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78 Cards in this Set
- Front
- Back
Subarachnoid hemorrhage
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Ruptured intracranial hemorrhage
Perimesencephalic venous hemorrhage (diagnosis of exclusion with patients with blood in the pontine cistern and normal cerebral angiography) Trauma Parenchymal hematoma Brain arteriovenous malformation/fistula Spinal AVM Cervical Eependymoma No cause found |
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Complications of Subarachnoid hemorrhage
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hydrocephalus
vasospasm infarct rebleeding diffuse cerebral swelling and cerebral herniation |
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Acute Bacterial Meningitis
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normal (most common finding early)
diffuse brain swelling meningeal enhancement ventriculitis (linear enhancement of ependymal lining) hydrocephalus (more typically communicating) subdural empyema sterile collections focal sepsis within temporal bone, paranasal sinus or skull vault arterial infarct venous infarct cerebritis/cerbral abscess venous infarct atrophy encepahalomalacia |
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Viral encephalitis
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Herpes Simplex hemorrhagic necrotizing encephalitis-prediliction limbic system, medial temporal lobes and inferior frontal lobes)
HIV Sporadic Creutzfeldt Jacob Disease Variant Creutzfeldt Jacob Disease Progressive multifocal leukoencepalopathy PML Rasmussens Encephalitis Polio Acute cerebellitis |
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Congenital CNS Infection
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CMV (targets the developing germinal matrix -produces multiple foci of calcification in a periventricular distribution-other feature microcephaly, deafness choriretinitis and polymicrogyria-lissencephaly, hypoplastic cerebellum and marked ventriculomegaly occur with early in utero infection)
Toxoplasma (foci of calcification more scattered than those seen in CMV-hydrocephalus occurs secondarily to aqueduct stenosis-microcephaly, porencephaly and choriretinitis are other manifestations) Rubella (deafness cataracts, micropthalmia atrophy parenchymal calcifications) Herpes Simplex (acute neonatal form -diffuse or focal white matter edema +/- hemorrhage-infection not localized to the limbic system as in older kids and adults-mermingeal enhancement in the acute stage-subsequent atreophy and cystic encephalomalacia) HIV (diffuse cerebral atrophy. Calcification of the basal ganglia after the first year of life) |
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Head Injury
Extra axial |
extradural hemorrhage
subdural hemorrhage subarachnoid hemorrhage intraventricular/choroid plexus hemorrhage skull fracture csf laek pneumocephalus cranial nerve palsy (VII nerve du to temporal bone invovlment) |
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Head Injury
Intra axial |
Diffuse axonal injury
Hemorrhagic Contusions Deep grey matter and brainstem lesions Hypoxia |
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Head Injury
Secondary Brain Injury |
Intracerebral herniation
Diffuse cerebral edema and ischemia Embolic complications (secondary to arterial damage ie dissection) Meningitis Hypoxia |
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Head Injury
Delayed Brain Injury |
Atrophy
CSF leak Arterial pseudoaneurysm (following arterial laceration) Arteriovenous fistula Leptomeningeal cyst |
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Non Accidental Injury
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Subdural hematomas
Skull fracture Cortical contusion / shearing injuries Cerebral Edema Hypoxia Subarachnoid and intraventricular hemorrhages Subdural Hygromas Cerebral Laceration Vascular Injuries Coexsting non CNS injury (retinal hemorrhages, skeletal #s) |
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Large Head in Infancy
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hydrocephalus
chronic subdural hematoma neurofibromatosis mucoplysachiridosis megaencephaly Alexander's Disease (leukodystrophy involves the frontal lobes early in its course) Canacan's Disease (leukodystrophy involves the subcortical arcuate fibres, but often the entire cerebral white matter) hydranencephaly |
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Wide Cranial Sutures
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RAISED INTRACRANIAL PRESSURE (kids < 10)
Subdural hematoma Hydrocephalus Intracranial Tumor INFILTRATION OF SUTURES Neuroblastoma Leukemia Lymphoma METABOLIC DISEASE Ricket's Hypoparathyroidism Lead intoxication Bone dysplasias with defective mineralization RECOVERY FROM ILLNESS (rapid regrowth of the brain following) Deprivational Dwarfism Chronic Ilness Prematurity Hypothyroidism |
