Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
151 Cards in this Set
- Front
- Back
|
What is the mcc of an epidural hematoma
|
disrupted mid meningeal artery
|
|
|
What percent of epidural hematomas have an accompanying skull fx
|
85-95%
|
|
|
Where do venous epidural hematomas tend to occur
|
vertex, posterior fossa, anterior aspect of the middle cranial fossa.
|
|
|
What is the shape of an epidural hematoma
|
lenticular or biconvex
|
|
|
Do epidural hematomas cross sutures
|
usually will not
|
|
|
What is the MC extra-axial tumor
|
meningioma
|
|
|
Where do meningiomas tend to occur
6 |
parasagital dura, Convexities, CPA cistern, olfactory groove, planum spenoidale, cavernous sinus, intraventricullar
|
|
|
What percent of meningiomas are hyperdense on NCCT
|
60%
|
|
|
What percent of meningiomas have calcificationa
|
20%
|
|
|
What are the signal characteristics of a meningioma on MR
|
T1- iso to hypo
T2- iso to hyper |
|
|
What is the classic angiographic finding with a meningioma
|
mother in law sign
|
|
|
Can a meningioma have cystic, osteoblastic, chondromatous, fatty degeneration
|
yes
|
|
|
What is the enhancing characteristic of a meningioma
|
avidly enhances
|
|
|
What percent of meningomas have a dural tail
|
62 percent
|
|
|
can a meninigoma encase arteries
|
yes
|
|
|
What genetic disorder is associated with multiple meningiomas
|
NF2
|
|
|
What is the MC post radiation mass
|
meningioma
|
|
|
What are signs of an extra-axial mass
|
buckling of gray-white jxn, expanded ipsilateral CSF space, may have bony reaction/hyperostosis
|
|
|
Can a meningioma have associated hyperostsosis
|
yes
|
|
|
What is the ddx of a meningioma
8 |
dural mets, lymphoma, epidermoid, arachnoid cyst, schwannoma, neurofibroma
|
|
|
What should be a consideration as a ddx if there is ehancing CPA mass
|
schawnnoma and meningioma
|
|
|
Can a meningioma arise from the sphenoid ridge along the optic nerve sheath.
|
yes
|
|
|
How do you differentiate a meningioma from a hemangiopericytoma
|
narrower dural attachment, lobulated
heterogenous destroy bone no calcifications, large internal vessels on MR |
|
|
What is essential to always include in a suprasellar mass.
|
suprasellar aneurysm
|
|
|
What are the likely locaitons of a suprasellar aneurysm
|
PICA, AICA, veterbral, basilar tip, MCA trifurcation
|
|
|
Where do mycotic aneurysms tend to occur
|
distally
|
|
|
What are risk factors for cerebral venous thrombosis
|
dehydration, hypercoaguable states, pregnancy, sepsis, meningitis, tumor invasion
|
|
|
When should you consider a CV sinus thrombosis
5 |
young patient
not corresponding to vascular territory hemorrhage rounded sparring cortex bilateral parasagital |
|
|
What are radiographic findings in a patient with cerebral venous sinus thrombosis
on angiogram |
lack of filling of veins
delayed arterial filling prolonged parenchymal blush |
|
|
What are 3 vascular complications of a fungal infection of the brain
|
Vasculitis, occlusions, mycotic aneurysms
|
|
|
Can a venous sinus thrombosis cause infarct
|
yes
|
|
|
What are 6 risk factors of a cerebral venous aneurysm
|
Risk factors: dehydration, hypercoagulable state, pregnancy, sepsis, meningitis, tumor invasion
|
|
|
When should a venous aneurysm be considered
|
young patient with stroke
not corresponding to a territory hemorrhage sparring cortex bilateral parasagital |
|
|
What are findings on a venogram in a pt with venous sinus thrombosis
|
lack of filling of a segment of a vein
engorgement of other veins slow arterial filling prolonged parenchymal blush |
|
|
When is the empty delta sign sing
|
CTA
|
|
|
Can mastoiditis lead to sinus thrombosis
|
yes
|
|
|
What should you suspect if you see an area of infarction in an atypical area and hemorrhage
|
sinus thrombosis
|
|
|
Is adjacent infection a set up for a sinus thrombosis
|
yes
|
|
|
Where is the pineal gland located in axial images
|
posterior aspect of the 3rd ventricle
|
|
|
Where is the pineal gland located on sagittal images
|
top of midbrain colliculi
|
|
|
What are the radiographic findings of a germinoma of the pineal gland
|
NCCT: hyperdense
MR: intermediate T1, slightly hypo T2 Often see Ca+ pineal adjacent to it |
|
|
What are the radiographic findings of a pineocytoma and a pineoblastoma
|
NCCT: hyperdense
MR: intermediate T2 Both enhance avidly May explode the pineal Ca+, displacing it peripherally |
|
|
What are the MR findings of a pineal cyst
|
Axial T1 C+ MR shows a pineal mass with no enhancement, typical of a pineal cyst. If there is rim or nodular (rare) enhancement, it may not be distinguishable from a pineocytoma on imaging alone.
