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108 Cards in this Set
- Front
- Back
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LESIONS OF CORPUS CALLOSUM
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lymphoma
glioblastoma shear injury infarct encephalitis metabolic |
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PERIVENTRICULAR WHITE MATTER LESIONS
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vasculopathies
htn, migraines, small vessel ischemic dz, vasculitis demyelinating dz inflammatory lyme dz, sarcoid |
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HEMANGIOBLASTOMA VS
JPA |
hemangioblastomas often have flow voids from large vessels around nodular component
assoc. w/ VHL |
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MOST COMMON LOCATION FOR CHOROID PLEXUS PAPILLOMA
in adults in children |
adults-- fourth ventricle
children-- atrium of lateral ventricle |
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MOST COMMON LOCATION OF INTRAVENTRICULAR MENINGIOMA IN ADULTS
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choroid plexus of atrium of lateral ventricle
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CONDITIONS ASSOCIATED W/ MULTIPLE MENINGIOMAS
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NF 2
prior radiation basal cell nevus syndrome |
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MICROANEURYSMS OF DEEP PENETRATING VESSELS
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Charcot-Bouchard aneurysms
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CAUSES OF COMMUNICATING HYDROCEPHALUS
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meningitis
ventriculitis SAH carcinomatous meningitis |
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OPTIC NERVE MASS
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tumor
meningioma glioma mets schwannoma inflammatory optic neuritis TB/syphilis sarcoid pseudotumor |
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OCCULAR LESIONS ASSOCIATED w/ CALCIFICATION
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retinoblastoma
astrocytic hamartoma choroidal osteoma other causes calcification of globe: infxn (toxo, CMW) trauma hypercalcemia congenital (Sturge-Weber VHL, retrolental fibroplasia, Coat's dz, persistent hyperplastic primary vitreous) |
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VASCULAR CAUSES OF ENLARGEMENT OF EXTRAOCCULAR MUSCLES
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CC fistula
thrombosis of superior ophthalmic vein cavernous sinus thrombosis AVM |
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COMMON EXTRAOCCULAR MUSCLES INVOLVED IN THYROID OPHTHALMOPATHY
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all of them or inferior and medial rectus muscles only
isolated involvement of LR is rare (consider another diagnosis) |
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CRANIOSYNOSTOSIS--types
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DOLICOCEPHALY (large AP diameter)
closure of saggital suture PLAGIOCEPHALY closure of single coronal or lambdoid suture Harlequin eye BRACHYCEPHALY closure of both coronal sutures TRIGONOCEPHALY: closure of metopic suture |
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PROCESSES AFFECTING BASILAR CISTERNS
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INFECTION
TB, syphilis crytpococcus INFLAMMATORY sarcoid chemical meningitis TUMOR lymphoma leptomeningeal spread of tumor (mets, primary brain) |
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PRIMARY TUMORS w/ LEPTOMENINGEAL SEEDING
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PNET (medulloblastoma, pineoblastoma)
Germinoma, GBM, Oligo, CPP |
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WELL DEFINED BRAIN NEOPLASMS
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ganglioglioma
DNET PXA JPA low grade astrocytoma |
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MULTIPLE SUPERFICIAL (GREY/WHITE JTN) BRAIN LESIONS
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Tumor
mets Infectious septic emboli abscesses cysticercosis (pork tapeworm) |
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PATTERNS OF CYSTICERCOSIS
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1. Parenchymal pattern
2. Intraventricular pattern 3. Subarachnoid pattern |
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HYPERDENSE SELLAR MASSES ON CT
CALCIFIED SELLAR MASSES |
HYPERDENSE MASSES
Hemorrhagic pit adenoma meningioma aneurysm craniopharyngioma germ cell tumor aneurysm CALCIFIED MASSES craniopharyngioma meningioma germ cell tumor aneurysm |
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ENHANCEMENT PATTERNS OF LYMPHOMA IN AIDS
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can have spectrum of enhancement
single mass / multiple masses solid enhancement ring enhancement |
