Neuro Skull Base Temporal Bones, And Orbits

Front 1

Benign anterior skull base neoplasms (2)

Back 1

Juvenile nasopharyngeal angiofibroma
olfactory groove meningioma

Front 2

Who gets juvenile nasopharyngeal angiofibroma and how does it present?

Back 2

adolescent boys with nasal obstruction and epistaxis

Front 3

Where does JNA arise?

Imaging appearance?

3 classic findings?

Back 3

around medial boundary of the pterygopalatine fossa

enhances avidly and centered on the nasopharynx. extends into the pterygopalatine fossa or the orbits.

1. nasopharyngeal mass
2. expansion of pterygopalatine fossa.
3. anterior bowing of the posterior maxillary sinus wall.

Front 4

Differential for malignant anterior skull base neoplasms

Back 4

esthesioneuroblastoma
squamous cell carcinoma
adenoid cystic carcinoma
rhabdomyosarcoma

Front 5

What is the age distribution for esthesioneuroblastoma?

Imaging characteristics

Back 5

bimodal

intermediate on T1 and T2, avidly enhancing. calcs commonly seen.

**peripheral tumor cysts considered to be pathognomonic at the itnracranial portion of the mass.

Front 6

What is the most common head and neck tumor in kids?

Back 6

rhabdomyosarcoma

Front 7

What is a common finding of adenoid cystic carcinoma in the region of the anterior skull base?

Back 7

perineural spread along the trigeminal nerve.

Front 8

Middle ear tumors (4)

Back 8

glomus tympanicum
facial nerve schwannoma
cholesterol granuloma
Cholesteatoma

Front 9

Between cholesterol granuloma and cholesteatoma, what is a differentiating imaging finding in the middle ear?

Back 9

cholesteatoma shows diffusion restriction. They also do not enhance.

Also, appears as a white mass on otoscopic exam as opposed to blue mass for cholesterol granuloma

Front 10

In thyroid ophthalmopathy, what extraocular muscle is affected first?

What is the sequence of muscles affected?

Back 10

Inferior rectus

IM SLow

Front 11

How is thyroid ophthalmopathy contrasted from orbital pseudotumor?

Back 11

thyroid: symmetrical and does not involve the tendons.

Front 12

Orbital pseudotumor:

1. Causes painful proptosis, contrasting with what?
2. Most commonly involved orbital structure?
3. Other imaging findings?
4. This finding + cavernous sinus involvement =?

Back 12

1. lymphoma, painless proptosis
2. lacrimal gland.
3. orbit fat stranding, icnreased orbital soft tissue, and enlargement of the extraocular muscles.
4. Tolosa-Hunt syndrome

Front 13

Bilateral optic nerve gliomas in a child suggests what?

Back 13

NF1

Front 14

Classic appearance of retinoblastoma

Back 14

hyperattenuating enhancing retinal mass with calcification in a normal sized globe

Front 15

VAscular retinal disease with subretinal lipoprotein exudates leading to retinal detachment

Back 15

Coats disease
-usually a bit older than retinoblastoma patients
-globe normal size.

Front 16

REtinopathy of prematurity can demonstrate intraocular calcifications similar to retinoblastoma. How is it differentiated?

What causes it?

Back 16

Micropthalmia

Prolonged oxygen therapy causes it.

Front 17

A different entity causes micropthalmia with increased attenuation of the vitreous.

What makes this different?

Back 17

PHPV
-hemorrhage, cataracts, retinal detachment

ABSENT calcifications

Front 18

DDX micropthlamia (2)

Back 18

PHPV
ROPrematurity
coloboma

Front 19

Characteristic finding of sphenoid wing dysplasia?

Back 19

Pulsatile exophthalmos

can be seen in NF1

Front 20

If there is a lesion in the masticator space, what nerve is important to assess for perineural spread?

