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107 Cards in this Set
- Front
- Back
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Persistent embyronic ICA to vertebrobasilar connections
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trigeminal (#1), hypoglossal, otic, proatlantic artery
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Intraaxial hemorrhage
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HTN (#1), tumor, trauma, AVM, aneurysm, coagulopathy, amyloid angiopathy, emboli, hemorrhagic infarction, vasculitis, HTN encephalopathy (eclampsia, cyclosporine)
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Aneurysm
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saccular – degenerative, trauma, mycotic, vasculopathies; fusiform – atherosclerotic; dissecting – trauma > vasculopathy > spontaneous
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SAH
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aneurysm (#1), trauma, AVM, coagulopathy, extension of intraparenchymal bleed, idiopathic, spinal AVM
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Vascular malformations
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AVM, capillary telangiectasia, cavernous malformation, venous anomaly, vein of Galen AVM or varix
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Stroke
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atherosclerosis, cardiac emboli, arterial dissection, vasculopathy, IVDA, venous thrombosis, blood dyscrasias
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Venous sinus thrombosis
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pregnancy, dehydration, infection, tumor, hypercoagulable state, trauma
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Primary brain injury
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epidural hematoma, SDH, subdural hygroma, DAI, cortical contusion
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Secondary brain injury
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cerebral herniation, diffuse cerebral edema, arterial dissection (spontaneous, trauma, HTN, vasculopathy, migraine, IVDA), CCF
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Extraaxial masses
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hemisphere – meningioma, mets, lymphoma, arachnoid cyst, dermoid/epidermoid, hemorrhagic or infectious fluid collections, hemangiopericytoma; clivus/prepontine cistern – meningioma, mets, chordoma, chondrosarcoma; CPA mass – acoustic neuroma, meningioma, mets, epidermoid, petrous apex cholesterol granuloma, paraganglioma, aneurysm, arachnoid cyst
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Intraaxial masses
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hemisphere – astrocytoma, GBM, oligodendroglioma, lymphoma, mets, PNET, ganglioglioma, DNET; sella – adenoma, craniopharyngioma, Rathke’s cyst, mets, abscess, sarcoid, EG stalk; brainstem – astrocytoma, GBM; pineal region – germinoma, teratoma, pineocytoma, pineoblastoma; cerebellum – astrocytoma, medulloblastoma, hemangioblastoma, mets, ependymoma, choroid plexus papilloma; temporal lobe in young patient – ganglioglioma, DNET, JPA, PXA
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Multiple lesions
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tumor – mets, GBM, lymphoma; infection – abscess, fungus, cysticercosis, toxoplasmosis; vascular – embolic infarctions, multifocal hemorrhage, DAI, contusions, cavernous hemangiomas, vasculitis
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Corpus callosum lesions
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tumors – GBM, lymphoma, lipoma, mets (rare); demyelinating – MS, ADEM, PML; infarct – always also involves cingulate gyrus; trauma - DAI
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Intrasellar masses
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pituitary adenoma, apoplexy, craniopharyngioma, Rathke’s cyst, mets, aneurysm, abscess
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Suprasellar masses
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SATCHMOE – sellar lesion extending superiorly, sarcoid, aneurysm, arachnoid cyst, teratoma, craniopharyngioma, hypothalamic glioma, mets, meningioma, optic nerve glioma, EG, epidermoid/dermoid; adults – macroadenoma (#1), meningioma, glioma, craniopharyngioma, aneurysm; children – craniopharyngioma (#1), glioma, germinoma, hypothalamic hamartoma, EG
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Posterior fossa tumors
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adults – mets, hemangioblastoma, astrocytoma, choroid plexus papilloma, meningioma, epidermoid, dysplastic gangliocytoma; children -–JPA, medulloblastoma, brainstem glioma, ependymoma
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Brain tumor in infant
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teratoma (#1), PNET, choroid plexus papilloma, astrocytoma
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Intraventricular tumors
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adults – astrocytoma, subependymoma, meningioma, mets, cysticercosis; children – choroid plexus papilloma, ependymoma, medulloblastoma, teratoma, astrocytoma; lateral ventricle – PNET, choroid plexus papilloma, glioma, JPA, subependymoma, astrocytoma, mets, oligodendroglioma, meningioma, central neurocytoma; 3rd ventricle – astrocytoma, EG stalk, germinoma, extrinsic craniopharyngioma, colloid cyst, glioma, mets, pituitary or pineal mass, aneurysm, sarcoid; 4th ventricle – ependymoma, medulloblastoma, choroid plexus papilloma, mets, hemangioblastoma, subependymoma
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CPA mass
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acoustic neuroma (#1), meningioma, epidermoid, arachnoid cyst, mets, ependymoma through Luschka, lipoma
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Cystic mass
