/absent transverse sinus
b. High-splitting tentorium (low density fluid in superior vermian fissure between leaves of high tentorium)
3. Giant Arachnoid Granulation
4. False “Empty Delta” Sign
c. Subdural hematoma/empyema
d. Empty delta sign requires contrast!