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Non Comunicating Hydrocephalus
(intraventricular obstruction) |
LATERAL VENTRICLES
intrinsic tumor (solid or ependymal) extraventricular tumor (mass effect) FORAMEN of MUNRO tumor (colloid cyst, subependymal giant cewll astrocytoma) ventriculitis (adhesive arachnoiditis) hemorrhage (fresh clot or delayed adhesive arachnoiditis) cerebral swelling (subfalcine herniation) THIRD VENTRICLE intraventicular tumor extraventricular tumor (pit adenoma, cranio, arachnoid cyst) CEREBRAL AQUEDUCT intraventricular tumor (ependymal seeding) extraventricular tumor (pineal mesencephalic, tentorial mass lesions) developmental aqueductal stenosis ventriculitis hemorrhage FOURTH VENTRICLE intraventricular tumors (ependymoma, mets) extraventricular tumors (medulloblastoma, mets, hemangioblastoma, large posterior extrinsic masses (meningioma, vestibular schwannoma) |
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Comunicating Hydrocephalus
(extraventricular obstruction) |
(impaired reabsorbtion by arachnoid granulation accounts for the majority of cases)
SAH Infectious meningitis Malignant Meningitis (breast, lung) Granulomatous meningitis (sarcoid, TB) Altered venous dynamics (Vein of Galen malformation) |
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Hydrocephalus (other)
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External Hydrocephalus
(benign enlargemenr of subarachnoid space seen in some young children. Caused by a disproportionate growth between skull and intracranial contents) Overproduction Hydrocephalus (choroid plexus papilloma) Normal Pressure Hydrocephalus Clinical Syndrome of Memory Loss, gait disturbance and urinary incompeteance. Imaging demonstrates ventricular enlargement disproportionate to the degree of sulcal widening) |
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Clinical Syndromes Associated with Enlarged Ventricles
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Achondroplasia
Soto's Syndrome (cerebral giantism, advanced skeletal maturity) Acrocephalosyndactly (Aperts and Pfeiffer) Crouzon Syndrome Fetal Alcohol Syndrom Lissencephaly |
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Pneumocephalus
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Trauma
Iatrogenic Osteoma of the Ethmoid Sinus Tumor eroding the base of the skull arising in the siuses or nasopharynx Empty Sella (spontaneous communication between the sella and the spenoid sinus) |
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Differential Diagnosis of a Solitary Intracerebral Mass
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GBM
Mets Arterial Infarct Abscess Demyelination Hematoma Encephalitis Aneurysm |
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Intracranial Calcification
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NORMAL
pineal gland choroid plexus (atria of lateral ventricles, unusual in 3rd and 4th ventricles) Dura Habenular Commisure (C shaped calcification within the tela choroidea of the 3rd ventricle) Basal Ganglia Dentate Nuclei Parasellar ligaments Arachnoid Granulations VASCULAR atherosclerosis aneurysm AVM cavernous angioma chronic SDH Old infarct/hemorrhage TUMORS meningioma glioma (<10% of astrocytomas calcify) Oligodendroglioma 50% calcify Craniopharyngioma Ependymoma Choroma and Chondrosarcoma DNET Central Neurocytoma Mets (adenocarcinoma (breast, GIT)) Pineal Tumors (teratoma germinoma) Lipoma (crescentic calcification in the midline) INFECTION TORCH Cysticercosis periventricular, cisternal and corticomedullary nodules) TB (basal cisterns, ventricle and parenchyma) BASAL GANGLIA CALCIFICATIONS normal endochrine metabolic (mitochondrial disorders, Fahrs) Infection Toxic (hypoxia, carbon monoxide, lead) Chemotherapy/Radiation NEUROCUTANEOUS Sturge Weber (dystrophic calcification of the cerebral cortex) TS (periventricula or parenchymal) Neurofibromatosis (choroid plexus, premature, excessive), subependymal and basal ganglia, neoplastic) |
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Enhancement of the Meninges on CT and MRI
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LEPTOMININGEAL
Infection (TB, bacterial, fungal, syphilis, viral Lymes Disease) Tumor (mets, GBM, leukemia, lymphoma, germinoma, pinealblastoma, ependymoma, medulloblastoma LCH) DURAL Infection (skull base osteomyelitis) TRumor (meningioma, mets, lymphoma) Postoperative (craniotomy, shunt) Sarcoid RA |
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Enhancement of the Ependyma and Sub Arachnoid Space on CT and MRI
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EPENDYMA