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OBSTRUCTION AT AQUEDUCT
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aqueductal stenosis
clot/adhesions from prior SAH/infection tumors tectal gliomas pineal tumors cerebellar neoplasms occult vascular malformations |
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TOXIC EXPOSURES AFFECTING GLOBUS PALLIDUS
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Carbon monoxide
cyanide manganese (hypodensity on CT, hyperintensity on T2) -- anoxia |
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CYSTIC MASS SELLA
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rathke's cleft cyst (usually center of gland)
cranio hemorrhagic pituitary adenoma |
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WHITE MATTER T2 HYPERINTENSITY, PT w/ HIV
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demyelination d/t infxn (HIV or CMV) (tends to be symmetric)
CMV/HIV encephalitis PML (bilateral, asymmetric) Lymphoma |
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CAVERNOUS SINUS MASS
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lymphoma / mets / plasmacytoma
meningioma / schwannoma / pit adenoma cavernous sinus thrombosis Tolosa-Hunt (pseudotumor) sarcoid *note neoplasms can spread to foramen ovale / perineural spread along V3 |
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NEOPLASTIC PROCESSES HYPOINTENSE ON T2
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lymphoma
meningioma plasmacytoma schwannoma sarcoid |
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MULTIPLE FOCI OF SUSCEPTIBILITY
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amyloid
multiple cavernomas hemorrhagic mets melanoma mets old hemorrhage (HTN, DAI, XRT) |
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PINEAL TUMORS
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often present w/ Parinaud's syndrome (paresis of upward gaze)
1. germ cell tumors -male > female -children 2. pineal cell tumors (cytoma/blastoma) -pineocytomas--adults -pineoblastomas--children ddx in pineal region in adult meningioma, glioma calcification in pineal in children |
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DIFFUSE AXONAL INJURY
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common locations of injury
anterior frontal and temporal lobes corpus callosum (posterior body/splenium) dorsolateral brain stem (midbrain/pons) can be associated w/ parenchymal or intraventricular hemorrhage |
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HIGH T2 LESIONS IN TEMPORAL LOBES
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herpes encephalitis
(usu bilateral, asymmetric) gyral enhancement primary neoplasm ischemia |
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SUBEPENDYMAL LESIONS
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gray matter heterotopia
tubers do not follow gray on all seqs often calcified mets enhance |
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TECTAL LESIONS
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intrinsic
glioma (solid or cystic mass, can show solid or no enhancement) extrinsic pineal tumors vein of Galen AVM demyelinating trauma congenital (Chiari II) |
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BEADING OF INTRACRANIAL CAROTID, POSSIBLE SMALL ANEURYSMS
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fibromuscular dysplasia
proximal 2cm of internal carotid usually spared |
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DDX SEGMENTAL NARROWING OF CEREBRAL VESSELS
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vasculitis
atherosclerosis vasospasm lymphoma (rarely) |
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DDX HEMORRHAGIC LESIONS IN BRAIN
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tumor (primary, mets)
coagulopathy trauma amyloid vasculitis HTN AVM infection infarct drugs pregnancy |
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VASCULITIS IN BRAIN
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infxs:
TB, syphilis noninfxs: periarteritis nodosa sarcoidosis Wegener's lupus rheumatoid Drugs cocaine, amphet normal angiogram does not exclude vasculitis |
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PCOM INFUNDIBULUM CRITERIA
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1. <3mm
2. triangular or funnel shaped 3. PCOM arises from apex |
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EPIDERMOID CYST TYPICAL CHARACTERISTICS
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insinuates around vessels
brighter than CSF on T2 heterogenous on T2 No enhancement Lobulated contour |
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Wallenberg's Syndrome
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lateral medullary syndrome
loss of pain and temperature on contralateral body and ipsilateral face |
