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55 Cards in this Set

  • Front
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ddx: young patient with infarct
dissection
vasculitis
sickle cell
OCPs
HIV (neurosyphilis)
how is dissection diagnosed
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
name 3 complications from SAH and when they occur
hydrocephalus - hours to days
rebleed - 10% @ 1 week, 20% @ 1 month, 50% @ 6 months
vasospasm - 1 week
what are features of vasospasm
occurs around 7 days
70% prevalence by angio
30% prevalence clinically
10% have neuro deficit due to vasospasm
how is vasospasm treated
triple H therapy: hypertension, hypervolemia, hemodilution
vasodilators
angioplasty
what are features of temporal arteritis
older pts
headache
visual changes
elevated ESR
extracranial vessel irregularity
treated with steroids
what increases risk for cerebral aneurysms
atherosclerosis
marfan's
pseudoxanthoma elasticum
syphilis
coartation
polycystic kidney disease
FMD
persistent fetal vessels
ddx: young patient with nasal vault mass
encephalocele
dermoid
nasal glioma
esthesioneuroblastoma
ddx: cerebral vasculitis
drugs (cocaine, amphetamines)
SLE
PAN
meningitis
SAH
radiation
primary granulomatous CNS infection
HIV
syphilis
ddx: cerebral atrophy
HIV
ETOH
metabolic
MS
lupus
steroids
malnutrition
chemotherapy
ddx: lobar hemorrhage
A TIN HAT

AVM/aneurysm
trauma
infection
neoplasm
HTN
amyloid
thrombosis (venous)
ddx: mass at maxillary ostium
antrochoanal polyp
inverting papilloma
mucocele
ddx: pansinus disease
allergic polyposis
CF
wegener's
ddx: destruction of nasal septum
midline granuloma
wegener's
cocaine abuse
trauma
what is midiline granuloma?
wegener's variant
aka mutilating granuloma
worse prognosis than wegener's
ddx: mandibular lesion
unilocular:
-abscess
-radicular cyst
-dentigerous cyst
multilocular:
-amelobastoma
-odontogenic keratyocyst
-fibrous dysplasia
what is the approach to disease of the basal ganglia
bilateral symmetric: methanol (putamen), CO (globus pallidus)
bilateral asymmetric: infection
unilateral: glioma, hemorrhage, toxo, lymphoma
ddx: infrahyoid neck, visceral space mass
thyroglossal duct cyst
thyroid lesion
squamous cell ca
ddx: parotid space mass
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
ddx: masticator space mass
odontogenic infection/lesion
sarcoma
lymphoma
what is a thornwald cyst
a notochordal remnant
cystic
superior nasopharynx, midline
ddx: pharyngeal mucosal space mass
squamous cell carcinoma
tonsillar abscess
pleomorphic adenoma
thornwald cyst
ddx: parapharyngeal space mass
tonsillar abscess
atypical 2nd branchial cleft cyst
pleomorphic adenoma

*pearl* pterygoid venous plexus may normally enhance here
ddx: carotid space mass
paraganglioma
schwannoma
lymphadenopathy
pseudoaneurysm
what is the most common middle ear mass?
glomus tympanicum
where do middle ear acquired cholesteatomas live
prussak's space (between ossicles and scutum)
ddx: petrous apex mass
cholesterol cyst (granuloma)
congenital cholesteatoma
mucocele
metastasis
chondrosarcoma
chordoma (atypical)
what is the difference between vasogenic and cytotoxic edema
vasogenic:
-most common
-spreads along white matter tracts
-BBB breakdown
cytotoxic:
-inflammation or ischemia
-gray matter and white matter
-due to cell death
ddx: hyperdense sinus
fungal sinusitis
inspissated secretion
hemorrhage
most common osseous tumor of sinuses
osteoma
what are the findings in chiari 2
small posterior fossa
cervico-medullary kink
vermian peg
beaked tectum
elongated 4th ventricle
agenesis of corpus callosum
stenogyria
myelomeningocele
what are the findings in dandy-walker
large posterior fossa
agenesis of vermis
torcular inversion
migrational abnormalities
agenesis of corpus callosum
most common cause of solitary lesion in AIDS
lymphoma
most common infection of brain in AIDS
HIV
second most common infection of brain in AIDS
toxoplasmosis
ddx: pulsatile tinnitus
dehiscent jugular bulb
aberrant carotid artery
glomus tumor
dural AVM/F
petrous aneurysm
meningioma
what are the types of carotid-cavernous fistula
direct:
-large hole
-trauma or cavernous aneurysm
-severe symptoms
-any age
indirect:
-dural AVF
-many small holes
-mild progressive symptoms
-older females
ddx: chronic sinus disease
cystic fibrosis
osteomeatal complex obstruction
fungal sinusitis
allergic sinusitis
obstructing neoplasm
wegener's
midline granuloma
cocaine
ddx: subarachnoid hemorrhage
aneurysm
truama
dural AVF?M
dissection
what are typical injection rates in cerebral angio
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
how does the signal of parenchymal blood change over time on T1 and T2 WIs
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
ddx: intradural, extramedullary lesion
nerve sheath tumor
meningioma
CNS 'drop mets'
extra-CNS mets
ependymoma
dermoid/epidermoid
sarcoid
what primaries like to spread to leptomeninges
lung
breast
melanoma
leukemia/lymphoma
name the CNS primaries that can give 'drop mets'
medulloblastoma
ependymoma
germinoma
pineoloblastoma
choroid plexus papilloma
GBM
ddx: lateral intraventricular mass
astrocytoma
choroid plexus papilloma
ependymoma
meningioma
PNET
mets
subependymal giant cell astrocytoma
central neurocytoma
dermoid/epidermoid
which CNS tumors hemorrhage
GBM
oligodendroglioma
PNET
ependymoma
mets
which mets hemorrhage
MRICT

melanoma
renal cell ca
islet cell tumors
choriocarcinoma
thryoid cancer
which mets spread to the dura
breast
lymphoma
prostate
neuroblastoma
describe a giant intracranial aneursym
aneurysm > 25 mm
2-5% of all aneurysms
F>M
40% involve cavernous ICA
compare CT and MR evaluation for infarction
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
ddx: spinal intramedullary lesion
astrocytoma
ependymoma
mets
hemangioblastoma
syringohydromyelia
demyelination
viral mets
sarcoid
infarct
vascular malformation
ddx: sellar/parasellar mass
SATCHMOE

-suprasellar germinoma/sarcoid
-adenoma/aneurysm
-TB
-crangiopharyngioma/rathke cleft cyst
-hypothalamic glioma/hamartoma
-meningioma/mets
-optic nerve glioma
-eosinophilic glioma
ddx: pineal lesion
Baby Germs Make Some People Cough

pineoBlastoma
germ cell tumor
meningioma
spelenium glioma
pineocytoma
cyst (pineal)
what's too large for a pineal cyst
> 8.5 mm
what sign on CT may differentiate an intra- from an extra-pineal lesion
exploded pineal - intrapineal lesions push normal calcs outside them, extrapineal lesions engulf normal calcs