infection tumor Sarcoid Enlarged ependymal veins Inflammatory Sub Arachnoid Space meningitis neoplasm post angiography |
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Basal Ganglia Bilateral Abnormalities
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Corpus Striatum +Caudate nucleus and Putamen
NORMAL age related change perivascular spaces VASCULAR Lacunar Infarcts Hypoxia Venous Infarction NEURODEGENERATIVE DISEASE Parkinson's Huntington's Other Extrapyramidal Disorders (multisystem atrophy, supranuclear palsy) TOXIC Exogenous (methanol, cyanide, carbon monoxide) Endogenous Kernicterus (bilirubin encepalopathy) Acquired Metabolic Disease Hypoglycemia Osmotic Myelinolysis Hemolytic Uremic Syndrome Inherited Metabolic Disease Wilsons Mitochondrial cytopathies Amino Acid Disorders Lipidoses Hallevorden Spatz OTHERS basal ganglia calcifications NF I Microabscesses cryptococcus, toxoplasmosis ADEM |
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Hyperechoic Lesions in the Basal Ganglia of Neonates and Infants
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Congenital infections
Asphyxia Hypoxia Cardiac Disease (particularlly hypoplastic L haert syndrome) Chromosomal Disorders Feta alcohol Drug Exposure Twin Twin transfusion Idiopathic |
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Thalamus Bilateral Abnormalities
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VASCULAR
lacunar infartcs arterial infarcts venous infarcts severe anoxia INFECTION variant CJD Japenese Encephalitis METABOLIC Carbon Monoxide Poisening Wernicke's Encepalopathy (thiamine deficiency, mesial thalamic nuclei, mamillary bodies mid brain and floor of the 3rd venticle show increased T2W signal Inherited Metabolic Disease |
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Inherited Metabolic Disease
(best seen on T2W images) Dysmyelination (leukodystrophies) |
Enzyme deficiencies prevent the normal formation of maintenace of myeli.They are disorders of children and presenr with variable mental retardation.
LYSOSOMAL DISORDERS Metachromatic Leukodystrophy Krabbe Leukodystrophy PEROXISOMAL DISORDERS Adrenoleukodystrophy (ALD) Zellwegers (cerebrohepatorenal) Syndrome MITOCHONDRIAL DYSFUCTION Leighs Disease MELAS (mitochondrial myopathy, encepalopathy, lactic acidosis and stroke like episodes) MERFF (myoclonus epilepsy with ragged red fibres) AMINO ACID and ORGANIC ACID METABOLIC DISODERS Canavan's Disease Maple Syrup Urine Disease OTHER Pelizaeus-Merzbacher Disease Alexander's Disease |
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Differential Diagnosis of Common Myelination Leukosdystrophies
Lack Proper Myelin |
L= Leighs
Disaese A=ALD, Alexander's C=Canavans K=Krabbe P=Pelizaeus-Merzbacher M=Metachromatic Leukodystrophy |
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Cerebral Atrophy
Diffuse |
normal aging
excessive alcohol intake severe head injury MS cerebrovascular disease Drugs (corticosteroids) encephalitis/meningitis radiation and chemotherapy |
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Cerebral Atrophy
Focal |
Infarct
hemorrhage encephalitis/meningitis trauma alzheimers disease (changes in the mesialtemporal lobes may be more pronounced) Frontotemporal Dementia Parkinson's (diffuse atrophy + atrophy of the substantia nigra Progressive Supranuclear palsy (atrophy of the midbrain (tectum) globis pallidus and frontal lobes) Pick's (severe frontal and temporal atrophy) Huntington's Disease Focal atrophy of the caudate nucleus) |
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Diffuse Cerebellar Atrophy
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normal aging
excessive alcohol intake paraneoplastic (oat cell carcinoma) Ataxia telangiectasia (olivopontocerebellar degeneration) Drugs (phenytoin) encephalitis/meningitis radiation Gluten Sensitivity Friedrich's Ataxia |
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Disorders of Neuronal Migration
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Agyria Pachgyria (poorly formed gyri and sulci
Polymicrogyria may coexist with pachygyria Lissencephaly = extreme cases with a small brain Complete lissencephaly = agyria Type I Lissencephaly small brain with few gyri smooth thicked 4 layer cortex (resembles cortex of a 13 w fetus) shallow vertical sylvian fissures (figure of eight configuration) Type II Lisencephaly (Walker-Warberg Syndrome) smoooth cortex, cerebellar hypoplasia and vermian aplasia, hydrocephalus |
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Disorders of Neuronal Migration
Polymicrogyria |
The neurons reach the cortex but are abnormally distributed. Macroscopically the surface of the brain is covered in small bumps. Localized abnormalities more common than than generalized and often involve arterial territories especially MCA. Most common loaction is the sylvian fissure.