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HIGH SIGNAL T1 BASAL GANGLIA
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likely d/t manganese
liver failure hyperalimentation portosystemic shunting abnormal ca/phos metab NF1 (focal lesions) |
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LOW SIGNAL FROM IRON IN GLOBUS PALLIDUS
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Hallervorden-Spatz syndrome
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NF 1 -- AT RISK FOR THESE TUMORS
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most common in CNS: optic glioma
neurofibrosarcoma (degen of neurofibroma) JPA leukemia lymphoma medullary thyroid CA pheochromocytoma melanoma Wilms' tumor |
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MOST COMMON CNS TUMOR IN NF-1
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optic nerve glioma
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2 TYPES OF CAROTID-CAVERNOUS VASCULAR MALFORMATIONS
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1. Direct:
-CC fistula 2. Indirect: -CC dural AVF: shunt between meningeal branches of internal/external carotid aa and cavernous sinus tx: direct: transarterial coils indirect: transvenous embolization |
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WHITE MATTER DZ IN HIV
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HIV encephalitis (may be deep gray involvement)
PML CMV infection lymphoma |
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GENERAL DDX FOR HYPERINTENSE ON T1
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fat
protein methemoglobin manganese some calcium cholesterol pantopaque melanin |
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CAUSES OF PRES PATTERN
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malignant HTN
pregnancy (eclampsia) TTP HUS dialysis cyclosporine** cocaine |
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MOYA MOYA
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narrowing of supraclinoid internal carotid; collateral vessels from external carotid and basal ganglia perforators
conditions: sickle cell, NF-1, atherosclerosis, XRT, idiopathic presents w/ TIAs, infarcts; prevalent in Japanese |
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DDX NONNEOPLASTIC POSTERIOR FOSSA MASSES
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Dandy-Walker
direct communication bet 4th ventricle and posterior fossa cyst; incomplete formation of vermis; in utero insult to 4th ventricle Arachnoid cyst Giant cisterna magna |
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DDX CALVARIAL MARROW REPLACEMENT
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hematologic malignancy
granulomatous (sarcoid, TB) myelofibrosis mets chronic anemia dysplasias (Paget's, fibrous dysplasia, osteopetrosis) |
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DDX ENHANCING MASS IN JUGULAR FORAMEN
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glomus jugulare
(arise from Arnold's nerve [auricular branches of vagus]) -salt and pepper appearance -multiple flow voids -almost always involve and sometimes fill jugular vein -erosion of bone schwannoma -usually displace jugular v. -arise from pars nervosa -smooth remodelling of bone met -can have flow voids -can erode bone NP carcinoma meningioma chordomas, chondroid lesions (stippled calcification) (CN IX,X,XI run through JF) |
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CALCIFICATION OF BASAL GANGLIA, DENTATE NUC OF CEREBELLUM
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Fahr Dz (familial cerebrovascular ferrocalcinosis)
Idiopathic (can be normal esp. if in globus pallidus) abnormalities of calcium/phosphate metabolism postinflammatory TB, cystercicosis |
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HEMORRHAGE AT G/W JTN
NOT IN VASC DISTRIBUTION INFARCT IN YOUNG PT |
characteristics of venous infarcts
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DISTINGUISH HYDRANENCEPHALY FROM ALOBAR HOLOPROSENCEPHALY
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-holoprosencepaly:
thalamic fusion absent falx -hydranencephaly: falx present no thalamic fusion |
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WHITE MATTER LESIONS
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vasculitis
ADEM (subcortical wm) infection (lyme, ect) demyelination dysmyelinating ischemia pt w/ HIV PML lymphoma HIV/CMV encephalitis |
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TRAM TRACK ENHANCEMENT OF OPTIC NERVE SHEATH
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meningioma
lyphoma mets pseudotumor sarcoid |
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PITUITARY STALK LESION
IN CHILDREN IN ADULTS |
CHILDREN:
-e gran -germinoma -infection (TB, meningitis) -lymphoma/leukemia -hypothalamic glioma ADULTS: -sarcoid/TB -mets -germinoma -lymphoma -hypothalamic glioma -lymphocytic hypophysitis (pregnancy, postpartum) |
