Neuro: Test 1 : 15&16. Maki : Radiology I & Ii

Front 1

PT comes in with headache or other acute neuro findings in the ER

What is the first imaging study you want to use?

******

Back 1

NON CONTRAST CT

Front 2

What is one key reason why CT is better than MRI?

***

Back 2

it is good for quick evaluation of acute bleeding: Excellent for acute intracranial hemorrhage


(also, MRI might require pre-approval for access)

Front 3

where do epidural bleeds most commonly occur

Back 3

fronto-temporal area

Front 4

What is this? Where is it occuring

Back 4

Epidural bleed

frontal lobe

Front 5

what are the Hounsfield units for:
water
bone
air
blood
Fat

Back 5

0 = water density
+ 1000 = bone
-1000 = air
+ 60 – +80 = blood
- 5 to –12 = fat

Front 6

T1 vs T2 on MRI?

Back 6

T1 = the “anatomic” sequence
T2 = the “pathology” sequence


On T1 water is dark black
On T2 water is bright white

Front 7

T1 or T2?
What 4 things are black on this type of image?

Back 7

T1

Cortical bone
Bone
Moving blood
Fluid

Front 8

T1 or T2

Back 8

T2

Front 9

Which study, MRI or CT can detect ischemic injusry 24-36 hours earlier than CT?

Back 9

MRI

Front 10

This imaging study has no bone artifact (especially in the posterior fossa), and is better at assessment of tumors, white matter, and disease/early edema?

Back 10

MRI

Front 11

Which imaging study (CT or MRI) has unchanged multi-planar capability?

**

Back 11

MRI

Front 12

A 26 y/o patient presents to the ED after being struck by a softball bat. You want to rule our intracranial hemorrhage. You order:
A. CT
B. MRI

Back 12

CT (no contrast)

Cranial bone will be white

Front 13

Which modality is best for evaluating white matter disease?
A. CT
B. MRI

Back 13

MRI

Front 14

CT or MRI?

Back 14

MRI

Front 15

type of image? Path?

Back 15

Front 16

what normally causes an epidural hematoma?

Subdural?

Back 16

epi: skull fracture

sub: direct blow to the head w change in lvl of conciousness

Front 17

What happens in shear injuries?

Back 17

diffuse axonal injury

can be due to rotational injury (not necessarily blow to a head)

Front 18

path?

will it cross sutural lines?

what blood vessel causes it?

Back 18

epidural hematoma

DOESN'T CROSS SUTURAL LINES

assoc with skull fracture

due to arterial tear (middle meningeal artery)

Front 19

epidural hematoma vs subdural hematoma

which crosses suture lines?

Back 19

epidural hematoma :DOESN'T CROSS SUTURAL LINES

Sub: does

Front 20

for an epidural hematoma, at what amount of bleeding do you have to consider operative tx?

Back 20

less than 5mm: NON OPERATIVE

greater than 5mm: drain

Front 21

Back 21

epidural hematoma in kid

Front 22

describe some of the characteristics of subdural hematomas (shape, blood source, who it happens to)

Back 22

crecentic,
bridging veins,
old people who fall

Front 23

SDH more common with ____ while

EDH more common with _____

(cause of injury)

Back 23

SDH more common with falls
EDH more common with MVA

Front 24

Back 24

Subdural Hematoma

Front 25

this type of bleed is Spread over a larger area, limited by the falx and the tentorium

Back 25

Subdural Hematoma

Front 26

there are 3 densities seen on CT with a SDH..what are they and what are the time frames assoc with them

Back 26

Acute 0 to 3-4 days hyperdense

Subacute 3 to 20 days isodense

Chronic > 20 days hypodense

Front 27

Back 27

SDH

Front 28

Back 28

epidural hematoma

Front 29

this type of injury Occur with rapid acceleration/deceleration
Usually involves large WM tracts: corpus callosum, brainstem and deep white matter
Occurs at gray-white matter interface due to slight differences in mass
Minor differences in tissue inertia

Back 29

Shear Injuries

Front 30

Back 30

Intraparenchymal hemorrhage from shear injuries

Front 31

Back 31

MRI showing
intra parenchymal
hemorrrhage

Front 32

Left Middle Cerebral Artery Infarction with midline shift:

what is the most useful landmark for measuring midline shift?

Back 32

Most useful landmark for measuring midline shift: Septum Pellucidum

note:This type of edema is called cytotoxic edema


cytotoxic edema visible on CT and MRI

Front 33

what is key to remember about cytotoxic edema?

Back 33

Affects both gray and white matter

Front 34

History: stroke symptoms

Back 34

cytotoxic edema

Front 35

44 y/o female
New onset seizures
Fell, hit head

hemorrhage or tumor?

Back 35

This is an enhancing
tumor with edema
confined to the
white matter (vasogenic
edema)

Front 36

vasogenic edema is found where?

cytogenic?

causes?
***

Back 36

vasogenic edema: CONFINED TO WHITE MATTER (tumor or infection)

where cytogenic could be in white or gray (infarct or stroke)

Front 37

SUMMARY SLIDE

CT is 1st in the emergent setting to rule out hemorrhage.
MRI is more sensitive for edema, tumors, infections and white matter disease.
Be able to distinguish SDH from EDH.

Be able to distinguish cytotoxic (stroke) from vasogenic (tumor or infection)

Back 37

CT is 1st in the emergent setting to rule out hemorrhage.--FAST

MRI is more sensitive for edema, tumors, infections and white matter disease.--CONTRAST MAKES IT EVEN MORE SENSITIVE

Be able to distinguish SDH from EDH.--SDH more cresentic, covers further distance, not confined by sutures

Be able to distinguish cytotoxic (stroke-effects both grey and white matter) from vasogenic (tumor or infection--just in white matter)