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Disorders of Neuronal Migration
Schizencephaly |
Clefts which extend through the full cerebral mantle from the ventricle to the sab arachnoid space. Lined by heterotopic grey matter and microgyrias
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Disorders of Neuronal Migration
Heterotopic Grey Matter |
Collections of neurons in subependymal location ie at the site of germinal matrix or arrested within the white matter on the way to the cortex
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Intracranial Manifestations of Well Known Neurocutaneous Disorders
Neurofibromatosis I |
Optic glioma
non-optic glioma (tectum brainstem) plexiform neurofibroma vascular abnormalities skull (spenoid wing dysplasia, calvarial defects and dural ectasia) orbit (lisch nodules, retinal phakomas, buphthalamos and pulsatile exopthalamus, harlequin orbit |
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Intracranial Manifestations of Well Known Neurocutaneous Disorders
Neurofibromatosis II |
cranial nerve schannomas
Meningiomas Non-neoplastic choroid plexus lesion ependymomas |
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Intracranial Manifestations of Well Known Neurocutaneous Disorders
Tuberous sclerosis |
cortical tubers
subependymal nodules giant cell astrocytoma white matter lesions (disorganized collection of dysplastic cells) orbit (retinal phakoma) Vascular abnormalities *aneurysm and vessel stenosis) |
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Intracranial Manifestations of Well Known Neurocutaneous Disorders
Sturge Weber Syndrome |
cerebral atrophy (compensatory thickening of the skull
cortical calcification (tram track gyriform calcification underlying pial angioma surface enhancement ( correspond to embryonal pial angioma that persist in SWS because of hypoplasia of the cortical veins. Bilateral in 20%. Enlarged Choroid Plexus Enlarged medullary/subependymal veims (centripital shunting often by anomalous venous structure in response to an inadequate cortical venous system) Orbit bupthalamos, sclera/choroidal angioma, glaucoma |
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Intracranial Manifestations of Well Known Neurocutaneous Disorders
Von Hiippel Lindau |
Hemangioblastoma
Orbit (retinal angioma, micropthalmia +/- dystrophic calcification) Non -CNS (visceral cyst pheochromocytoma, renal cell carcinoma) |
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Intracranial Manifestations of Well Known Neurocutaneous Disorders
Osler-Weber-Rendu (Hereditary Hemorrhagic Telangiectasia) |
cerebral abscess (caused by septic emboli passing though pulmonary arteriovenous malformation
Embolic Infarcyts Vascular Abnormalities (telangeictasia,cavernoma, AVM. AVF, aneurysm and epistaxis) Non-CNS (mucutaneous and visceral telangiectasia) |
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Supratentorial Lesions in Children
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hemispheric astrocytoma
craniopharyngioma optic pathway glioma giant cell subependymal astrocytoma germ cell tumore PNET DNET Ganglioglioma (peripheral cystic tumor with mural nodule +/- calcification) choroid plexus papilloma Ependymoma (often in the frontal lobe adjacent to the frontal horn but not within the ventricular system) |
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Infratentorial Lesions in Children
(comprise 50% of pediatric cerebral tumors) |
Cerebellar Astrocytoma (25% of posterior fossa tumors Vermis 50%, hemispheres 20%, both sides 30%)
Medulloblastoma (30-40% of posterior fossa tumors, 80% in the vermis, 30% extend into the brain stem) Ependymoma (mostly in the floor of the 4th ventricle 8-15% 0f posterior fossa tumors, tumor extension through the foramona of Magendie(foramen magnum)or Luschka CP angle)) Brainstem Glioma 20-30% of posterior fossa tumors (4 subgroups i)medullary ii) pontine (most common) iii) mesencephalic iv) those associated with NF I |
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Small Pituatary Fossa
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Normal Variant
Dystrophia Myotonica (starts early adult life, ctaracts baldness, testicular atrophy, thick skull large frontal sinus) Radiotherapy as a child Hypopituatarism |
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Expanded Pituatary Fossa
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Size Normal Range height 6.5-11, length 9-16mm, breadth 9-19mm)
Elevation destruction of clinoid process Loss of Lamina Dura Para/intasella mass Raised ICP (due to dilated 3rd ventricle) Nelson Syndrome (post adrenolectomy for Cushings Syndrome) |