Back 20

V3

Front 21

What is the ddx for a masticator space lesion? (3)

Back 21

odontogenic disease
mandibular lesion (osteosarcoma and mets)
rhabdomyosarcoma

Front 22

Carotid space mass differential

Back 22

paraganglioma
schwannoma
neurofibroma

Front 23

What is the only nerve the is in the carotid space through its entirety?

Back 23

vagus nerve.

9,11,12 pass through transiently

Front 24

In addition to paraganglioma of the the vagus, what else can push the ICA and ECA anterior and medially?

Back 24

Schwannoma
-is not nearly as vascular as paraganglioma

Front 25

intramedullary spinal lesions (4)

Back 25

ependymoma
astrocytoma
hemangioblastoma
demyelinating lesion

Front 26

intradural extramedullary lesions

Back 26

schwannoma
neurofibroma
meningioma
myxopapillary
ependymoma
epidermoid/dermoid
arachnoiditis

Front 27

Extradural spinal lesions

Back 27

degenerative disease
vertebral neoplasm
epidural mets
hemangioma
epidural lipomatosis.

Front 28

Petrous apex lesions (9)

Back 28

Cholesterol cyst (granuloma)
apical petrositis
congential cholesteatoma
schwannoma
Langerhans cell histiocytosis
chondrosarcoma
chordoma
meningioma
mets

Front 29

Expansile mass with internal hemorrhage in the petrous apex without fat suppresion

Back 29

cholesterol cyst

Front 30

Apical petrositis

Back 30

Complication of infectious otomastoiditis
bony demineralization and resorption
Gradenigo triad

Front 31

What is the gradenigo triad?

Back 31

Otomastoiditis
facial pain from trigeminal neuropathy at meckels cave
lateral rectus palsy fomr 6th nerve palsy at Dorellos canal

Front 32

Vascular complications of apical petrositis

Back 32

internal carotid arteritis
dural venous thrombosis

Front 33

What is a typical MR finding of congenital cholesteatoma?

Back 33

restricted diffusion.

Front 34

What nerves could a schwannoma at the petrous apex originate from?

Back 34

5,7,8

Front 35

Most common site of skull base involvement in langerhans histiocytosis

Back 35

temporal bone

CT: well circumscribed destructive lesion with NONsclerotic margins
MR: soft tissue masses with surround marrow and edema. MARKED enhancement.

Front 36

Petrous apex ring and arc chondroid matrix. Lobular, CAULIFLOWER shaped T2hyperintense mass.

Back 36

Chondrosarcoma

Front 37

Petrous apex: well circumscribed lytic lesion in a child?

Back 37

Langerhans

Front 38

Petrous apex: intralesional cysts, smoothly enhancing, bony remodeling?

Back 38

Schwannoma

Front 39

Clivus ddx

Back 39

chordoma
chondrosarcoma
mets

Front 40

Common locations for chordomas

Back 40

near sacrum, clivus, some in vertebral column

Front 41

Common mets to the clivus?

Back 41

Breast

Front 42

Glomus tumors characteristic bony destruction

Back 42

moth-eaten

Front 43

DDX retro-tympanic mass

Back 43

Glomus tympanicum
aberrant carotid artery
tympanic membrane hemangioma

Front 44

All of the extraocular muscels arise from a common fibrous ring called the annulus of Zinn except for:

Back 44

Inferior oblique

Front 45

What passes through the superior orbital fissure (5)

Back 45

3,4, V1, 6
superior ophthalmic vein

Front 46

Where is the most common site of orbital lymphoma?

Classic appearance?

Back 46

lacrimal gland

downward painless proptosis

Front 47

Extraconal orbital multilocular cystic mass with fluid levels in a pediatric patient

Back 47

lymphangioma

Front 48

Classic imaging finding for metastatic breast cancer to the orbit

Back 48

enophthalmos due to fibrosis

Front 49

Most common expansile lesion of the paranasal sinuses

Back 49

Mucocele
-frontal sinus most common, then ethmoid sinus

Front 50

CN7 exits the brainstem in whwat relation to CN8?

Back 50

Anterior.