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55 Cards in this Set
- Front
- Back
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ddx: young patient with infarct
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dissection
vasculitis sickle cell OCPs HIV (neurosyphilis) |
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how is dissection diagnosed
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MR: cresenteric high signal on T1WI surrounding the vessel
MRA: signal loss over long segment Angio: long segment narrowing from proximal ICA to skull base |
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name 3 complications from SAH and when they occur
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hydrocephalus - hours to days
rebleed - 10% @ 1 week, 20% @ 1 month, 50% @ 6 months vasospasm - 1 week |
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what are features of vasospasm
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occurs around 7 days
70% prevalence by angio 30% prevalence clinically 10% have neuro deficit due to vasospasm |
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how is vasospasm treated
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triple H therapy: hypertension, hypervolemia, hemodilution
vasodilators angioplasty |
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what are features of temporal arteritis
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older pts
headache visual changes elevated ESR extracranial vessel irregularity treated with steroids |
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what increases risk for cerebral aneurysms
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atherosclerosis
marfan's pseudoxanthoma elasticum syphilis coartation polycystic kidney disease FMD persistent fetal vessels |
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ddx: young patient with nasal vault mass
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encephalocele
dermoid nasal glioma esthesioneuroblastoma |
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ddx: cerebral vasculitis
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drugs (cocaine, amphetamines)
SLE PAN meningitis SAH radiation primary granulomatous CNS infection HIV syphilis |
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ddx: cerebral atrophy
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HIV
ETOH metabolic MS lupus steroids malnutrition chemotherapy |
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ddx: lobar hemorrhage
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A TIN HAT
AVM/aneurysm trauma infection neoplasm HTN amyloid thrombosis (venous) |
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ddx: mass at maxillary ostium
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antrochoanal polyp
inverting papilloma mucocele |
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ddx: pansinus disease
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allergic polyposis
CF wegener's |
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ddx: destruction of nasal septum
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midline granuloma
wegener's cocaine abuse trauma |
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what is midiline granuloma?
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wegener's variant
aka mutilating granuloma worse prognosis than wegener's |
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ddx: mandibular lesion
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unilocular:
-abscess -radicular cyst -dentigerous cyst multilocular: -amelobastoma -odontogenic keratyocyst -fibrous dysplasia |
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what is the approach to disease of the basal ganglia
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bilateral symmetric: methanol (putamen), CO (globus pallidus)
bilateral asymmetric: infection unilateral: glioma, hemorrhage, toxo, lymphoma |
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ddx: infrahyoid neck, visceral space mass
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thyroglossal duct cyst
thyroid lesion squamous cell ca |
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ddx: parotid space mass
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pleomorphic adenoma
wharthin's tumor (bilateral) adenoid cystic carcinoma mucoepidermoid carcinoma lymphoepithelial cyst lymphoma *pearl* 2/3 of parotid masses are benign; 2/3 of submandibular/sublingual gland masses are malignant |
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ddx: masticator space mass
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odontogenic infection/lesion
sarcoma lymphoma |
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what is a thornwald cyst
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a notochordal remnant
cystic superior nasopharynx, midline |
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ddx: pharyngeal mucosal space mass
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squamous cell carcinoma
tonsillar abscess pleomorphic adenoma thornwald cyst |
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ddx: parapharyngeal space mass
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tonsillar abscess
atypical 2nd branchial cleft cyst pleomorphic adenoma *pearl* pterygoid venous plexus may normally enhance here |
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ddx: carotid space mass
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paraganglioma
schwannoma lymphadenopathy pseudoaneurysm |
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what is the most common middle ear mass?
