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60 Cards in this Set
- Front
- Back
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What is the DDX for density in the subarachnoid space
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blood
cellular material : carcinomatosis disease, sarcoid iodinated contrast CSF hypotension Anoxia |
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What pt tend to have contrast that leaks out of the meninges into the subarachnoid space
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renal failure pt
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Do pt with CSF hypotension and brain anoxia have fluid in the subarachnoid space
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no, it just looks like it
global anoxia has dense venous stasis CSF hypotension has crowded normal blood vessels |
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What is the white cerebellum sign
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The density of the cerebellum and other infratentorial structures is preserved and shows a relatively hyperdense appearance that contrasts with the supratentorial structures
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Do pts with CSF hypotension or brain anoxia have hydrocephalus
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no
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What happens to the venous sinuses in CSF hypotension
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the size of the sinuses become more distinct and more easily seen
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What are 3 signs of global anoxia
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dense material in SA space, bright cerebellum, loss of grey white differenitation of the basal ganglia
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If there is hydrocephalus and dense material in the subarachnoid space what is the ddx
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blood
cellular material iodinated contrast |
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What 2 pt tend to have iodinated material in the subarachnoid space
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renal failure pts and pt with recent CT myelogram
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What are the causes of cellular material in the SA space
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carcinomatosis
Infection: Bacterial (pyogenic), TB, fungal granulomatous: sarcoid |
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If a pt has diffuse SA would blood in the ventricles be expected
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yes
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Can coccidioidomycosis cause a pyogenic infection of the subarachnoid space
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yes
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What does coccidioidomyocosis typically affect first
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lungs (it is an airborne infection)
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Can coccidioidomyocosis go on to the disseminatedd form without the pt being immunocompromised
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yes
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What is- normal opening pressure of CSF
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80-150mmhg
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What is it called when opening pressure is elevated in an otherwise normal appearing brain on CT
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idiopathic intracranial hypertension or pseudotumor cerebri
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What are 2 clinical SS of IIH
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headache and changes in visual acuity (papiledema)
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What is a classic imaging feature of IIH on MR
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focal narrowing of bilateral transverse sinuses
empty sella flatened posterior globe tortous and disended optic sheath uncommonly slit like ventricles |
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What is the classic demographic of a pt with IIH
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women , 3rd decade, obese
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What are causes of intracranial htn besides IIH
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mass, edema, DST
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What are 4 general classifications for causes of stroke
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cardiac (embolic)
prothrombic inherited aquired disorder |
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What are some cardiac causes of stroke 3
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congenital heart disease (low output)
Valve disease (low output) LA myxoma (embolic) |
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What are causes of prothrombic disorders which may lead to stroke 10
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sickle cell
Protein S or C antithrombin deficiency factor 5 leiden lupus anticoagulant polycythemia platelet disorder leukemia chemotherapy related |
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What is the ddx of inherited vascular disorders which may lead to stroke
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neurocutaneous syndrome
CADASIL |
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What is the ddx of metabolic disorders which may lead to stroke
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MELAS, homcystinuria
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What are the acquired vascular disorders which may lead to stroke
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dissection, moya-moya, systemic or CNS angiitis, migraines, birth control, methamphetamine
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What are 4 causes of basal ganglia calcifications
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fahrs syndrome
hypo/hyper parathyroidism MELAS HIV |
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What is MELAS
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mitochondrial encephalopathy lactic acidosis
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What is FAHRs syndrome
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It is a rare degenerative neurological disorder characterized by calcifications and cell loss within the basal ganglia
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What does CADASIL stand for?
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(cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)
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What are the clinical SS of CADASIL
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CADASIL may start with attacks of migraine with aura or subcortical transient ischemic attacks or strokes, or mood disorders between 35 to 55 years of age.
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Where are the most common locations for MELAS to present
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parietal and occipital lobes
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What does MELAS look like on imaging
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stroke-like cortical lesions that cross usual vascular territories
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What lab/imaging technique can be used to determine if the pt has MELAS
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spectroscopy, if it is put of the part of the brain that is not affected there will be a peak in the range of lactate
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What does the S in MELAS stand for
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stroke like episodes
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When does MELAS typically present
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2nd decade of life
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What are the clinical signs and symptoms of MELAS
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headache, hemianopsia, psychosis, aphasia
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Does MELAS have basal ganglia calcification
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yes
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What causes the strokes associated with MELAS
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proliferation of dysfunctional mitochondria in endothelial smooth muscles of small arteries
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What are the MR findings of central pontine myelinolysis
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pontine T2 hyperintensity
enlarged pons Restricted diffusion no abnormal enhancement |
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What does the T2 hyperintensity of CPM look like
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symmetrical
bat wing contour |
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What is the DDX of T2 pontine hyperintensity
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ischemia
infection brainstem glioma white matter pathology |
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If a pt has pontine hyperintensity on T2 and no enhancement what can be ruled out
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infection (will usually have enhancement)
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Besides the pontine area where else does CPM affect
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basal ganglia, thalami, midbrain
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What is the cause of CPM
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rapid correction of sodium
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Is it possible for CPM to not effect the pons and affect other areas of the brain
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yes
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How is CPM distinguished from MS or ADEM
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CPM will have restricted diffusion whereas MS and ADEM will not
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What does PRES stand for
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posterior reveresible encephalopathy
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What does PRES look like on MR
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extensive hyperintensity of subcortical WM (T2) of the posteriror frontal parietal and occipital lobes
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What does Press look like on CT
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bilateral symmetric hypodensity of the posterior frontal, parietal and occipital lobe
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Is there restricted diffusion in PRES syndrome
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no, and therefore this is secondary to vasogenic edema
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Does PRES have an acute onset
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yes
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What is the current favored theory for pathophysiology of PrES
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vasoconstriction and hypoperfusion
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What is PRES associated with
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HTN
Eclampsia/preeclampsia Acute GN HUS TTP lupus Sz Drug toxicity |
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What are some examples of drugs which may cause PRES
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tacrolimus FK 506
cyclosporine erythropoietin cisplatin |
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Can PRES involve the grey matter
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yes, but is mostly subcortical white matter
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Does PRES have restricted diffusion
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yes, in the non-reversible areas
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What is the 'posterior' in PRESS refer to
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that the majority of the pathology is in the posterior circulation
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What is the cause of the signal abnormality in PRES
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vasogenic edema
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If something is DWI positive (restricted diffusion) in PRES does that mean it is non reversible
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yes, these areas are usually non-reversible
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