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tumor – cystic astrocytoma/GBM, hemangioblastoma, mets, necrotic pituitary adenoma, craniopharyngioma; benign – epidermoid/dermoid, arachnoid cyst, porencephalic cyst, colloid cyst, cavum variants, Rathke’s cyst, thrombosed aneurysm
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Diffuse infiltrative
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lymphoma, gliomatosis cerebri, white matter disease
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Restricted diffusion
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infarct, infection, possibly subacute hemorrhage
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Metastasis
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intraaxial – lung, breast, colon, melanoma; extraaxial – breast, lymphoma, prostate, neuroblastoma; hemorrhagic – melanoma, renal, chorioCA, thyroid
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Tumors with CSF seeding
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choroid plexus papilloma, ependymoma, PNET (medulloblastoma), piineoblastoma, germinoma, GBM
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Hyperdense lesion on CT
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lymphoma, medulloblastoma/PNET, ependymoma, germinoma, GBM, hemorrhagic mets, mucinous mets, osteogenic tumor, hemorrhage, meningioma, colloid cyst, aneurysm
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Calcified intraparenchymal lesions
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oligodendroglioma, ependymoma, mucinous adenoCA, osteogenic sarcoma, toxoplasmosis, CMV, cysticercosis, TB, AVM, aneurysm, TS, Sturge-Weber, hematoma; sellar lesions – meningioma, craniopharyngioma, germ cell tumor, aneurysm
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T2 hypointense lesions
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ferritin, hemosiderin, deoxyhemoglobin, intracellular methemoglobin, melanin, calcification, lymphoma, myeloma, neuroblastoma, fibrous tissue (meningioma), high protein concentration, flow void
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T1 hyperintense lesions
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Gd, methemoglobin, melanin, certain states of calcium, fat (dermoid), high protein concentration (colloid cyst), slow flow
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Lesions with no enhancement
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cysts, tumors with intact BBB (low-grade gliomas)
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Lesions with strong enhancement
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meningioma, medulloblastoma/PNET, AVM, paraganglioma, aneurysm, HIV-associated lymphoma, GBM
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Ring enhancement
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mets, abscess, GBM, infarct, contusion, AIDS, lymphoma, demyelinating, resolving hematoma, radiation
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Diffuse meningeal enhancement
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meningitis, carcinomatosis (lymphoma, mets), post-op, SAH, intracranial hypotension, CSF leak
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Basilar meningeal enhancement
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infection - TB (#1), fungal, pyogenic (more common on convexity), cysticercosis; tumor – lymphoma, leukemia, carcinomatosis; inflammatory – sarcoid, rheumatoid pachymeningitis, drugs, pantopaque, ruptured dermoid
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Ependymal enhancement
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tumor – lymphoma, mets, CSF seeding (PNET, GBM); infection – spread of meningitis, CMV (rare); inflammatory ventriculitis – postshunt or after instrumentation, posthemorrhage
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T2 hypointense basal ganglia lesions
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old age, any chronic degenerative disease (MS, Parkinson’s), childhood hypoxia
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T2 hyperintense basal ganglia lesions
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tumor – lymphoma, NF; ischemia – hypoxic encephalopathy, venous infarction; neurodegenerative diseases (uncommon), Leigh’s dz; toxin – CO, CN, H2S poisoning, hypoglycemia, methanol; infection – Cryptococcus, parasites
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T1 hyperintense basal ganglia lesions
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dystrophic calcifications (any cause), hepatic failure, NF, manganese
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Basal ganglia calcification
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physiologic (#1), hypoparathyroid, HPT, TORCH, AIDS, TB, toxoplasmosis, cysticercosis (common), lead, CO, radiation, chemotherapy, Fahr’s disease, mitochondrial (common), ischemic-hypoxic injury
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White matter disease
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demyelinating (MS, ADEM, CPM), dysmyelinating (leukodystrophies), tumor (lymphoma, mets) vasculopathies (small vessel ischemic dz, vasculitis, HTN, eclampsia, migraines, radiation, chemotherapy, cyclosporine, IVDA), inflammatory (Lyme, sarcoid, HIV, PML, CMV)
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Wallerian degeneration
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infarction, trauma, demyelinating, radiation, neurodegenerative, tumor
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Neurodegenerative disorders
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WM – demyelinating, dysmyelinating; GM – Alzheimer’s, Pick’s, multiinfarct dementia, Parkinson’s, lysosomal storage disorders, Wernicke’s, Creutzfeldt-Jakob, mesial temporal sclerosis; BG – Huntington’s, Wilson’s, Fahr’s, Leigh’s, ALS