|
|
|
What does the post gad imaging of a germinoma look like
|
well-defined, enhancing pineal
|
|
|
What syndrome is a germinoma assoicated with
|
Also called dorsal midbrain or collicular syndrome, this disorder is characterized by an upward fixed gaze and pupils. Structures in the vicinity of the dorsal midbrain area, including cranial nerve IV, the superior and inferior colliculi, pretectal area, and pineal gland, are affected. Pineal tumors and hydocephalus are main causes of damage to these structures.
|
|
|
What are the enhancement characteristics of a pineocytoma
|
p. Enhancement of pineocytoma can be solid, peripheral, or both. Imaging of a pineocytoma may mimic a pineal cyst or pineoblastoma.
|
|
|
What is the classic calcification pattern of a pineal germinoma
|
Central, "engulfed" Ca++ classic
|
|
|
What pineal lesion has a poor prognosis
|
Pineoblastoma is a highly malignant tumor with poor survival.
|
|
|
What are the MR findings of pineocytoma
|
Demarcated round or lobular mass, typically with Ca++
Strong, homogeneous enhancement (may be ring) May compress adjacent structures, but no invasion |
|
|
What are the radiographic findings of pineoblastoma
|
Large, heterogeneous pineal mass with "exploded" peripheral Ca++ & hydrocephalus
Large |
|
|
What is the most common pineal tumor
|
germinoma
|
|
|
Are pineoblastomas typically large, heterogenoous and cause hydrocephalus
|
yes
|
|
|
What are some additional findings that may help differentiate a pineocytoma from pineoblastoma
|
Typically less than 3 cm
Rarely extends into 3rd ventricle Rarely invasive May compress adjacent structures Can compress aqueduct → hydrocephalus Occasionally hemorrhages |
|
|
What other GCT besides germinoma may go to the pineal gland
3 |
teratoma (contains fat), choriocarcinoma, embryonal cell CA
|
|
|
Is it normal to have calcifiation of the pineal gland in a child less than 7
|
no
|
|
|
What cells cause pineocytoma
|
pineal gland cells
|
|
|
Is a pineocytoma typically well defined, rounded homogenous mass
|
yes
|
|
|
Does pineocytoma occur in an older age group than pineoblastom
|
yes
|
|
|
What is the 2nd most common GCT of the pineal gland
|
teratoma (multicystic mass with fat and calcs)
|
|
|
Are pineal gland cyst a frequent incidental finding
|
yes
|
|
|
What must a pineal gland cyst be differentiated from
|
cystic neoplasm
|
|
|
What are the typical features of a pineal cyst
|
The typical pineal cyst is smooth, well-rounded, and follows CSF signal characteristics. High protein content or hemorrhage may give altered signal.
|
|
|
What are atypical pineal cyst features that may warrant further investigation
|
Atypical features include thick or nodular walls, septation, a soft-tissue component, or non-peripheral contrast enhancement, and should prompt further investigation, including testing for hormones from germ cell tumours.
|
|
|
Do many clinicians opt to follow up an incidentally discovered pineal cyst with interval imaging.
|
yes
|
|
|
When do findings of a stroke first appear on MR imaging
|
8h
|
|
|
What is the DDX of a multiple ring enhancing lesions within the brain
|
Mets
Abscesses, Asperigilosis Glioma Infarct Contusion Lymphoma Demyelinating Radiation/Resolving hematoma |
|
|
What else should be included in the MAGICL DR acrynomn
2 |
toxo, tuberculoma
|
|
|
What are types of ring enhancing lesions that should be strongly suspected in a patient who is immunocompromised
|
toxo, lymphoma
|
|
|
Is it sometimes difficult to differentiate toxo and lymphoma
|
yes
|
|
|
What findings favor toxoplasmosis over lymphoma
3 |
multiple, BG location, eccentric nodule
|
|
|
What findings favor lymphoma over toxoplasmosis
6 |
periventricular location, callosal involvement, hyperdensity on NCCT, iso/hypointensity on T2, supependymal spread and ventricular encasement.
