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129 Cards in this Set
- Front
- Back
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Ring-enhancing intracranial lesions
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MAGICAL DR mnemonic:
Metastasis Abscess: AIDS, IVDA, immunocompromised state Glioblastoma multiforme, high grade glioma Infarct Contusion/hematoma AIDS (toxoplasmosis) Lymphoma Demyelinating disease Radiation necrosis] |
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Lesions crossing the corpus callosum]
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Glioblastoma multiforme
Lymphoma Progressive multifocal leukoencephalopathy Multiple sclerosis Mimic: parafalcine meningioma |
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Posterior fossa mass, child
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Medulloblastoma
Cerebellar pilocytic astrocytoma Ependymoma Pontine glioma |
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Posterior fossa mass, adult
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Metastasis (most common)
Cerebellar pilocytic astrocytoma Hemangioblastoma (von Hippel-Lindau disease) Medulloblastoma (cerebellar hemisphere) Hemorrhage (hypertensive) |
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Extra-axial mass
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Meningioma
Arachnoid cyst Epidermoid cyst Dural metastasis Bone lesion with intracranial extension Empyema, subdural or epidural Sarcoidosis |
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Cerebellopontine angle mass
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Vestibular schwannoma (bilateral, neurofibromatosis-2)
Meningioma Arachnoid cyst Epidermoid cyst (most common) Other: ependymoma, schwannoma, glomus jugulare |
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Sellar or suprasellar mass
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GATCH MODE mnemonic:
Germ cell tumor, Granuloma Adenoma, Aneurysm, Arachnoid cyst Tuber cinerum hamartoma Craniopharyngioma, Rathke’s cleft cyst Hypothalamic glioma Meningioma, Metastasis Optic chiasm glioma Dermoid Epidermoid Lymphoma |
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Suprasellar mass, adult (common)
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Pituitary adenoma (prolactinoma > GH)
Craniopharyngioma (30-40 y/o) Meningioma Chiasmatic/hypothalamic glioma Aneurysm |
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Suprasellar mass, child (common)
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Craniopharyngioma (4-5 y/o)
Chiasmatic/hypothalamic glioma (NF-1) Germinoma |
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Suprasellar mass, homogeneously enhancing
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Macroadenoma
Meningioma (planum sphenoidale, clivus) Aneurysm Germinoma, teratoma |
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Suprasellar mass, partially calcified
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Meningioma
Craniopharyngioma Aneurysm Granuloma Dermoid |
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Suprasellar mass, high attenuation
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Meningioma
Craniopharyngioma Adenoma (hemorrhagic) Aneurysm Glioma Germinoma |
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Pituitary hemorrhage
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adenoma
bromocriptine therapy pregnancy XRT anticoagulation LP |
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Suprasellar mass, Hyperintense T1/T2
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Adenoma (hemorrhagic)
Craniopharyngioma (cystic, proteinaceous material) Rathke's cleft cyst |
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Infundibular mass, child
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Germinoma
Eosinophilic granuloma Meningitis Lymphoma Glioma Racemose cysticercosis |
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Infundibular mass, adult
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Metastasis
Sarcoid Germinoma Lymphoma Glioma Choristoma (granular cell tumor) |
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Cavernous sinus mass
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Meningioma
Schwannoma neurofibroma Aneurysm of ICA Cavernous sinus thrombosis Carotid-cavernous fistula Metastasis Lymphoma sarcoid Macroadenoma Extension from bone tumors: metastasis, chordoma, chondrosarcoma |
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Cavernous sinus mass, bilateral
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Macroadenoma
Meningioma Lymphoma Metastases |
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Cranial nerves traversing the cavernous sinus?