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Cerebellar atrophy
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oligopontocerebellar degeneration, alcohol, dilantin, hemosiderin deposition
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Noncommunicating hydrocephalus
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Foramen of Monro obstruction – 3rd ventricle tumors, colloid cyst, oligodendroglioma, central neurocytoma, giant cell astrocytoma in TS, ependymoma, suprasellar tumors; aqueduct obstruction – congenital aqueductal stenosis, ventriculitis, IVH, tumor (mesencephalic, pineal, posterior 3rd ventricle region); 4th ventricle obstruction – DW malformation, IVH, infection, subependymoma, exophytic brainstem glioma, posterior fossa tumors
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Communicating hydrocephalus
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meningitis (infectious, carcinomatous), SAH, surgery, venous thrombosis; NPH
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Cystic supratentorial congenital anomalies
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holoprosencephaly, hydrancephaly, aqueductal stenosis, callosal dysgenesis, porencephaly, arachnoid cyst, cystic teratoma, epidermoid/dermoid, vein of Galen AVM
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Posterior fossa cystic abnormalities
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DW malformation (vermian hypoplasia/aplasia and large posterior fossa), DW variant (normal size posterior fossa and vermian hypoplasia), megacisterna magna (normal vermis), retrocerebellar arachnoid cyst (must show mass effect), Chiari 4 (near complete absence of cerebellum), epidermoid/dermoid, cystic tumor, Joubert’s syndrome (superior vermian hypoplasia/aplasia), rhomboencephalosynapsis (vermian hypoplasia/aplasia + fusion)
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Absent septum pellucidum
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holoprosencephaly, ACC, septooptic dysplasia, Chiari 2
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Migration and sulcation anomalies
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lissencephaly, schizencephaly, polymicrogyria, pachygyria, cortical heterotopia (focal, diffuse, subependymal), hemimegalencephaly
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Phakomatoses
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NF, TS, VHL, Sturge-Weber
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Diffuse marrow involvement
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mets, myeloma, lymphoma, leukemia, anemia, Paget’s, FD
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Spinal cord compression
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criteria – no CSF seen around cord, narrowed AP diameter of cord (<7mm), deformity of cord; causes – infection (TB, pyogenic), compression fracture (CA, trauma), spondylosis and disk disease (herniated nucleus, hypertrophy of ligaments, osteophyte, facet hypertrophy), primary bone disorders (Paget’s), epidural hematoma
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Intramedullary lesions
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astrocytoma (#1), ependymoma (#2), hemangioblastoma, lymphoma, mets (rare), demyelinating disease/myelitis, syrinx, AVM, trauma (contusion), radiation, sarcoid, infection (rare), infarction
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Intradural extramedullary lesions
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nerve sheath tumor (#1), meningioma, drop mets, lipoma, teratomatous lesion, arachnoid cyst, arachnoiditis/meningitis, AVM/AVF, ependymoma, sequestered disc fragment, lymphoma, sarcoid, pantopaque
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Extradural lesions
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disc disease, mets, lymphoma, epidural abscess, epidural hematoma, lipomatosis (thoracic), synovial cyst, extramedullary hematopoiesis, Tarlov cyst, discitis/osteomyelitis, spondylolysis, RA
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Syrinx
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primary – Chiari malformations, spinal dysraphism, DW, diastematomyelia; acquired – tumor (astrocytoma, ependymoma), trauma (spinal cord injury, vascular insult), inflammatory (arachnoiditis/meningitis, SAH)
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External auditory canal
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exostoses, malignant otitis externa, atresia
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Clivus mass
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chordoma, chondrosarcoma, plasmacytoma, mets, lymphoma, FD, EG
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Petrous apex mass
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cholesterol granuloma, mucocele, petrous apicitis, epidermoid, mets, myeloma, chondrosarcoma, meningioma, aneurysm
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Soft tissue mass in middle ear
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cholesteatoma, cholesterol granuloma, glomus tympanicum tumor, aberrant ICA, high or dehiscent jugular bulb
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Intracanalicular IAC masses
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exclusively intracanalicular – acoustic neuroma, facial neuroma, hemangioma, lipoma; not primarily intracanalicular – meningioma, epidermoid
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Hearing loss
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conductive – otitis media, cholesteatoma, otosclerosis, trauma (longitudinal fracture); sensorineural – idiopathic hereditary, acoustic neuroma, trauma (transverse fracture)
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Pulsatile tinnitus
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aberrant ICA, jugular bulb anomalies, glomus jugulare, glomus tympanicum, AVM, ICA aneurysm at petrous apex
