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134 Cards in this Set
- Front
- Back
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Ring-enhancing intracranial leions
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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
• Pilocytic astrocytoma • Ependymoma • Pontine glioma |
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Posterior fossa mass, adult
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• Metastasis (most common)
• 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 can occur
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with 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 3, 4, 51, 52, 6
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Cranial nerves 3, 4, 51, 52, 6 traverse the cavernous sinus, so a cavernous sinus mass may present with CN neuropathy. 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; rare adult, 4th ventricle) • Colloid cyst • Astrocytoma (giant cell astrocytoma in Tuberous Sclerosis) • Central neurocytoma (rare, adult) • Medulloblastoma (child, 4th ventricle; adult, cerebellar hemisphere) • Racemose cysticercosis (mimics epidermoid cyst, arachnoid cyst) |
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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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Hyperacute blood MRI
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Hyperacute blood (oxyhemoglobin) is diamagnetic (no unpaired electrons) on MRI, appearing T1 isointense/T2 hyperintense
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White matter disease (multiple)
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• Ischemia
• Multiple sclerosis • Acute disseminated encephalomyelitis: measles, mumps, mononucleosis, varicella; post-vaccination (basal ganglia/thalamus abnormalities differentiate from MS) • PML (classically occipitoparietal regions) • Central pontine myelinolysis • SLE and other collagen vascular diseases • Sarcoid • Lyme disease • Vitamin B12 deficiency • Radiation injury • Dysmyelinating disease: Canavan’s disease (diffuse, macrocephaly), Krabbe’s disease (diffuse), Alexander’s disease (anterior), adrenal leukodystrophy (posterior), metachromatic leukodystrophy (diffuse), Pelizaeus-Merzbacher disease |
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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; sarcoidosis; SLE, Wegener’s disease, Behcet’s disease; methamphetamine, ergotism • Basilar meningitis: bacterial, TB, fungal, syphilis • Fibromuscular dysplasia • Migraine • Moyamoya disease (child): idiopathic; mimics include Sickle cell anemia, NF-1, connective tissue disorders (Marfan’s syndrome, Ehlers-Danlos, homocysteinuria), radiation injury, Menke’s kinky hair syndrome, atherosclerosis (uncommon) |
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Traumatic dissection of the ICA
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Traumatic dissection of the ICA usually occurs immediately above the carotid bifurcation, near the skull base, or at the level of the supraclinoid ICA. Dissection of the vertebral artery occurs at 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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Hypertensive encephalopathy can occur in pregnancy, renal failure, TTP, hemolytic-uremic syndrome. It’s similar in appearance to 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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Which aneurysm is bleeding?
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• Proximity to site of hemorrhage on CT
• Large size • Adjacent spasm • Beaking of aneurysm contour • Frank extravasation of contrast (rare) |
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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); GBM, oligodendroglioma • Amyloid angiopathy • Drugs abuse: cocaine, amphetamine • Other: coagulopathy, vasculitis, encephalitis |
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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; otomastoiditis • Post-surgical • SAH • Meningeal (pial) angiomatosis in Sturge-Weber |
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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; CMV (AIDS) |
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Hydrocephalus
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• Congenital: idiopathic, Chiari II malformation, Dandy-Walker malformation, aqueductal stenosis, perinatal hemorrhage or meningoencephalitis (STARCH)
• Communicating: 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) • STARCH mnemonic: 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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• 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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Fahr’s disease
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Idiopathic Basal Ganglia Calcification, also known as Fahr disease or Fahr’s Syndrome is a rare,[1] genetically dominant, inherited neurological disorder characterized by abnormal deposits of calcium in areas of the brain that control movement, including the basal ganglia and the cerebral cortex. It is a rare degenerative neurological disorder characterized by calcifications and cell loss within the basal ganglia.[2]
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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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Cockayne’s syndrome
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Cockayne syndrome (also called Weber-Cockayne syndrome, or Neill-Dingwall Syndrome) is a rare autosomal recessive[1] congenital disorder characterized by growth failure, impaired development of the nervous system, abnormal sensitivity to sunlight (photosensitivity), and premature aging.[2]:575 Hearing loss and eye abnormalities (pigmentary retinopathy) are other common features, but problems with any or all of the internal organs are possible. It is associated with a group of disorders called leukodystrophies. The underlying disorder is a defect in a DNA repair mechanism.[3]
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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; adenocarcinoma, melanoma, lymphoma/leukemia • Dermoid, epidermoid • Lipoma • MANDELIN mnemonic: 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; neurofibroma, schwannoma
• Abscess • Ewing’s sarcoma • Lymphoma/leukemia • Eosinophilic granuloma • Other vertebral body tumors (above) |
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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; adult: breast, lung, prostate, melanoma to uvea, rectus muscles, 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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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 vs glomus vagale/jugulare
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Remember: carotid body tumor usually splays the carotid bifurcation, while glomus vagale/jugulare 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 include
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SCC, lymphoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, adenocarcinoma; hemangioma, lymphangioma, abscess (child)
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Larynx extends from the valleculae to the space between cricoid cartilage/1st tracheal ring. Supraglottis is epiglottic tip to laryngeal ventricle (if lesion here only, voice sparing procedure). Lesions in these areas:
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SCC, laryngocele, thyroglossal duct cyst, stenosis, trauma
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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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ADC is calculated with