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3, 4, 51, 52, 6
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CN V foramen
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Standing Room Only: V1-Spinosum, V2-Rotundum, V3-Ovale
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Pineal region mass
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Pineal cyst (NL <15 mm)
Germ cell tumor (germinoma) Pineoblastoma (rare, child), pineocytoma (rare, adult) Metastasis Tectal glioma Meningioma Vein of Galen malformation |
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Temporal lobe lesion, adult
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GBM
metastasis Ganglioglioma (young adult, also parietal lobe/cerebellum) DNET HSV Trauma Mesial temporal sclerosis |
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Absent posterior pituitary bright spot
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EG
Diabetes insipidus |
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Intraventricular mass
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Meningioma (left atrium)
Metastases, lymphoma Ependymoma (4th ventricle) Subependymoma (rare, 4th ventricle or frontal horn) Choroid plexus papilloma (child, left atrium |
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CSF seeding of tumor
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Germinoma
PNET: medulloblastoma, pineoblastoma, retinoblastoma Ependymoma Choroid plexus carcinoma GBM Metastases |
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White matter disease (multiple)
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Ischemia
Multiple sclerosis Acute disseminated encephalomyelitis: measles, mumps, mononucleosis, varicella |
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Infarct, young adult
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Dissection: post-traumatic, Marfan’s syndrome, FMD, extension of Type A thoracic aortic dissection into common carotid artery
Drug abuse: cocaine, amphetamine Vasculitis: giant cell arteritis, PAN, temporal arteritis |
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Traumatic dissection of the ICA usually occurs where
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immediately above the carotid bifurcation
near the skull base at the level of the supraclinoid ICA |
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Dissection of the vertebral artery occurs at
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C6, where it enters the foramina transversarium
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Gyriform cortical enhancement
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Stroke
Cerebritis Postictal state Hypertensive encephalopathy, eclampsia Drugs: cyclosporine, MTX, FK506 (Tacrolimus) |
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Hypertensive encephalopathy
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pregnancy
renal failure TTP hemolytic-uremic syndrome. |
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Hypertensive encephalopathy is similar in appearance to
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cyclosporine
FK-506 therapy |
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Dural venous sinus thrombosis
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Infection: otomastoiditis
Pregnancy Dehydration Sepsis Neoplasm: falx meningioma Hypercoagulable states |
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Conditions associated with cerebral aneurysms
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AVM
ADPCKD Fibromuscular dysplasia NF-1 Collagen vascular disease Marfan’s syndrome Coarctation of the Aorta |
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Aneurysm in unusual location
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Mycotic: bacterial endocarditis
Vasculitis: PAN, SLE, Wegener’s granulomatosis, Takayasu’s disease AVM Post-traumatic |
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Hemorrhage, intraxial
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Trauma
Hypertension (putamen, thalamus, pons, cerebellum) Aneurysm (multiple in 15%) AVM, cryptic vascular malformation (cavernous hemangioma, capillary telangiectasia) Thromboembolic, venous infarct (temporal lobe from transverse sinus thrombosis, parasagittal subcortical white matter from superior sagittal sinus thrombosis, thalami from straight sinus or vein of Galen thrombosis) Hemorrhagic metastasis: melanoma, thyroid carcinoma, choriocarcinoma, adenocarcinoma (breast, lung, renal, colon) |
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Hemorrhage spontaneous intra-axial, elderly
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HTN
Amyloid angiopathy Metastasis |
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Hemorrhage spontaneous intra-axial, young
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AVM
Aneurysm Drug abuse: cocaine, amphetamine Neoplasm |
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Hemorrhage multifocal intra-axial
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Trauma
Metastases Amyloid angiopathy Vasculitis Venous infarction Coagulopathy |
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Hemorrhage, subarachnoid
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Aneurysm
Trauma AVM |
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Hemorrhage, epidural/subdural
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Trauma
Coagulopathy |
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Leptomeningeal enhancement
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Metastases: lung, breast, melanoma, lymphoma/leukemia, PNETs (child)
Meningitis: TB, fungal |
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Meningitis bugs