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PETROUS APEX MASSES DDX
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mucocele
cholesterol granuloma hyperintense on all pulse seqs. can have fluid levels multiple myeloma met chondrosarcoma schwannoma of CN V petrous apicitis |
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INTRAVENTRICULAR NEOPLASMS NEAR FORAMEN OF MONRO
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SEGA
ependymoma oligodendroglioma central neurocytoma |
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ENHANCEMENT OF OPTIC NERVE SHEATH COMPLEX
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optic neuritis
sarcoid infection primary tumor (glioma, meningioma) metastatic dz |
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LAMINAR NECROSIS DDX
(calcification and petech hemorrhage in gyral pattern) |
infarct
enchephalitis primary neoplasm |
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ATROPHY OF TEMPORAL LOBES
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alzheimer's dementia
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DIFFUSE DURAL ENHANCEMENT
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spontaneous intracranial hypotension
mets (breast, prostate) lymphoma/leukemia TB, sarcoid, Wegener's idiopathic hypertrophic pachymeningtis |
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LARGE BRAIN MASS IN INFANT
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DIG (desmoplastic infantile ganglioglioma) large cystic and solid lesion
ependymoma PNET astrocytoma |
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LYTIC LESION W/ SCLEROTIC BORDER IN SKULL
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hemangioma
epidermoid cyst leptomeningeal cyst healing e gran (bevelled margins) |
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ATROPHY OF CEREBRAL HEMISPHERE W/ COMPENSATORY ENLARGEMENT OF HEMICRANIUM
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Dyke-Davidoff-Masson syndrome
-vascular insults -Sturge-Weber |
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DEEP GRAY STRUCTURES WHICH SHOULD NOT HAVE HYPOINTENSITY ON T2 w/ ADVANCING AGE
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thalamus, caudate
(globus pallidus can have iron accumulation w/ age, and putamen after 6th decade) |
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DISORDERS w/ IRON DEPOSITION
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MS
leukodystrophies anoxia/infarction Wilson's Hallervorden Spatz trauma |
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DISORDER ASSOCIATED W/ BILATERAL SUBDURAL EFFUSIONS AND CEREBRAL ATROPHY
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Menke's Kinky Hair syndrome
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DISORDER ASSOCIATED W/ BILATERAL SUBDURAL EFFUSIONS AND CEREBRAL ATROPHY
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Menke's Kinky Hair syndrome
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T2 HYPERINTENSITY IN GLOBUS PALLIDUS, PUTAMEN, CAUDATE
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Leigh Dz (subacute necrotizing encephalomyelopathy)
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HOT FOCUS PROJECTING OVER BRAIN/SKULL IN BONE SCAN
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-infarct
-bone tumor -bone dysplasia |
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HIGH SIGNAL IN MESIAL TEMPORAL LOBES ON T2
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-in pt w/ malignancy (most commonly small cell lung CA)
LIMBIC ENCEPHALITIS -herpes -infarct -mesial temporal sclerosis (associated w/ vol loss of hippocampus) |
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PATCHY HIGH SIGNAL IN BRAIN STEM, CEREBELLUM
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-rhombencephalitis--Listeria
(TB, syphilis) -ddx MS ADEM sarcoid infarcts |
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DURAL BASED LESIONS ALONG TENTORIUM
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meningioma
plasmacytoma sarcoid lymphoma |
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MASS ARISING FROM BODY OF LATERAL VENTRICLE NEAR FORAMEN OF MONRO
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central neurocytoma
CPP meningioma fibrillary astrocytoma ependymoma / subependymoma SEGA met **in adults, CPP most often in fourth ventricle, in children in atrium of lateral ventricle **oligo difficult to distinguish from central neurocytoma |
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CHARACTERISTICS OF MELAS
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MELAS: mitochondrial encepalopathy, lactic acidosis, stroke
-basal ganglia signal abn -cortical strokes -cortical atrophy -white mtr dz -spinal cord atrophy |
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ATROPHY OF PONS, MIDDLE CEREBELLAR PEDUNCLE, CEREBELLUM