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glomus tympanicum
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where do middle ear acquired cholesteatomas live
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prussak's space (between ossicles and scutum)
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ddx: petrous apex mass
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cholesterol cyst (granuloma)
congenital cholesteatoma mucocele metastasis chondrosarcoma chordoma (atypical) |
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what is the difference between vasogenic and cytotoxic edema
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vasogenic:
-most common -spreads along white matter tracts -BBB breakdown cytotoxic: -inflammation or ischemia -gray matter and white matter -due to cell death |
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ddx: hyperdense sinus
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fungal sinusitis
inspissated secretion hemorrhage |
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most common osseous tumor of sinuses
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osteoma
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what are the findings in chiari 2
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small posterior fossa
cervico-medullary kink vermian peg beaked tectum elongated 4th ventricle agenesis of corpus callosum stenogyria myelomeningocele |
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what are the findings in dandy-walker
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large posterior fossa
agenesis of vermis torcular inversion migrational abnormalities agenesis of corpus callosum |
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most common cause of solitary lesion in AIDS
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lymphoma
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most common infection of brain in AIDS
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HIV
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second most common infection of brain in AIDS
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toxoplasmosis
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ddx: pulsatile tinnitus
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dehiscent jugular bulb
aberrant carotid artery glomus tumor dural AVM/F petrous aneurysm meningioma |
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what are the types of carotid-cavernous fistula
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direct:
-large hole -trauma or cavernous aneurysm -severe symptoms -any age indirect: -dural AVF -many small holes -mild progressive symptoms -older females |
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ddx: chronic sinus disease
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cystic fibrosis
osteomeatal complex obstruction fungal sinusitis allergic sinusitis obstructing neoplasm wegener's midline granuloma cocaine |
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ddx: subarachnoid hemorrhage
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aneurysm
truama dural AVF?M dissection |
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what are typical injection rates in cerebral angio
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arch: 20-25 cc/total of 40-50
CCA: 7-8/9-10 ICA: 5-6/7-8 ECA: 4/6 vert: 4-5/6-10 |
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how does the signal of parenchymal blood change over time on T1 and T2 WIs
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hyperacute: iso and hyper
acute: iso and hypo early subacute: hyper and hypo late subacute: hyper and hyper chronic: hypo and hypo ItBe IdDy BiDy BaBy DooDoo |
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ddx: intradural, extramedullary lesion
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nerve sheath tumor
meningioma CNS 'drop mets' extra-CNS mets ependymoma dermoid/epidermoid sarcoid |
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what primaries like to spread to leptomeninges
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lung
breast melanoma leukemia/lymphoma |
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name the CNS primaries that can give 'drop mets'
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medulloblastoma
ependymoma germinoma pineoloblastoma choroid plexus papilloma GBM |
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ddx: lateral intraventricular mass
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astrocytoma
choroid plexus papilloma ependymoma meningioma PNET mets subependymal giant cell astrocytoma central neurocytoma dermoid/epidermoid |
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which CNS tumors hemorrhage
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GBM
oligodendroglioma PNET ependymoma mets |
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which mets hemorrhage
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MRICT
melanoma renal cell ca islet cell tumors choriocarcinoma thryoid cancer |
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which mets spread to the dura
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breast
lymphoma prostate neuroblastoma |
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describe a giant intracranial aneursym
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aneurysm > 25 mm
2-5% of all aneurysms F>M 40% involve cavernous ICA |
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compare CT and MR evaluation for infarction
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CT:
acute: early insular ribbon sign, hyperdense vessels late: gray-white differentiation lost, hypodensity subacute: sulcal effacement chronic: encephalomalacia *pearl* may see fogging subacute (infarct is isointense and unseen) MRI: hyperacute: abnormal diffusion/perfusion; intravascular enhancement acute: lost grey-white differentiation, T2 high signal; meningeal enhancement subacute: mass effect, sulcal effacement, gyral enhancement chronic: encephalocmalcia, gyral enhancement *pearl* gyral enhancement may persist for months |
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ddx: spinal intramedullary lesion
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astrocytoma
ependymoma mets hemangioblastoma syringohydromyelia demyelination viral mets sarcoid infarct vascular malformation |
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ddx: sellar/parasellar mass
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SATCHMOE
-suprasellar germinoma/sarcoid -adenoma/aneurysm -TB -crangiopharyngioma/rathke cleft cyst -hypothalamic glioma/hamartoma -meningioma/mets -optic nerve glioma -eosinophilic glioma |
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ddx: pineal lesion
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Baby Germs Make Some People Cough
pineoBlastoma germ cell tumor meningioma spelenium glioma pineocytoma cyst (pineal) |
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what's too large for a pineal cyst
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> 8.5 mm
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what sign on CT may differentiate an intra- from an extra-pineal lesion
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exploded pineal - intrapineal lesions push normal calcs outside them, extrapineal lesions engulf normal calcs
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