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Group B streptococcus (newborn)
H. infuenzae (child) N. meningititis (adolescent) S. pneumonia (adult) |
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Dural enhancement/mass
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Post-craniotomy or LP, CSF diversion
Neoplasm: meningioma, metastases (breast, prostate, lymphoma), direct extension of primary intracranial tumor, neuroblastoma (child) Meningitis Post-hemorrhagic: remote SDH, EDH Spontaneous intracranial hypotension (CSF leak from lumbosacral root sleeve cyst) Sarcoidosis |
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Ependymal enhancement
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Neoplasm: lymphoma, glioma, CSF spread of primary intracranial tumor or metastasis
Ventriculitis: meningitis, post-shunting |
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Congenital Hydrocephalus
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idiopathic
Chiari II malformation Dandy-Walker malformation aqueductal stenosis perinatal hemorrhage or meningoencephalitis (STARCH) |
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Communicating Hydrocephalus
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meningitis
SAH meningeal carcinomatosis |
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Parenchymal calcifications, neonate
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CMV
Toxoplasmosis Rubella infection Herpes Simplex infection HIV (basal ganglia) |
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STARCH mnemonic:
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Syphilis
Toxoplasmosis AIDS Rubella CMV Herpes simplex virus-2 |
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T1 hyperintensity
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Intracellular/extracellular methemoglobin
Fat Proteinaceous fluid Melanin Slow blood flow on certain sequences Calcification (hydrated) |
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T2 hypointensity
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Vascular flow voids
Deoxyhemoglobin (acute bleed), intracellular methemoglobin, ferritin, hemosiderin Calcification or ossification Proteinaceous fluid Densely cellular mass: meningioma, lymphoma, PNET (pineoblastoma, medulloblastoma, neuroblastoma) Iron deposition, physiologic (basal ganglia, substantia nigra, red nucleus, dentate nucleus), iron deposition, pathologic |
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Calvarial button sequestrum
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O ME mnemonic:
Osteomyelitis Metastases EG |
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Solitary lytic defect in skull
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MT HOLE (“empty hole”) mnemonic:
Metastasis multiple myeloma TB trauma Histiocytosis, hemangioma Osteomyelitis Leptomeningeal cyst Epidermoid |
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Loss of lamina dura
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CHOMP mnemonic:
Cushing’s disease Hyperparathyroidism Osteomalacia, osteoporosis Multiple myeloma Paget’s disease |
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Calcifications in brain
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PINEAL mnemonic:
Physiologic: pineal gland, choroid plexus, basal ganglia Infections: Cysticercosis, toxoplasmosis, TB, CMV Neoplasm: craniopharyngioma, oligodendroglioma, meningioma, chordoma Endocrine: hypervitaminosis D, hypoparathyroidism, hyperparathyroidism, Fahr’s disease Arterial: atherosclerosis, aneurysm Lipoma, dermoid |
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Calcified intracranial mass
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Ca++ COME mnemonic:
Craniopharyngioma Astrocytoma, aneurysm Choroid plexus papilloma Oligodendroglioma Meningioma Ependymoma (25%) |
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Basal ganglia calcification
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Idiopathic
Hypoparathyroidism, hyperparathyroidism Fahr’s disease (familial idiopathic cerebral ferrocalcinosis) Post-inflammatory, post-anoxia AIDS Cockayne’s syndrome |
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Intramedullary lesion
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Neoplasm: ependymoma (adult, conus medullaris/filum, can be cystic or calcified or bloody), astrocytoma (child), hemangioblastoma, metastasis (rare)
Infarct, ischemia Hematoma Demyelinating disease: MS Transverse myelitis: post-viral, inflammatory, ischemia, MS, ADEM, SLE, XRT Cryptic vascular malformation: cavernous hemangioma, capillary telangiectasia Syrinx Contusion Abscess |
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Syringomyelia
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Trauma (myelomalacia)
Neoplasm Chiari 1 or 2 malformation Infarct (myelomalacia) Arachnoiditis: meningitis, back surgery |
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Intradural, extramedullary lesion
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Meningioma (posterolateral)
Nerve sheath tumor (anterolateral): schwannoma, neurofibroma Metastases (drop): germ cell tumors, ependymoma, PNET |
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MANDELIN mnemonic
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meningioma
metastasis (drop) arachnoiditis arachnoid cyst AVM neurofibroma dermoid epidermoid ependymoma lipoma infection (TB, cysticercosis) NL but tortuous nerve roots |
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Extradural lesion
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Degenerative disease: disc protrusion, osteophyte, synovial cyst