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olivopontocerebellar degeneration
-can see mild high signal on T2 in affected structures |
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CYSTLIKE LESIONS IN VENTRICLES
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-arachnoid cysts
-colloid cysts -cystic neoplasm -epidermoid -cystercicosis, echinococcus -ependymal cysts |
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CAUSES OF DIFFUSE HEMOSIDEROSIS
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-SAH (usu from brain or spinal cord tumor)
-AVM -amyloid -causes cranial nerve palsies |
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CAPILLARY TELANGIECTASIA
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cluster of abnormally dilated capillaries w/ intervening normal brain tissue
see blush w/ contrast T1W; no abnormality on noncontrast T1 or T2 images--or can see hypointensity on GRE d/t stagnant blood flow |
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HIGH T2 SIGNAL IN CENTRAL PONS
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central pontine myelinolysis
-usually spares corticospinal tracts -can also see abn of deep gray, deep white matter, cerebellum **usu no mass effect or enhancement -ddx: MS, encephalitis, ischemia |
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DISTRIBUTION OF METACHROMATIC LEUKODYSTROPHY vs ADRENOLEUKODYSTROPHY
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METACHROMATIC:
-begins in frontal lobes, progress posteriorly ADRENOLEUKODYSTROPHY -begin posteriorly both spare subcortical U-fibers |
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STURGE-WEBER
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-pial vascular malformation
-port wine stain -enhancing pial malformation -hypertrophied, enhancing choroid plexus -hemiatrophy -compensatory bony hypertrophy |
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JOUBERT'S SYNDROME
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aplasia/hypoplasia of vermis (superior)
enlarged fourth ventricle (bat-wing shaped) vertically oriented, elongated superior cerebellar peduncles (molar-tooth appearance) |
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DDX EPENDYMAL ENHANCEMENT
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1. Infection:
ventriculitis, ependymitis 2. Neoplasm: lymphoma, seeding from systemic and primary neoplasms |
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DEMYELINATION IN CORPUS CALLOSUM, BRAIN ATROPHY
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Machiafava-Bignami Disease
-assoc. w/ red wine / malnutrition -can see additional periventricular WM abnormalities -ddx MS |
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T2 HYPERINTENSITY IN CEREBELLUM, THICKENING OF FOLIA, LAMINATED APPEARANCE
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Lhermitte-Duclos dz
(Dysplastic Gangliocytoma of the Cerebellum) poorly demarcated, mass effect associated w/ Cowden disease |
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CHIARI III
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herniation of cerebellum/brain stem into foramen magnum
high cervical / low occipital encephalocele agenesis of corpus callosum lumbosarcal myelomeningocele not present |
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MECKEL GRUBER
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encephalocele
microcephaly polydactyly cystic kidneys |
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BILATERALLY SYMMETRIC HIGH SIGNAL IN POSTERIOR LIMB INTERNAL CAPSULE, EXTENDING DOWN CORTICAL SPINAL TRACTS
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ALS
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MULTIPLE ENHANCING CYSTIC/SOLID LESIONS IN CEREBELLUM
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VHL w/ multiple hemangioblastomas
multiple cystic mets |
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MULTIPLE CALCIFIED AND RING ENHANCING PARENCHYMAL LESIONS
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infection such as TB, cystercicosis, toxo, fungal infection, CMV
mucinous mets osteosarcoma |
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LENS DISLOCATIONS-- positions of lenses
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MARFAN'S:
subluxed superiorly HOMOCYSTINURIA: subluxed inferiorly/laterally (down and out) |
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ENLARGEMENT OF LACRIMAL GLANDS
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-unilateral:
dacroadenitis pleomorphic adenoma pseudotumor sarcoid -bilateral: Sjogren's Mikulicz's syndrome associated w/ lymphoma, leukemia, TB, sarcoid sarcoid Wegener's |
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DDX OF MESIAL TEMPORAL SCLEROSIS
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-mesial temporal sclerosis (see volume loss, high T2 signal)
