Ucsf: Video E 46 Part 1 Neuro Self-Assessment

Front 1

What MR sequence is recommended if you suscpect a carotid dissection

Back 1

Fat Sat T1 sequence
(methhemoglobin will be bright)

Front 2

What are the clinical SS of a ICA dissection

Back 2

neck pain, stroke symptoms, horners, CN 12 palsy

Front 3

What is a cranial nerve 12 palsy

Back 3

paralysis of the tongue deviation towards the side that is injured (hypoglossal nerve)

Front 4

Where are the common location of ICA dissection

Back 4

above the bifurcation (spontaneous)
distal cervical
skull base

Front 5

What types of ICA dissections occur in the distal cervical ICA and at the skull base

Back 5

traumatic

Front 6

Where do vetebral artery dissections mc occur

Back 6

C1-C2

Front 7

What are 4 presenting radiographic features of an iCA dissections

Back 7

string sign
aneurysmal dilation
occlusion
intimal flap

Front 8

Can amyloid angiopathy present as a lobar hemorrhagic stroke

Back 8

yes (15% over 60y and 50% over 70)

Front 9

What caues multiple areas of suseptibility on a GRE sequence
2

Back 9

amyloid angiopathy
hypertensive hemorrhage

Front 10

What is more likely to have basal ganglia bleeds, amyloid or hypetensive

Back 10

hypertensive

Front 11

What does amyloid angiopathy and hypertensive bleeds look like on GRE

Back 11

multiple black dots (microhemorrhages)

Front 12

Does Amyloid angiopathy spare the basal ganglia

Back 12

yes

Front 13

What is the ddx for non-traumatic intraparenchymal hemorrhage

Back 13

underlying lesions
amyloid angiopathy
Dural venous sinus thrombosis
hypertension
coagulopathy

Front 14

What are the underlying lesions which may cause a non-traumatic intraparencymal hemorrhage

Back 14

tumor, AVM, Cavernoma, aneurysm

Front 15

Where is the classic locations of hypertensive hemorrhage

Back 15

BG, pons, cerebellum

Front 16

What percent of hypertensive hemorrhage occur in the putamen and thalamus

Back 16

60% putamen
15-25% thalamus

Front 17

What are the 2 patterns of hypertensive bleeds

Back 17

acute focal hematoma
subacute/chronic mirobleeds

Front 18

What is the ddx for multiple intraparnecymal calcifications

Back 18

cavernomas
neurocysticercosis
prior infections such as treated tb or toxo

Front 19

What is a cavernoma

Back 19

They are usually solitary, although upto 1/3rd of patients with sporadic lesions have more than one . Multiple lesions may be familial and screening of family members may be indicated. (see familial multiple cavernous malformation syndrome) Additionally, they are commonly seen after therapeutic irradiation of the brain, along with capillary telangiectasias

Front 20

What does a cavernoma look like on T2

Back 20

a hemosiderin (dark) ring with T2 bright signal centrally

Front 21

What is the DDX of multiple foci of susceptibility (dark) areas on GRE

Back 21

amyloid angiopathy
HTN
Cavernoma
shear injury

Front 22

What is the make up of cavernous malformation

Back 22

discrete collections of endothelial lined sinusoids 'caverns'

Front 23

Do cavernomas have a tendency to rebleed

Back 23

yes

Front 24

What % of cavernomas are sporadic

Back 24

75%

Front 25

What % are familial

Back 25

10-30%

Front 26

What are the MR characteristics of a cavernous malformation

Back 26

hemosiderin ring 'black ring'
popcorn T2 hyperintensity
T1: hyper and hypo locules

Front 27

Does a cavernoma enhance

Back 27

minimal or no enhancement

Front 28

What % of cavernous malformations have calcification on CT

Back 28

50%

Front 29

What does capillary telangiectasia look like on MR

Back 29

T2: no signal
T1 +gad: 'brush enhancement'
GRE: Dark

Front 30

Where is a classic location of a telangiectasia

Back 30

brainstem

Front 31

What are capillary telangiectasia associated with

Back 31

radiation

Front 32

What do you want to determine about an AVM when doing a

Back 32

the feeding vessel and draining vessel

Front 33

How is an AVM different from a cavernoma (cavernous malformation)

