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153 Cards in this Set
- Front
- Back
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What causes the normal T1 bright spot of the neurohypophysis? |
Proteins bound to vasopressin |
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What can cause bilateral high T1 signal in the globus palladi, pontine tegmentum and anterior pituitary? |
Manganese deposition from long term TPN |
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Cyst in the interventricular foramen of Monroe? |
Colloid cyst |
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Time frame for high T2 signal (edema) in acute stroke? |
Arises in 6-24 hrs Peaks at 3-7 days Persists for 6-8 weeks |
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What is the max size for the central canal of the spinal cord to not be considered pathologic? |
3mm |
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Increased intracellular free water in the brain is known as _____ edema |
Cytotoxic |
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Increased extracellular free water in the brain is known as _____ edema |
Vasogenic (BBB breakdown) |
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Bilateral optic nerve hyperintense T2 signal with extension of signal to the chiasm? |
NMO |
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Greater than 3 vertebral body length involvement with high T2 signal of the central spinal cord? |
NMO |
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Where is the motor cortex controlling the hand? |
Its the "inverted omega" (motor cortex is anterior) |
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Describe what cavum velum interpositum is. |
Extension of the quadrigeminal plate cistern to the foramen of Monro |
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Name the points of the star and the smile face. |
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How does immature myelin look on T1/T2? |
Low T1, high T2 because of high water content |
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At what age is the adult myelination pattern seen for T1 and T2? |
T1 pattern at 1 yo
T2 pattern at 2 yo |
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What is the order of brain development/myelination? |
Central to peripheral (inf to sup) UP Sensory to motor (post to ant) FORWARD |
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What is the last part of the brain to myelinate? |
Subcortical white matter Occipital lobe at 12 mo Frontal lobe at 18 mo |
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Where are the terminal zones of myelination? |
Subcortical frontotemporalparietal regions Finish around 40 mo |
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What parts of the brain are normally myelinated at birth? |
Brainstem Posterior limb of internal capsule |
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What are the parts of the corpus callosum and what is the order of development? |
Order: Genu Body Splenium Rostrum |
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What is the order of sinus development? |
Maxillary Ethmoid Sphenoid Frontal (MESF) |
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Contents of foramen ovale? |
V3 Accessory meningeal artery (sole of a high healed shoe) |
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Contents of foramen spinosum? |
Middle meningeal artery |
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Contents of foramen rotundum? |
V2 (R2V2) |
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Contents of the superior orbital fissure? |
3 4 V1 6 |
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Contents of the inferior orbital fissure? |
V2 |
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Contents of the jugular foramen? |
Jugular vein 9 10 11 |
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Contents of the hypoglossal canal? |
12 |
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Contents of the optic canal? |
2 Opthalmic artery |
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What runs in the cavernous sinus? |
3 O 4 CAT V1 O V2 M C 6 |
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Name the branches of the trigeminal nerve. |
V1 Opthalmic V2 Maxillary V3 Mandibular |
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Name the cranial nerves. |
1 Olfactory 2 Optic 3 Oculmotor 4 Trochlear 5 Trigeminal 6 Abducens 7 Facial 8 Vestibulochoclear 9 Glossopharyngeal 10 Vagus 11 Spinal accessory 12 Hypoglossal |
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What are the branches of the external carotid artery? |
Some Admins Like to F Over Poor Med Studs Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superficial temporal |
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What portion of the ICA has to be carefully avoided when exposing Meckel's cave? |
Lacerum (C3) |
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An aneurysm of which portion of the ICA has the strongest association with hypertension? |
Cavernous |
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What are the deep cerebral veins? |
Basal vein of Rosenthal Vein of Galen Inferior petrosal sinus |
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What vascular anomaly can give CN 3 palsy? |
PCOM aneurysm |
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What entity can give CN 6 palsy? |
Increased ICP Petrous apicitis |
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Middle aged obese woman with slit-like ventricles, small or empty sella and compressed venous sinuses? |
Psuedotumor cerebri |
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What type of intraventricular mass causes obstruction at the foramen of Monro and can cause a thunderclap headache? |
Colloid cyst |
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What type of midbrain hemorrhage is from rapidly herniating brain causing compression of perforating basilar artery branches? |
Duret hemorrhage |
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What causes pupil dilation during a stroke? |
CN 3 getting caught between PCA and superior cerebellar artery |
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Transverse myelitis + optic neuritis = ? |
NMO |
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Bright central pons? |