Metastases to vertebrae: lung, breast, prostate, lymphoma Other tumors: myeloma, chordoma, aneurysmal bone cyst, giant cell tumor, lymphoma/leukemia, osteoblastoma, eosinophilic granuloma, schwannoma, neurofibroma, ganglioneuroma, ganglioneuroblastoma, neuroblastoma Epidural abscess: discitis, osteomyelitis Hematoma |
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Epidural lesion, child
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Extension of paraspinal or vertebral tumor: neuroblastoma, ganglioneuroblastoma, ganglioneuroma
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Epidural extension over many levels
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Abscess
Hematoma Metastases Lymphoma |
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Destructive midline, skull-base lesion
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Metastases
Myeloma Nasopharyngeal carcinoma Chordoma (midline) Chondrosarcoma (off midline) Meningioma Macroadenoma Lymphoma Esthesioneuroblastoma (cribiform plate) Aggressive sinusitis: aspergillus, mucormycosis Mucocele, polyposis |
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Destructive skull-base lesion, frontal
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Esthesioneuroblastoma
Metastasis Meningioma Sinonasal carcinoma Lymphoma Rhabdomyosarcoma Aggressive sinusitis Mucocele, sinonasal polyposis |
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Destructive skull-base lesion, basisphenoid
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Nasopharyngeal carcinoma
Chordoma Chondrosarcoma Metastases, myeloma Macroadenoma Meningioma Aggressive sinusitis: aspergillus, mucormycosis |
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J-shaped sella
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Cretinism
Idiopathic Hydrocephalus Gargoylism Achondroplasia Optic glioma NF-1 |
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Jugular foramen mass
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Glomus jugulare
Schwannoma Metastasis Meningioma Asymmetrical or thrombosed jugular vein, ectatic carotid artery, carotid pseudoanuerysm |
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Far lateral disc herniation mimics
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Conjoined nerve root
Perineural cyst Neurofibroma |
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Tarlov cyst mimics
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Intrasacral meningocele
Dural ectasia |
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Arachnoiditis
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Trauma, surgery
Intrathecal steroids, anesthesia Myelogram Infection |
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Globe lesions
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Uveal melanoma (lobular), uveal metastases (plaque-like)
Choroidal or retinal detachment Vitreous hemorrhage Pseudotumor Retinoblastoma (child) Optic disc Drusen, choroidal osteoma (lateral to optic disc) |
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Optic nerve or nerve sheath enlargement
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Optic glioma (child, NF-1), optic nerve sheath meningioma (adult), lymphoma/leukemia, metastasis
Pseudotumor Optic neuritis Sarcoidosis |
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Rectus muscle enlargement
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Thyroid opthalmopathy (inferior>medial>superior>lateral)
Pseudotumor Myositis: extension from paranasal sinus infection, pseudotumor Metastasis, lymphoma, others Vascular congestion from mass at orbital apex, carotid-cavernous fistula, cavernous sinus thrombosis, dural AVM |
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Lacrimal fossa mass
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Viral infection
Benign neoplasm: dermoid, pleomorphic adenoma Malignant neoplasm: adenoid cystic carcinoma, lymphoma, metastases Pseudotumor Sarcoidosis Sjogren’s syndrome Wegener’s granulomatosis |
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Lacrimal fossa mass, bilateral
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Lymphoma
Sarcoid |
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Intraconal mass
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Cavernous hemangioma (adult), capillary hemangioma (child), lymphangioma (child)
Orbital cellulitis, pseudotumor Varix, carotid-cavernous fistula Lymphoma, rhabdomyosarcoma (child), metastasis (child: neuroblastoma to bone |
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Extraconal mass
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Metastasis to bony orbit
Invasion by adjacent primary tumor: paranasal sinus or nasal SCC, sphenoid wing meningioma Lacrimal fossa mass Subperiosteal abscess or hematoma |
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Orbital mass, child
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LO VISHON mnemonic: Leukemia, lymphoma
Optic nerve glioma Vascular malformation (capillary hemangioma, lymphangioma) Inflammation (pre-, post-septal) Sarcoma (rhabdomyosarcoma) Histiocytosis Orbital pseudotumor, osteoma Neuroblastoma |
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Middle ear mass
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Cholesteatoma, cholesterol granuloma, inflammatory debris/granulation tissue
Vascular: aberrant carotid artery, dehiscent jugular bulb Neoplasm: glomus tympanicum (cochlear promontory, ascending pharyngeal artery embolization), glomus jugulare invading middle ear (glomus jugulotympanicum), hemangioma, others |
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Lesion causing pulsatile tinnitus
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Aberrant carotid artery, high jugular bulb or dehiscent jugular bulb
Transverse sinus/internal jugular vein thrombosis, high grade carotid stenosis, dural AVF Glomus tympanicum, glomus jugulare invading middle ear |