Back 33

Unlike an arteriovenous malformation , there is no large feeding artery and no large draining vein in a cavernoma

Front 34

What are 2 additional names of a cavernoma

Back 34

cavernous malformation, also known as a cavernous hemangioma or cavernoma

Front 35

What is an AVM

Back 35

is a site of abnormal connectivity between arteries and veins. It is basically like a tangle of worms, where the greatest concentration of worms in the central portion of the AVM (this part is the "nidus") is made up of abnormal blood vessels that are hybrids between true arteries and veins.

Front 36

Besides the feeding and draining vessels what other important information is determined from a angiogram

Back 36

eloquent location and size

Front 37

What is spetzler martin grading system

Back 37

a grading system for AVMs

Front 38

What are the 3 categories of the spetzler martin grading system

Back 38

size of AVM nidus
Eloquence of adjacent brain
pattern of venous drainage

Front 39

What are 3 treatments of AVMs

Back 39

surgical resection
gamma knife
embolization

Front 40

Does an AVM have intervening capillary bed

Back 40

no, it is AV shunting

Front 41

What % of AVMs are solitary and sporadic

Back 41

98%

Front 42

What has a higher risk of bleeding per year; cavernoma, AVM

Back 42

AVM (1-4%)
cavernoma (.24-1%)

Front 43

What are two hereditary conditions that will cause AVMs

Back 43

Hereditary hemorrhagic hematoma
oslo-weber-rendu

Front 44

What cause an increased risk of aneurysm

Back 44

feeding artery aneurysm (15%)
nidus aneurysm (50%)
deep location
smaller nidus

Front 45

What is the appearance of an AVM on CT

Back 45

calcification 25-30%
iso/hyperdense vessels

Front 46

What is the classical shape of an MRI of a AVM

Back 46

bag of worms

Front 47

What are 2 types of vascular malformations that cause shunts

Back 47

AVM
Dural Arteriovenous fistula

Front 48

What are 3 valcular malformations in which there is no shunt

Back 48

Cavernous malformation
Developmental venous anomaly
capillary telangiectasia

Front 49

What is the major vessel that leads to a meningioma

Back 49

external carotid artery

Front 50

What does a meningioma look like on external carotid angiography

Back 50

a hypervascular mass

Front 51

What is the mother in law sign in angiography of a meningioma

Back 51

contrast comes early stays late

Front 52

What is the ddx of an extraaxial vascular mass

Back 52

meningioma, met, hemangiopericytoma, lymphoma, chondroma, mets

Front 53

Can a aneursym cause both intraparencymal and SAH

Back 53

yes

Front 54

What are the 3 portions of the ICA

Back 54

petrous
cavernous
supraclinoid

Front 55

What is a proxiamal branch of the supraclinoid

Back 55

opthalamic branch (helps to differentiate cavernous and supraclinoid

Front 56

What test should be ordered if SAH is seen

Back 56

CTA to look for an aneurysm

Front 57

What is a common symptom associated with PCOMM aneurysm

Back 57

3rd nerve palsy

Front 58

What are 2 complications of ruptured aneurysm

Back 58

hydrocephalus
Vasospasm

Front 59

What do many patients who have a ruptured aneursym end up needing

Back 59

EVD

Front 60

What is the section of the ICA called before the base of the skull

Back 60

the cervical ICA

Front 61

What are some genetic conditions that are associated with aneursyms

Back 61

fibromuscular dysplasia
Type 4 ehlers danlos
NF1
ADPCKD
Anatomic vascular anatomy (trigeminal artery)

Front 62

What is a persitent trigeminal artery

Back 62

fetal connection which remains after birth and connects the cavernous carotid to the upper 1/3 of the basilar artery