|
|
|
What does subependymal spread and ventricular encasement favor; toxo or lymphoma
|
lymphoma
|
|
|
What is best for differentiating toxo and lymphoma
|
PET or SPECT thallium are better than MR
|
|
|
What are the findings of findings of lymphoma on pet or spect thallium studies
|
Lymphoma is hot on PET and thallium, but toxo is not
|
|
|
What is the poor mans way to differentiate toxo and lymphoma
|
Another way to distinguish is by trial of antitoxo meds (f/u imaging in 14 d), or if needed, biopsy
|
|
|
What will result in restriction on DWI sequence
|
infarct, pyogenic abscess, cellular tumors (lymphoma, PNET), some demyelinating lesions
|
|
|
On MR perfusion do the lesions have increased cerebral blood volume
|
yes
|
|
|
What is a difference in the peritumoral blood volume in Mets Vs glioma
|
mets (nonelevated peritumoral rCBV), glioma (elevated peritumoral rCBV)
|
|
|
When do you see increased choline
|
mets and gliomas
|
|
|
When do you see decreased metabolites
4 |
abscess, demyelinating, radiation necrosis, infarct
|
|
|
When do you see elevated lactate
|
ischemia, inflammation, infection
|
|
|
In an abcess what are other spectroscopy findings
|
Other amino acids, acetate, succinate
|
|
|
Do you see increased CBV in the pneumbra of in infarct
|
yes
|
|
|
Can toxoplasmosis have variable enhancement that ranges from nodular and ring enhancment . Expansile or non-evident on non-contrast CT
|
yes
|
|
|
Do tuberculomas demonstrate ring enhancement
|
yes, this is a rare cause of ring enhancing lesions of the brain
|
|
|
What are 3 sequelea of aspergillosis
|
hemorrhage
infarct aneurysm |
|
|
Can a subacute infarct be ring enhancing
|
yes
|
|
|
If you see multiple T1 hypointense lesions in the corpus callosum what should come to mind
|
MS
|
|
|
Where is the typical location of lesions in MS
|
periventricular WM, corpus callosum
|
|
|
What does it mean when an MS lesion is enhancing
|
it is probably active disease
|
|
|
What is the appearance of MS on CT
|
hypodense
|
|
|
What is the appearance of MS on MR
|
MR: iso to low T1 and high T2, best seen on FLAIR
|
|
|
What is the appearance of MS on CT
|
hypodense
|
|
|
What is the MR appearance of MS
|
MR: iso to low T1 and high T2, best seen on FLAIR
|
|
|
What sequence is MS best seen on
|
FLAIR
|
|
|
What percent of pts with MS plaques of the brain will have concurrent plaques of the spinal cord
|
2-20%
|
|
|
Can MS appear as multiple punctate lesion or confluent
|
yes
|
|
|
What is the lesion most of the time if it involves the corpus callosum
|
MS lesion
|
|
|
What are dawsons fingers
|
these are the ovoid periventricular lesions of MS
|
|
|
What type of MS may enhance
|
tumefactive or acute
|
|
|
Can tumefactive MS have a mass like appearance
|
yes
|
|
|
How long does acute MS tend to enhance if it does
|
2-8wks
|
|
|
What is the appearance of optic neuritis
|
high signal in optic nerve on T2 w/enhancement and enlargement of nerve
|
|
|
What is optic neuritis associated with
|
MS
|
|
|
If you see intramedullar lesions of the spinal cord and think its MS what other study should you get
|
brain MR
|
|
|
What is the ddx of MS
|
Lyme disease, ADEM, vasculitis
|
|
|
What is devics disease
|
optic neuritis (often bilateral) + acute transverse myelitis
|
|
|
What is another name for devics disease
|
neuromyelitis optica
|
|
|
Is the optic neuritis of devics disease often bilateral
|
yes
|
|
|
How big does the lesion in the spinal cord tend to be in devics disease
|
greater than 3 vetebral segments across the full thickness of the spine on axial images
|
|
|
What is marburg type of MS
|
this is an acute fulminant variant
|
|
|
What does the marburg variant of MS look like
|
Large confluent white matter lesions w/edema, possible enhancement
|
|
|
What does the Balo concentric sclerosis variant of MS look like
|
Irregular, concentric zones of increased signal on T2 MR
|
|
|
What will dawsons fingers look like on Flair
|