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Vascular retrotympanic mass
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Congenital: aberrant carotid artery, high jugular bulb or dehiscent jugular bulb
Neoplasm: glomus tympanicum, glomus jugulare invading middle ear Cholesterol granuloma, inflammatory debris/granulation tissue |
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Paranasal sinus mass
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Mucocele
Squamous cell carcinoma adenocarcinoma lymphoma inverted papilloma esthesioneuroblastoma ameloblastoma rhabdomyosarcoma juvenile angiofibroma Infectious sinusitis granulomatous sinusitis Osteoma Odontogenic cyst |
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Parapharyngeal space
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Fat
branches of V3 salivary gland rests SCC invading from pharyngeal mucosal , parotid, masticator spaces Abscess from pharynx (tonsillar abscess), masticator space (odontogenic abscess) |
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Pharyngeal mucosal space
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Mucosa
Waldeyer’s ring eustachian tube opening minor salivary glands muscles SCC Non-Hodgkin’s lymphoma, tonsillar abscess |
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Masticator space
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Muscles of mastication (pterygoids, masseter, temporalis)
mandibular ramus branches of V3 Abscess (odontogenic) Mandibular osteosarcoma Rhabdomyosarcoma SCC invasion from pharyngeal and parotid spaces Non-Hodgkin’s lymphoma Neurogenic tumor |
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Retropharyngeal space
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Fat, nodes
Abscess Reactive adenopathy: NL in child, URI, tonsillitis SCC invasion from pharyngeal and mucosal spaces Nodal metastases from pharyngeal SCC, Non-Hodgkin’s lymphoma Hemangioma Neuroblastoma, rhabdomyosarcoma (child) |
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Prevertebral space
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Muscles (prevertebral, paraspinal, scalenes)
Brachial plexus roots, phrenic nerve, vertebrae, vertebral arteries Discitis, osteomyelitis Metastases Primary vertebral body tumor |
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Carotid space
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ICA
internal jugular vein cranial nerves 9, 10, 11, 12, nodes Schwannoma, neurofibroma Glomus jugulare, carotid body tumor Meningioma of jugular foramen Nodal metastases Asymmetrical or thrombosed jugular vein, ectatic carotid artery, carotid pseudoaneurysm |
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carotid body tumor usually
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splays the carotid bifurcation
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glomus vagale/jugulare usually
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displaces carotid anteriorly
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Parotid space
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Parotid glands (with Stenson’s duct)
intraparotid lymph nodes branches of CN 7 external carotid artery Pleomorphic adenoma (adult, T2 bright), Warthin’s tumor (adult) Mucoepidermoid carcinoma, adenoid cystic carcinoma, NHL Nodal metastases from SCC, NHL, melanoma Abscess Lymphoepithelial cysts (AIDS) Hemangioma or lymphangioma (child) Lymphoma 1st branchial cleft cyst |
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Parotid lesions, multiple or bilateral
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Warthin’s tumor
Nodal metastases from SCC, NHL, melanoma Lymphoepithelial cysts (AIDS) |
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Submandibular and sublingual spaces
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Salivary glands
mylohyoid muscle anterior tongue nodes branches of V3, CN 7, 9, 12 |
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Submandibular space (with Wharton’s duct)
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Nodal metastases
Direct invasion from SCC, NHL, salivary gland neoplasm Dermoid or epidermoid cystic hygroma hemangioma salivary gland neoplasm lipoma Abscess, lymphadenitis Second branchial cleft cyst (anterior to sternocleidomastoid muscle) Diving ranula |
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Submandibular space, cystic mass
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Second branchial cleft cyst
Cystic hygroma Dermoid or epidermoid Thyroglossal duct cyst Diving ranula Abscess or necrotic neoplasm |
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Sublingual space
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Invasive SCC of the tongue, salivary gland neoplasm
Dilated Wharton’s duct, abscess (odontogenic or sialoadenitis) Dermoid or epidermoid Ranula (dives below mylohyoid to submandibular space) Cystic hygroma Hemangioma, lingual thyroid posteriorly (child) |
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Sublingual space, cystic mass
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Dermoid or epidermoid
Ranula Cystic hygroma Abscess or necrotic neoplasm |
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Oropharynx lesions
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SqCC
lymphoma adenoid cystic carcinoma mucoepidermoid carcinoma adenocarcinoma hemangioma lymphangioma abscess (child) |
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Larynx extends from
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valleculae to the space between cricoid cartilage/1st tracheal ring
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Supraglottis extends from