Front 63

What is a potential complication of a persistent trigeminal artery

Back 63

aneurysm

Front 64

What is the only ddx of a persistent trigeminal artery

Back 64

a fetal PCA

Front 65

What does a fetal PCA connect

Back 65

supraclinoid ICA to posterior circulation

Front 66

What should be suspected if a pt comes in with cranial nerve palsy of CN 3, 4, 6

Back 66

a lesion with in the cavernous sinus, such as a cavernous aneurysm

Front 67

If there is an abnormality of both thalami what should be suspected

Back 67

Dural sinus thrombosis

Front 68

What is a centrally located vein that comes off the superior sagital sinus

Back 68

vein of trolard

Front 69

What veins branch off the confluence of the transverse sinus and superior sagital sinus

Back 69

the striaght sinus, which branches into the internal cerebral veins and veins of galen

Front 70

When is the empty delta sign seen

Back 70

on post contrast CT

Front 71

What is seen on CT in a pt with dural sinus thrombosis

Back 71

hyperdense and expanded sinus

Front 72

What is seen on MR in a pt with dural sinus thrombosis

Back 72

loss of normal flow void

Front 73

What are 2 MR pitfalls for a dural sinus thrombosis (Flair, TOF MRV)

Back 73

Flair: acute dural sinus thrombosis appears dark
TOF MRV: T1 shortening

Front 74

Where is the pattern of venous ischemia if a pt has a superior sagital sinus thombosis

Back 74

parasagittal ?

Front 75

Where is the pattern of venous ischemia if a pt has a transverse sinus thrombosis

Back 75

temporal lobe

Front 76

Where is the pattern of venous ischemia if a pt has a deep sinus thrombosis (ICV, VOG, straight sinus)

Back 76

bithalamic

Front 77

What are fudicial markers for on the scalp

Back 77

pt who is to have a biopsy

Front 78

What more commonly has decreased diffusion; arterial infarct or venous

Back 78

arterial almost always and venous will sometimes have decreased diffusion

Front 79

What general area does venous infarct commonly affect

Back 79

subcortical white matter

Front 80

What is more common a venous ischemic infarct hemorrhagic infarct

Back 80

hemorrhagic infarct

Front 81

What is a good landmark for the suprasellar cistern on axial slices

Back 81

anterior to the mickey mouse shape of the midbrain

Front 82

What is Moya Moya

Back 82

idiopathic progressive arteriopathy of childhood

Front 83

What part of cerebral arterial circulation does moya moya tend to affect; anterior or posterior

Back 83

anterior ( the supraclinoid internal carotid artery and proximal circle of willis)

Front 84

What are some disease that may mimic moya moya
4

Back 84

sickle cell, NF, atherosclerosis, radiation

Front 85

What is the classic angiographic appearance of Moya Moya

Back 85

a puff of smoke which represents a cloud like appearance of lenticulostriate collaterals

Front 86

What enhances in moya moya on MR and CT
2

Back 86

there is leptomeningeal enhancement and Basal ganglia enhancement

Front 87

What causes the enhancement seen in moya moya

Back 87

slow flow due to collaterals

Front 88

How does the infarct created by moya moya differ in adult and children

Back 88

children: ischemic
adult: hemorrhagic

Front 89

What are the findings of a Cavernous-carotid fistula

Back 89

proptosis, enlarged superior opthalamic veins, enlargement of extraocular muscles, retrobulbar stranding, bowing of cavernous sinus

Front 90

What are the two types of CC fistulas

Back 90

indirect and direct

Front 91

What is the MC cause of an indirect CCF

Back 91

spontaneous

Front 92

What is the MC cause of a direct CCF
2

Back 92

trauma, aneurysm rupture

Front 93

What is low flow CCF; direct or indirect

Back 93

indirect

Front 94

What is the branch which is usually involved in a indirect CCF

Back 94

meningeal branch