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J shapes sella
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Flatterened tuberculum sella with prominent sulcus chiasmaticus
Normal Otic chiasm glioma NF Achondroplasia Mucopolysachiridoses Chronic Hydrocephalus |
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Intrasella Mass
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NEOPLASTIC
Pit Microadenoma Pit Macroadenoma Meningioma Cranio Chordoma Pit met (braet most common) NON NEOPLASTIC Pit Cyst Pit hyperplasia Internal carotid aneurysm Ectatic carotid artery Rathke Cleft Cyst Lymphocytic hypophysitis LCH (more common infundibulum) Pit abscess (rare) |
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Infundibular Mass
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NEOPLASTIC
germinoma lymphoma leukemia glioma mets (breast hematogenous medulloblastoma leptomeningeal) NON NEOPLASTIC Sarcoid Lymphocytic Hypophysitis (lymphocytic infiltration of the anterior pit. occuring preganacy/post partum) LCH (with loss of pit bright spot) |
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Suprasellar Mass
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NEOPLASTIC
Pit Macroadenoma Meningioma Cranio Chiasmatic Glioma Infundibular Tumor Germinoma Hypothalamic Hamartoma NON NEOPLASTIC Aneurysm or ectatic carotid artery arachnoid cyst Epidermoid Dermoid (occurs midline fat and calcification Rathkes Cleft Cyst Lymphocytic Hypophysitis Sarcoidosis LCH |
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Cavernus Sinus/Parasellar Mass
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NEOPLASTIC
Schwannoma (trigemial can extent through foramen ovale) Meningioma Pit Adenoma Met Lymphoma Invasion by skull base tumor (Chordoma) Nasopharygeal Tumor NON NEOPLASTIC Aneurysm or ectatic carotid Carotid Cavernous fistula Invasive sinusitis Dermoid/epidermoid Sarcoid Lymphocytic hypophysitis Tolosa Hunt Syndrome opthalmaplegia casued by granulomatous infiltration of the cavernous sinus ad superior orbital fissue (steriod reponsive)) |
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Pineal Region Mass
Pineal Gland |
Benign Cyst
Germinoma (most common) Teratoma (2nd most common) Parenchymal cell tumors (present later in life Pineocytoma tend to be slow growing, Pinealoblastoma usually larger more heterogenous with greater propensity for local invasion and CNS dissemination) |
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Pineal Region Mass
Posterior Brainstem |
Glioma (tectal tumor aqueductal stenosis)
Mets Demyelination Infarct Hemorrhagic contusion Cavernoma |
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Pineal Region Mass
Posterior 3rd Ventricle |
Glioma
Mets Choroid Plexus Papilloma |
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Pineal Region Mass
Perimesephalic Cistern |
Arachnoid cyst
Dermoid Lipoma Meningioma Mets AVM Aneurysn PCA |
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Hyperdense Choroid Plexus on CT
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Calcification
Hemorrhage Hemangioma Choroid Plexus Neoplasm Aortic Obstruction in the newborn |
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Intraventricular Masses in Children
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LATERAL VENTRICLES
glioma PNET Choroid plexus papilloma choroid plexus cyst Choroid plexus enlargement (Sturge Weber, NF) Subependymoma Meningioma AVM Subependymal heterotopia Metastatic seading FORAMEN OF MUNRO subependymal giant cell astrocytoma THIRD VENTRICLE cranio glioma LCH Germinoma Choroid plexus papilloma Metastatic Seeding FOURTH VENTRICLE Medullablastoma Ependymoma Choroid plexus papilloma exophytic brain stem glioma |
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Intraventricular Masses in Adults
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LATERAL VETRICLE
GBM Oligodendroglioma Central Neurocytoma Lymphoma Mets Subependymoma Memingioma Choroid Plexus cyst/calcification Arteriovenous malformation subependymal heterotopia FORAMEN of MUNRO Colloid Cyst Subependymal giant cell astrocytoma THIRD VENTRICLE Cranio Germonoma Met Subependymoma Sarcoid FOURTH VENTRICLE mets Subependymoma Choroid plexus papilloma Inflammatory cyst (cysticercosis) hemangioblastoma |
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CP Angle Masses
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Vestibular Schwannoma