hyperintense periventricular fingers
|
|
|
Asymmetric hyperintensity of the optic nerve in a young women with vision problems
|
optic neurtitis
|
|
|
What does ADEM typically occur after
|
a viral infection
|
|
|
Can the lesions of ADEM ring enhance
|
YES (add to magicl dr) Can be the 3rd A (abscess, aspergillosis and ADEM)
|
|
|
What does ADEM stand for
|
acute disseminated encephalomyelitis
|
|
|
What is a major difference between ADEM and an abscess
|
no restriction
|
|
|
What is the tx of ADEM
|
steriods with rapid enhancement
|
|
|
What does ADEM usually follow
|
virus or vaccine
|
|
|
Do ADEM typically occur in children
|
yes
|
|
|
What is the MC spinal inflammatory condition
|
MS
|
|
|
Can upto 20% of MS be isolated in the spine
|
yes
|
|
|
Where do the plaques of MS typically occur in the spinal cord
|
peripheral (white matter tracts)
|
|
|
How large are the MS plaques of the spinal cord
|
Typically shorter than two vertebral segments in length and involve less than half the cross-sectional area of the cord
|
|
|
If you see multifocal infarcts in a young women what should be suspected
|
SLE
|
|
|
What are the angiographic findings in a patient with vasculits of the brain
|
mutifocal stensosi
|
|
|
What is the MC presentation of lupus vasculitis
|
Most common = multifocal WM microinfarcts, cerebral atroph
|
|
|
What should be suspected if there is a permeative skull base mass with involvement of the mastoid air cells
|
glomus jugulare
|
|
|
Do glomus jugular tumors enhance vividly
|
yes
|
|
|
What is the appearance of a glomus jugulare tumor on T2W imaging
|
salt and pepper vascularity of tumor(flow voids?)
|
|
|
should a glomus jugulare tumor be in the ddx of a CP angle tumor
|
yes
|
|
|
Where is the typical location of a glomus tympanicum
|
cochlear promotory (inferior part of the mid ear)
|
|
|
Is a carotid body tumor a type of glomus tumor
|
yes
|
|
|
What is the ddx of a glomus jugulare
|
swhannoma
meningioma met |
|
|
Where does a glomus vagale occur
|
Usually displaces carotid anteriorly in parapharyngeal space
|
|
|
Is the enhancement pattern of a glomus tumor specific
|
yes, intense enhancement in first 60 s, dip in the enhancement at 20-40 s
|
|
|
What may happen if iodinated contrast is given to a patient with a glomus tumor
|
Remember not to give iodinated contrast to pt w/known glomus w/o alpha adrenergic blockade, may get hypertensive crisis
|
|
|
If given iodinated contrast to a patient with a glomus tumor what should be done first
|
alpha adnergic blockade
|
|
|
What happens to the bifurcation of the CCA if there is a carotid body tumor
|
it will seperate the vessels (ICA and ECA)
|
|
|
Where does the glomus vagale occur
|
Along the course of the ICA above the level of the bifurcation but below the level of the skull base
|
|
|
What is the MC appearance of a hemangioblastoma
|
Usually posterior fossa intra-axial cyst w/enhancing mural nodule, off midline, in an adult
|
|
|
Can hemangioblastomas occur in the spine
|
yes
|
|
|
What is the appearance of a hemangioblastoma of the spine
|
Enlarged cord w/cystic and some solid, round, enhancing nodules (intramedullary in 60%, extra in 40%) and prominent flow voids around cord
|
|
|
Can a hemangioblastoma be either intramedullary or extramedullary
|
yes but mostly intramedullary
|
|
|
Are hemangioblastomas often multiple and produce edema
|
yes (especially VHL)
|
|
|
Why do hemangioblastomas somettimes produce htn
|
May cause hypertension b/c they secrete erythropoietin
|
|
|
What percent of hemangioblastomas are associated with VHL
|
25-45
|
|
|
What are other associated findings of VHL
|
Capillary hemangioblastomas of the CNS and retina
Cysts, renal clear cell carcinoma Pheochromocytoma Pancreatic cysts, islet cell tumors Endolymphatic sac tumors Epididymal cysts, cystadenomas |
|
|
What are the 4 MC associations we should know about VHL
|
hemangioblastomas (HGBLs), clear cell renal carcinoma, cystadenomas, pheochromocytomas
|