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epiglottic tip to laryngeal ventricle (if lesion here only, voice sparing procedure)
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Lesions in larynx/supraglottis:
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SCC
laryngocele thyroglossal duct cyst stenosis trauma |
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Visceral space lesions
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Thyroid and parathyroid glands
esophagus larynx and trachea recurrent laryngeal nerve nodes SCC of the larynx thyroid neoplasm esophageal carcinoma nodal metastases or lymphoma salivary gland neoplasm dermoid or epidermoid Reactive adenopathy abscess Laryngocele |
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Bells palsy
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Ramsay-Hunt syndrome (herpes zoster infection)
Facial nerve schwannoma Perineural tumor spread Sarcoidosis Lymphoma Lyme disease |
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Odontogenic cyst
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Radicular cyst
Dentigerous cyst (tooth) Keratocyst Lateral periodontal cyst |
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Enlarged vestibular aqueduct (>1.5 mm)
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Sporadic
Mondini’s disease [cochlear hypoplasia or incomplete partition of cochlear turns (only 1-1.5x) with vestibular aqueduct enlargement] |
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Cerebellar atrophy
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ETOH
Anti-seizure medications |
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Methanol poisoning results in
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decreased density of lateral Putamina
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CO poisoning causes
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hemorrhagic necrosis of Globus Pallidus
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TPN and liver failure:
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increased T1 signal in basal ganglia (hydrated Ca++)
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Wilson’s disease has
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increased T2 signal in basal ganglia (putamina)
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Huntington’s disease:
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caudate atrophy
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Amyotrophic lateral sclerosis:
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atrophy of frontal lobe, increased T2 signal posterior limb internal capsule
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Parkinson’s disease:
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increased iron in BG, midbrain
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Alzheimer’s disease:
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Diffuse atrophy, hippocampal atrophy, increased T2 signal in WM, temporal lobes
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young adult with supratentorial cystic mass with a mural nodule
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Pleomorphic Xanthoastrocytoma
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Hakeem Adams syndrome:
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NPH (gait ataxia, dementia, urinary incontinence) and may respond to VP shunt
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NMR findings suggestive of brain tumor
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2:1 choline:creatine ratio suggests tumor
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portion of 7th cranial nerve normally enhances minimally
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Cisternal
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Expansile diploic space can occur in
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chronic anemias, dilantin therapy
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Frequency and stability of Odontoid fracture
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type 1 fracture (dens tip) is rare, but mechanically STABLE. Type 2 (base of dens) is the most common, may result in non-union, and is mechanically unstable. Type 3 can be mechanically stable or unstable
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AVM bleed risk
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(2-3% per year) increases with intranidal aneurysm, deep periventricular location, deep venous drainage
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Brain hypoxia/near drowning causes
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BG, posterior limb internal capsule, temperoparietal lobes hypodensity and corresponding T2 hyperintensity
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Ossification of the posterior longitudinal ligament (OPLL) is associated…and located at…
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with DISH, usually at C4-C6
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T2 signal in Wallerian degeneration
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T2 hypointense the first month, then T2 hyperintense after 2-3 months
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Normal Basion-Dens distance:
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<12 mm.
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Power’s ratio:
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if the ratio of Basion to posterior arch C1/Opsthion to anterior arch C1 is >1.0, there is anterior displacement of the C-spine
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Branches of ECA
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SALFOPSI mnemonic:
Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Superficial temporal Internal maxillary (middle meningeal) |