Meningioma Epidermoid Trigeminal schwannoma aneurysm mets skull based tumors skull based infection (Gradenigo's syndrome (osteomyelitis of the petrous apex) and malignant otitis externa |
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Internal Auditory Canal Abnormality
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NEOPLSTIC vestibular nerve Schwannoma
Meningioma Facial nerve schannoma (arises geniculate ganglion) Mets Hemangioma Lipoma NON NEOPLASTIC Bell's Palsey Postoperative Sarcoid LCH |
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Middle Ear Mass
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INFLAMMATORY
Acquired cholesteatoma (a slowly expanding mas of epithelial debris originating in the middle ear Acute otitis media malignant otitis externa cholesterol granuloma (non-specific chronic inflammation of the middle ear and mastoid (ossicles may be eroded)) NEOPLASTIC glomus tympanicum glomus jugulare facial nerve schwannoma temporal bone mass Vascular aberrant internal carotid artery dehiscent jugular bulb serous otitis media (sterile fluid fills the middle ear, middle ear is typically intact however ossicles may be eroded) Middle Era effusion ( obstruction of the Eustacian tube nasopharyngeal carcinoma) Tympanosclerosis (deposits of fibrotic often calcified tissue in the middlew ear mass aroud the ossicular chain ankylosising |
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Temporal Bone mass
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NEOPLASTIC
glomus mningioma mets myeloma 'lymphoma nasopharyngeal carcinoma carcinoma of the external auditory canal Ca Parotid gland rhabdomyosarcoma (most common soft tissue sarcoma in children) chondrosarcoma (centered on petroclival suture) chordoma NON NEOPLASTIC cholesteatoma cholesterol granuloma apical petrositis aneurysm LCH |
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Temporal Bone Sclerosis
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Otosclerosis
Paget's Disease Fibrous Dysplasia Osteopetrosis Meningioma |
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Pulsatile Tinnitis
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ANATOMOICAL VARIANTS
Large/dehiscent jugular bulb Intratympanic course of the ICA Persistent stapedial artery VASCULAR Dural Arteriovenous fistula Aneurysm of the petrous carotid Venous thrombosis Arterial Stenosis NEOPLASTIC paraganglioma (glomus jugulare tympanicum) |
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Jugular Foramen Mass
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NEOPLASTIC
glomus jugulare schwannoma direct invasion NPC mets meningioma chondrosarcoma LCH lymphoma NON NEOPLASTIC Normal jugular bulb Venous thrombosis skull base osteomyelitis |
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Foramen Mgnum Mass
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INTRINSIC CERVICOMEDULLARY LESION
glioma ependymoma demyelination syrinx ANTERIOR INTRADURAL aneurysm meningioma schwannoma POSTERIOR INTRADURAL chiari malformation secondary tonsillar descent ependymoma medulloblastoma EXTRADURAL inflammatory arthropathies RA Skull based tumor chordoma, met, myeloma glomus Osteomyelitis |
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Diffuse Skull Based Abnormality
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NEOPLASTIC
mets (breast bronchus, prostate) 4 clinical syndromes i) orbital syndrome ii)parasellar and middle fossa syndrome iii) jugular foramen syndrome iv) occipital condyle syndrome) myeloma'NPC lymphoma meningioma rhabdomyosarcoma NON NEOPLASTIC fibrous dysplasia Pagets Disease Osteomyelitis LCH renal osteodystrophy hemaglobinopathy |
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Skull vault Lucency with No Surrounding Sclerosis
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NORMAL
parietal foramina venous lakes and vascular channels pachonian granulations Frontal temporal, occipital lucencies prominent digital markings fontanelles NEOPLASTIC ADULT Myeloma Mets Pagets sarcoma NEOPLASTIC CHILDREN mets LCH TRAUMATIC leptomeningeal cyst Burr hole METABOLIC HPT osteoporosis INFECTIVE pyogenic TB hydatid syphilis (moth eaten) VASCULAR hemangioma sinus pericranii Others osteoporosis circumscripta neurofibroma intradiploic arachnoid cyst |
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Skull Vault Lecency with Sclerosis
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Fibrous Dysplasia
DEVELOPMENTAL epidermoid encephaloce3le/meningocele NEOPLASTIC hemangioma LCH INFECTIVE chronic osteomyelitis frontal sinus mucocele |
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Generalized Incraese in Vault Density