Osmotic demylination syndrome (CPM) Can also have extrapontine myelinolysis |
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High T2/FLAIR signal in the medial thalamus and periaqueductal grey, enhancement of the mammillary bodies? |
Wernicke encephalopathy |
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Hypodense, T2 bright globus pallidus? |
Carbon monoxide poisoning ("globus" warming) |
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How do you distinguish Alzheimer, multi=infarct, Lewy body, Pick/frontotemporal dementia and Huntingtons on FDG/PET imaging? |
Alzheimer: low temporoparietal activity Multi-infarct: scattered low areas DLB: low lateral occipital activity Picks: low frontal activity Huntingtons: Low caudate and putamen activity |
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Difference between PML and HIV encephalitis on MRI? |
PML involves the subcortical U-fibers PML has associated T1 low signal |
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Difference between toxoplasmosis and lymphoma on nuclear imaging? |
Toxo is Thallium cold |
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Which MRI sequence is most sensitive for HSV encephalitis? |
DWI! |
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You see high T2 signal in the temporal region, but there is a negative HSV titer. What is it and what is the next best step? |
Limbic encephalitis Screen for lung cancer (SCLC) |
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Ddx for supratentorial mass in pediatric population? |
Astrocytoma (GBM and DIG) Pleomorphic xanthoastrocytoma PNET DNET |
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Ddx for infratentorial mass in pediatric population? |
Astrocytoma (85%) Medulloblastoma Ependymoma Brainstem glioma
Atypical teratoma/rhabdoid tumor (AT/RT)
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Ddx for supratentorial mass in adult? |
Mets+++ Astrocytoma (and GBM) Oligodendroglioma Primary CNS Lymphoma |
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Ddx for infratentorial mass in adult? |
JPA Hemangioblastoma (VHL) |
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Ddx for skull base mass? |
Chordoma (midline) Chondrosarcoma (off midline) Esthesioneuroblastoma Sinonasal carcinoma Mets Lymphoma Paraganglioma |
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Ddx for sella mass? |
SATCHMO: Sarcoid Aneurysm, Adenoma RAthke's cyst Teratoma Craniopharyngioma Hamartoma, Hypothalamic glioma Meningioma Optic nerve glioma |
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Ddx for intraventricular mass? |
Ependymoma Subependymoma Choroid plexus papilloma Central neurocytoma Colloid cyst Meningioma Giant cell astrocytoma |
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Ddx for CP angle mass? |
Schwannoma Meningioma Epidermoid Arachnoid cyst |
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Ddx for pineal region mass? |
Pineocytoma Pineoblastoma PNET Tectal glioma Meningioma Dermoid Germinoma |
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Ddx for cortically based tumor? |
DOG: DNET Oligodendroglioma Ganglioglioma |
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What types of brain tumors are seen in NF 1, NF 2, tuberous sclerosis and VHL? |
NF 1: Optic gliomas, astrocytomas
NF 2: MSME
TS: SEGA, tubers, astrocytomas
VHL: hemangioblastomas, endolymphatic sac tumor |
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What types of brain tumors enhance? |
Extraaxial or aggressive tumors: Schwannoma Meningioma Pineal Pituitary region GBM Exception: JPA, ganglioglioma |
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What types of lesions demonstrate ring enhancement? |
MAGIC DR: Mets Abscess GBM Infarct Contusion Demylination Radiation necrosis/Resolving hematoma |
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Slow growing brain mass with mural nodule? |
Pilocytic astrocytoma (young) Hemangioblastoma (older or VHL) |
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Brain lesion that expands the cortex? What gene deletion has a better prognosis? |
Oligodendroglioma 1p or 19q |
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What is an intensely enhancing homogenous solid mass along the periventricular region which is HOT on a thallium SPECT? |
Primary CNS lymphoma |
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Most common intraventricular mass in a 20-40yo? |
Central neurocytoma |
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Causes of pituitary apoplexy? |
Bromocriptine
Sheehan syndrome |
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Meningiomas take up what radiotracers? |
Tc99m MDP and octreotide
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13 year old with seizures, temporal lobe mass that is cystic and solid with focal calcifications? |
Ganglioglioma
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13 year old with bubbly cystic cortical bassed tumor in temporal lobe, drug resistant seizures? |
DNET |
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What is the most common location for an intraventricular meningioma? |
Trigone of the lateral ventricles |
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Ddx for brain tumor cyst with enhancing nodule? |
JPA PXA Ganglioglioma Hemangioblastoma |
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Enhancing mass attached to the septum pellucidum? |
Central neurocytoma |
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Nonenhancing mass attached to the septum pellucidum? |
Subependymoma |
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Ddx for masses that diffusion restrict? |
Epidermoid Mucinous adenocarcinoma met Abscess Highly cellular tumors (lymphoma, PNET, meningioma) |
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Ddx for tumors with calcium? |
Oligodenroglioma Ependymoma Meningioma Craniopharyngioma Choroid plexus tumor Central neurocytoma |
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Supratentorial cyst with nodule in an infant (<2 yrs)? How about >2 yrs? |
<2 yrs Desmoplastic infantile ganglioglioma (DIG) >2 yrs Pleomorphic xanthoastrocytoma (PXA) (usually temporal lobe) |
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PNET is similar to what other tumor histologically? |
Medulloblastoma (WHO IV) |