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at least 2 measurements of diffusion capacity with different b values. We use b=0, b=500 or 1000
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2. For epidermoid vs. arachnoid cyst,
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try FLAIR (arachnoid cyst is dark) or DWI (restricted diffusion;bright with epidermoid cyst)
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3. Methanol poisoning
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results in decreased density of lateral Putamina
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4. CO poisoning
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causes hemorrhagic necrosis of Globus Pallidus
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5. TPN and liver failure:
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increased T1 signal in basal ganglia (hydrated Ca++)
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6. Wilson’s disease
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has increased T2 signal in basal ganglia (putamina)
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7. Huntington’s disease:
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caudate atrophy
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8. Amyotrophic lateral sclerosis
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atrophy of frontal lobe, increased T2 signal posterior limb internal capsule
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9. Parkinson’s disease:
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increased iron in BG, midbrain
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10. Alzheimer’s disease
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Diffuse atrophy, hippocampal atrophy, increased T2 signal in WM, temporal lobes
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11. Pleomorphic Xanthoastrocytoma
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(young adult): supratentorial cystic mass with a mural nodule
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12. Hakeem Adams syndrome:
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NPH (gait ataxia, dementia, urinary incontinence) and may respond to VP shunt
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13. NAA
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should be highest peak; a 2:1 choline:creatine ratio suggests tumor
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14. CC/VV planes
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14. CC/VV planes are carotid-cochlea (anterior)/vestibular-vein (posterior)
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15. Diffusion MR will be bright with metastatic collapse of vertebral body, but
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15. Diffusion MR will be bright with metastatic collapse of vertebral body, but not with osteoporotic collapse
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16. Perimedullary and intramedullary AVMs
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16. Perimedullary and intramedullary AVMs are very difficult to treat with catheter. However, dural AVM is amenable to catheter treatment
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What portion of 7th cranial nerve normally enhances minimally
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17. Cisternal
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18. Hangman fracture
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is hyperextension, distraction/compression forces at C2
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19. Cerebral abscess
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may have thicker enhancing wall toward the cortical side, and a T2 hypointense rim (free radicals?)
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20. Expansile diploic space
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can occur in chronic anemias, dilantin therapy
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21. Odontoid type 1 fracture
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(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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22. 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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23. Cavernous angioma
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and developmental venous anomaly (most common malformation) often occur together. Cavernous angioma has no NL intervening brain, while capillary telangiectasia does
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24. A dural AVF
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may be due to occlusion of a dural venous sinus
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C-C fistula
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can be high flow (young males, trauma, direct communication between carotid and cavernous sinus) or low flow (middle-aged female, spontaneous, communication between dural branches of ICA or ECA and cavernous sinus). Try balloon occlusion
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26. Hypertensive bleed
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occurs in basal ganglia, thalamus, pons, cerebellum
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27. Brain hypoxia/near drowning
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causes BG, posterior limb internal capsule, temperoparietal lobes hypodensity and corresponding T2 hyperintensity
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28. An acute hemorrhage
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may be due to an underlying mass or vascular malformation if there is enhancement and/or disorganized/different clot stages
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29. Hemorrhagic transformation
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(15-50%) occurs on days 2-14 after ictus, while hemorrhagic infarction (5%) occurs within 24 hours of ictus
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30. Germinal matrix hemorrhage
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occurs in 67% of 28-32 week premies. Grades 1 & 2 have good prognoses, while 3 & 4 have poor prognoses. Grade 4 is probably due to hemorrhagic infarction from compression of the deep medullary veins (90% mortality)
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31. Ossification of the posterior longitudinal ligament
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31. Ossification of the posterior longitudinal ligament (OPLL) is associated with DISH, usually at C4-C6
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32. Unilateral interfacetal dislocation
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is mechanically STABLE, whereas bilateral is mechanically and neurologically UNSTABLE
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33. Wallerian degeneration
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is 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. Power’s ratio: 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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Acceptable spine terminology
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• Disc bulge
• Protrusion • Extrusion |
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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) |
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Cerebral angiography:
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Omnipaque 300 (full strength for cut-film, 50% dilution for DSA), 5F-7F Simmons (elderly), Berenstein catheter (young adult) or Head Hunter (general use), AP/lateral/oblique views as necessary
• CCA run: 10cc/sec for 12cc • ICA run: 8cc/sec for 10cc • ECA run: 4cc/sec for 6cc • VA run: 6cc/sec for 8cc with straight AP or Waters (basilar tip)/Towne view (PCA) • 2-4 frames/sec |