-neoplasm (e.g. ganglioglioma): see mass effect, possibly signal abnormalities extending into adjacent structures -cortical dysplasias |
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MOST COMMON VASCULAR ORBITAL MASSES
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cavernous hemangioma
capillary hemangioma lymphangioma (fluid levels can be seen) |
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CLIVAL MASS DDX
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chordoma
chondrosarcoma plasmacytoma mets lymphoma fibrous dysplasia NOF |
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CP ANGLE MASSES
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schwannoma
meningioma mets ependymoma lymphoma inflammatory disorders |
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MICROOPTHALMIA
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infectious
congenital rubella retinopathy of prematurity PHPV Aicardi's syndrome agenesis of cc seizures d/t heterotopia choroidal abnormalities vertebral abnormalities Oculocerebral renal dz (Lowe syndrome) |
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DDX HYPERDENSITY IN SUBARACHNOID SPACE
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acute hemorrhage
contrast material proteinaceous exudate (meningitis) **primary leptomeningeal melanosis |
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PHARYNGEAL MUCOSAL SPACE LESIONS
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MASSES:
NP carcincoma (sq cell most common) -look for cavernous sinus inv. Oropharyngeal CA Minor salivary gland CA (adenoid cystic, mucoepi, adenoCA) Lymphoma Pleomorphic adenoma (well defined) Ectopic thyroid CYSTIC: -tonsillar abscess -tornwald'ts cyst LYMPHOID HYPERPLASIA |
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ORAL CAVITY LESIONS
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oral cavity = anterior to ling tonsil
MASSES Oral cavity squamous cell carcinoma (lip most common, then tongue) Things to check... oral tongue: floor of mouth inv? lingual septum inv? gingivobuccal sulcus: mandible invaded? retromolar trigone: mand / masticator space/ V3 inv? hard palate: max sinus / V2 inv? Minor salivary gland malignancy CYSTIC: -abscess / Ludwig's angina -ranula (plunging has tail) -epidermoid/dermoid -sialocele -mucocele -2nd branchial cleft cyst SUBMANDIBULAR GLAND: -pleomorhphic adenoma, most common tumor of (well defined, lobular borders) -sialadenitis (inflam change) -carcinoma (mucoepidermoid, adenoid cystic) (invasive) -lymphoma MANDIBLE: -ameloblastoma (80% multiloc, no mineralization, enhancing mural nodules*) -dentigerous cyst (crown of tooth) -odontogenic keratocyst (oft multilocular) -ABC (fluid levels, multiloc) -fibrous dysplasia -abscess |
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MATICATOR SPACE LESIONS
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ameloblastoma
abscess met sarcoma chondrosarcoma (chondroid m) osteosarcoma (oss matrix) fibrosarcoma lymphoma CHILD rhabdomyosarcoma Ewing's lymphoma |
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PAROTID LESIONS
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BILATERAL CYSTIC AND CYSTIC/SOLID:
-benign lymphoepithelial lesions (HIV) -Sjogren's (look for NHL in addition) -Sarcoidosis -Warthin tumor SOLID: -pleomorphic adenoma (most common) -Warthin tumor (inhomogeneous) -lymphoma -nodal mets (scalp, face, ear) -mucoepidermoid/adenoid cystic CA (invasive mass) |
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CAROTID SPACE MASSES
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GLOMUS VAGALE (**above bifurcation**):
nasopharyngeal carotid space mass displacing paraphary fat anteriorly, ICA anteromedially, avid enhancement, salt(hemorrhage, not often seen) and pepper(flow voids) -intense blush w/ early draining veins and enlarged feeders VAGAL SCHWANNOMA -fusiform enhancing mass -absence of blush or enlarged feeders on angio; scattered contrast puddles -no flow voids CAROTID SPACE MENINGIOMA: -extends from juj foramen -permeative sclerotic bony changes -dural tail -prolonged but mild tumor blush CAROTID BODY PARAGANGLIOMA (**at bifurcation**): -oropharyngeal carotid space mass splaying ICA/ECA at bifurcation -flow voids / enlarged feeders/ early draining veins nodes |
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BRANCHIAL CLEFT CYSTS
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FIRST:
-type I: below or posterior to pinna -type II: parotid space/periparotid SECOND: -displaces carotid space medially, submandibular gland anteromedially, SCM posterolaterally |
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NONNEOPLASTIC CHOROID PLEXUS CALCIFICATIONS IN YOUNG PATIENT
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consider NF 2
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