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Jugular fossa mass
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glomus jugulare (#1), NF (#2), schwannoma, chondrosarcoma, mets
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Orbital masses by etiology
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tumors – hemangioma (adults
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Extraconal disease
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nasal disease – infection, neoplasm; orbital bone disease – subperiosteal abscess, osteomyelitis, FD, tumors, trauma; sinus disease – mucocele, invasive infections, neoplasm; lacrimal gland disease – adenitis, lymphoma, pseudotumor, tumor
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Intraconal disease
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well-defined margins – hemangioma, schwannoma, orbital varix, meningioma; ill-defined margins – pseudotumor, infection, lymphoma, mets; muscle enlargement – pseudotumor, Graves’, myositis, carotid-cavernous fistula
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Vascular orbital lesions
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tumor – hemangioma, lymphangioma, hemangioendothelioma, hemangiopericytoma, meningioma, hypervascular mets; vascular (with enlarged superior ophthalmic vein) – carotid cavernous fistula, cavernous thrombosis, orbital varix, ophthalmic artery aneurysm
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Optic neuritis
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abnormal T2 signal and enhancement but not enlarged – MS, sarcoid, infection
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Optic neuropathy
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abnormal T2 signal only – compression, ischemia, pharmacologic, toxins, trauma
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Optic nerve tumor
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abnormal T2 signal and enhancement and nerve enlarged – glioma, meningioma
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Optic nerve sheath enlargement
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tumor – optic nerve glioma, meningioma, meningeal carcinomatosis, mets, lymphoma, leukemia; inflammatory – optic neuritis, pseudotumor, sarcoid; increased intracranial pressure; trauma – hematoma
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Tramtrack enhancement of orbital nerve
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optic nerve meningioma, optic neuritis, idiopathic, pseudotumor, sarcoid, lymphoma, leukemia, perioptic hemorrhage, mets, normal variant
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Ocular muscle enlargement
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thyroid ophthalmopathy (#1, painless), pseudotumor (painful), infection from adjacent sinus, TB, sarcoid, carotid cavernous fistula, hemorrhage, tumor
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Childhood orbital masses
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retinoblastoma, rhabdomyosarcoma, optic nerve glioma, lymphoma, leukemia, hemangioma, lymphangioma, dermoid, neuroblastoma
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Adult orbital masses
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hemangioma, schwannoma, melanoma, meningioma, lymphoma, pseudotumor, trauma
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Cystic orbital lesions
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dermoid, epidermoid, teratoma, ABC, cholesterol granuloma, colobomatous cyst
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T1 hyperintense orbital masses
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tumor – melanoma, retinoblastoma, choroidal mets, hemangioma; detachment – Coat’s disease, persistent hyperplastic primary vitreous, trauma; other – hemorrhage, phthisis bulbi
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Globe calcifications
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tumor – retinoblastoma (95%), astrocytic hamartoma (TS, NF), choroidal osteoma; infection (chorioretinitis) – toxoplasmosis, herpes, CMV, rubella; other – phthisis bulbi (calcification in endstage disease, shrunken bulb), optic nerve drusen (most common cause of calcifications in adults, bilateral)
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Micropthalmia
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persistent hyperplastic primary vitreous, retinopathy of prematurity, congenital rubella, phthisis bulbi
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Sudden onset proptosis
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orbital varix, hemorrhage into cavernous hemangioma or lymphangioma, CCF, thrombosis of superior orbital vein
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Lacrimal gland enlargement
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benign lymphoid hyperplasia, pseudotumor, sarcoid, Sjogren syndrome, pleomorphic adenoma, adenoid cystic CA, lymphoma, leukemia, dacryoadenitis
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Diffuse bone abnormality
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FD, Paget’s, thalassemia, osteopetrosis, craniometaphyseal dysplasia, mets
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Radioopaque sinus
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normal variant – hypoplasia, unilateral thick bone; sinusitis (acute
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Mucosal space mass
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SCC, lymphoma, rhabdomyosarcoma, melanoma, adenoids, juvenile angiofibroma, Thornwald’s cyst
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Parapharyngeal and carotid space masses
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salivary gland tumors (80% benign), vagal schwannoma, cervical sympathetic plexus schwannoma, glomus vagale, nasopharyngeal CA, lymphadenopathy, abscess, cellulitis