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Pagets Disease
sclerotic mets (breast prostate) fibrous dysplasia myelofibrosis renal osteodystrophy fluorosis acromegaly phenytoin chronic hemolytic anemia sclerosing bone dysplasias (osteopetrosis, pyknodysostosis, Pyles Disaese (metaphyseal splaying of the long bones)) |
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Localized Increase in Skull Vault Density
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Within bone
tumor (osteoma, treated lytic mets, treated brown's tumor) paget's dx hyperostosis frontalis interna Adjacent to bone meningioma clacified cephalohematoma hair braids calcified sebaceous cyst fibrous dysplasia depressed boe fragment |
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Thick Skull
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Generalized
normal variant phenytoin microcephaly shunted hydrocephalus acromegaly extramedullary hematopoiesis Focal normal variant Paget's hyperostosis frontalis interna fibrous dysplasia meningioma osteoma mets |
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Thin Skull
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Genralized
HPT Osteogenesis Imperfecta Rickets Raised ICP Lacunar skull ((luckenschadel) bone dysplasia of the membranous skull. Deep indentations or pits in the frontal or parietal regions that may traverse the full thickness of the skull. The defects are seperated by thin rims of bone that have sharp edges creating a 'soap bubble' appearance) Cushings Disease Focal Normal variants Osteoporosis Circumscripta Arachnoid cyst slow growing cortical tumor large intracranial cyst (arachnoid and porencephalic cysts) |
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Multiple Wormian Bones
(intrasutural ossicles common in infancy) PORK CHOPS I |
pyknodysostosis
osteogenesi imperfecta rickets kinky hair (menkes) syndrome cleidocranial dysostosishypophosphatasia/hypothyroidism Otopalatodigital syndrome primary acroosteolysis (hadju/cheney) Pachydermoperiosttitis Progeria Syndrome of Down Idiopathic |
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Primary Craniosynostosis
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Sagital synostosis=scaphocephaly (elongated boat shape)
Unilateral coronal synostosis Bilateral coronal synostosis Metopic synostosis Unilateral lamdoid synostosis Bilateral lamdoid synostosisCloverleaf Skull (trilobed skull) kleeblattscheidel |
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Secondary Craniosynostosis
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Metabolic rickets, hypeparathyroidism, hypophosphotasia
inborn errors of metabolism hematologicla disease brain malformation (holoprosencephaly, microcephaly Iatrogenic (shunted hydrocephalus) |
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Bsilar Invagination
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primary developmental/segmental abnormality (Klippel Feil syndrome)
Rickets / Osteomalacia Paget's Dx Fibrous Dysplasia Osteogenesis imperfecta |
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Platybasia
flattened skull base |
Rickets / Osteomalacia
Paget's Dx Fibrous Dysplasia Osteogenesis imperfecta HPT |
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'HAIR ON END' Skull Vault
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hemolytic anemia
sickle cell anemia thalassaemia others Neoplastic hemangioma meningioma mets Others cyanotic heart disease iron deficiency anemia |
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Signal Void on T2W MRI
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Normal
normal arterial and venous flow densly packed bone (temporal bone is composed of air cells dense bone-emits no signal CSF filled membranous labyrinth is highlighted) dural calcification (dense calcificaion of the falx may present as an area of T2 void) AIR CSF flow Pathological anuerysms AVM Acute hemorrhage (deoxyhemaglobin) Chronic hemorrhage (hemosiderin deposition) |
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High Signal on T1W MRI
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Normal
posterior lobe of the pituitary mnoving structures(dural venous sinuses, moving CSF may have the same effect) Ossification of the falx Cacification of the basal ganglia Rathkes clet cyst Fat Pathalogical hemorrhage (methemoglobin in 'subacute' hematomas thrombus fat (lipoma, dermoids) Proteinaceous fluid craniopharyngioma, colloid cyst melanin (melanoma, neurocutaneous melanosis) heavy metals manganese in total parenteral nutrition) |