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Prevertebral mass
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mets, chordoma, osteomyelitis, abscess, hematoma
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Sublingual space mass
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lymphangioma, ranula, hemangioma, lingual thyroid, inflammatory
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Simultaneous sublingual and submandibular space mass
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diving ranula, lymphangioma, abscess
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Post-styloid parapharyngeal mass
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salivary tissue, nerves, nodes, glomus tumor
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Prestyloid parapharyngeal mass
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pleomorphic adenoma, Warthin’s, mucoepidermoid, adenoid cystic, branchial cleft cyst, neurogenic tumor, hemangioma, node
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Bilateral parotid low attenuation lesions
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HIV lymphoepithelial cysts, Sjogren’s, Warthin’s tumor, infection
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Enlarged parotids
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obesity, DM, alcohol, cirrhosis, malnutrition, drugs
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Sialoliths
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sarcoid, Sjogren’s, HPT
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Cystic extrathyroid lesions
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neck – branchial cleft cyst (lat to carotid), thyroglossal duct cyst (midline mass), ranula (retention cyst of sublingual glands), retention cysts of mucous glands (parotid), cystic hygroma (lymphangioma, most common < 2y/o); nasooropharnyx – Thornwald’s cyst, mucus retention cyst, necrotic SCC; larynx, paralaryngeal space – laryngocele, mucus retention cyst
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Cystic thyroid lesions
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colloid cyst, cystic degeneration, cystic papillary tumor, cystic mets
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Bilateral thyroid masses
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lymphoma, mets (RCC, lung), multiple primary tumors, MNG, thyroiditis, cysts
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Neck lymphadenopathy
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enlarged Waldeyer’s ring – lymphoma, mononucleosis, HIV; skin lesions – KS, sarcoid, lymphoma, CA, cat-scratch, TB, Actinomycosis; enlarged nodular salivary glands – HIV, Sjogren, sarcoid, lymphoma, cat-scratch; calcified – thyroid CA, treated lymphoma, sarcoid, silicosis, TB
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Solid neck mass
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SCC of larynx or nasooropharynx, lymphadenopathy, parotid tumor, neurofibroma, glomus tumor, dermoid, teratoma, infection, granulomatous inflammation, ectopic thyroid
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Vascular head and neck mass
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glomus tumor – carotid body, vagale, jugulare, tympanicum; hemangioma; AVM; aneurysm (often ICA) – pseudoaneurysm, posttraumatic
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Vocal cord paralysis
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tumor, post-op, iatrogenic, idiopathic
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AIDS
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ENT complications in 50%; parotid – multiple intraparotid cystic masses (benign lymphoepithelial lesion), lymphadenopathy; sinonasal – sinusitis, KS; oral cavity – Candida, periodontal an gingival infections; pharynx/larynx – opportunistic infections, epiglottitis, lymphoma; temporal bone (rare) – otitis media, otitis externa
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Odontogenic
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cysts, ameloblastoma, odontogenic carcinoma or sarcoma; nonodontogenic – osteosarcoma, chondrosarcoma, Ewing’s, myeloma
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Chiari I
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Low tonsils.
Small fourth ventricle. Hydromyelia. Klippel feil. Occipitalization of the atlas. |
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Chiari II
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Myelomeningocele.
Low tentorium. Medullary kink. Hydrocephalus. Beaked tectum. Corpus callosum agenesis. Polymicrogyria. Syringomyelia. Lacunar skull. |
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Chiari III
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Cervical occipital encephalocele that contains cerebellum.
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Chiari IV
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Severe cerebellar hypoplasia.
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Holoprosencephalies
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Failure to separate into hemispheres. Alobar: complete failure, no falx, single mono-ventricle, fused thalami. Semi lobar: Partial separation of the posterior occipital and temporal lobes. Frontal brain is fused, thalami partially fused. Ace of spades configuration of the ventricles. Lobar: fusion of only anterior inferior frontal lobes so no faux in that location. Otherwise the brain appears to be quite normal except for lack of septum pellucidum. Septal optic dysplasia: most mild form in which there is no septum pellucidum and the optic nerves are very atrophic. Schizencephaly may be present in fifty percent of these cases. Corpus callosum agenesis may also be seen with this entity.
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