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Pineal, suprasellar or basal ganglia mass that engulfs calcification? |
Germinoma |
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Pineocytoma vs pineoblastoma, which one is seen in kids? What type of calcifications do they have? |
Pineoblastoma Peripheral calcifications |
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Name the associated tumors of these syndromes: NF1 NF2 VHL TS Gorlin |
NF1: Optic nerve gliomas NF2: MSME VHL: Hemangioblastomas (brain and retina) TS: SEGA, tubers Gorlin: Medulloblastoma |
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What LeFort fracture is "Palate separated from the maxilla" or "Floating palate?" |
LeFort 1 |
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What LeFort fracture is "Maxilla separated from the face? or "Pyramidal?" |
LeFort 2 |
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What LeFort fracture is "Face separated from the cranium?" |
LeFort 3 |
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What LeFort fracture involves the lateral nasal aperature? |
LeFort 1 |
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What LeFort fracture involves the inferior orbital rim and orbital floor? |
LeFort 2 |
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What LeFort fracture involves the zygomatic arch and lateral orbital wall? |
LeFort 3 |
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Describe the appearance of the different stages of blood on MRI. |
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Patient with sensorineural hearing loss and ataxia, MRI shows thin dark outline of brainstem? |
Superficial siderosis |
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Most common site of intracranial aneurysm? |
Acomm |
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Diffuse white matter hyperintensities with anterior temporal lobe involvement? |
CADASIL |
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What is this called? What is this from? |
Colpocephaly (can also show Steer Horn or Vertical Ventricles) Agenesis of the corpus callosum or Pericallosal lipoma |
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What disease has the "molar tooth" appearance? What associations does it have? What is it called with liver fibrosis? |
Joubert syndrome MCDK, retinal dysplasia COACH |
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What is Meckel-Gruber syndrome? |
Holoprosencephaly Multiple renal cysts Polydactyly |
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What other conditions are associated with schizencephaly? |
Septo-optic dysplasia Absent septum pellucidum Epilepsy
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How do porencephaly and hydrancephaly differ? |
Porencephaly is normal brain development but with an in-utero ischemic event Hydrancephaly is the same but wipes out the whole brain |
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What is Chiari I and some associations? |
Downward tonsilar herniation >5 mm Syringohydromyelia Klippel-Feil |
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What is Chiari II? |
Hydrocephalus Myelomeningocele of L spine Towering cerebellum Tectal plate beaking (inferior colliculi) Interdigitating gyri |
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What is chiari III? |
Chiari II plus encephalocele (high cervical) |
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What closes in brachycephaly? |
Bicoronal and/or bilambdoid (Hey Arnold!) |
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What closes in scaphocephaly/dolichocephaly? |
Sagittal (Aliens!) |
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What closes in plagiocephaly? |
Unilateral coronal or lambdoid |
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What closes in trigonocephaly? |
Metopic |
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What causes the clover leaf or towering skull? |
Coronal, sagittal and lambdoid closure |
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What is the harlequin eye see in? |
Unilateral coronal plagiocephaly |
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You are shown a MRS with elevated alanine. Diagnosis? |
Meningioma |
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Slow growing petrous apex lesion with smooth bony remodeling. Ddx and how to tell the difference? |
Cholesterol granuloma: T1 bright, T2 bright
Cholesteatoma: T1 dark, T2 bright, DWI+ |
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Patient with otomastoiditis, face pain, and lateral rectus palsy? |
Grandenigo syndrome from petrous apicitis |
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What condition is endolymphatic sac tumor associated with? How do they look on MRI? |
VHL Amorphous Ca2+ Flow voids |
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What is it called when the vestibular aqueduct is bigger than the posterior semicircular canal? |
Large vestibular aqueduct syndrome |
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Whats the difference between fenestral and spongiotic forms of otosclerosis? |
Fenestral: Lytic area anterior to oval window Spongiform: demineralization around cochlea |
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What is the order of destruction in a cholesteatoma pars flaccida type? |
1. Scutum 2. Ossicles 3. Lateral semicircular canal |
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Which type of cholesteatoma maintains an intact scutum? |
Pars tensa |
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Patient with noise induced vertigo, diagnosis? |
Superior semicircular canal dehiscence (from long-standing high ICP) (tegmen tympani is thinned) |
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Causative agent in necrotizing external otitis? |
Pseudomonas
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Midline tumor in the clivus? |
Chordoma (off midline would be chondrosarcoma) |
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What is the center and primary artery feeding a juvenile nasal angiofibroma? |
Sphenopalatine foramen is the center Internal maxillary artery |
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Ddx for nasal mass? |
JNA Antrochoanal polyp Inverting papilloma Esthesioneuroblastoma |
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What nasal mass is centered in the middle meatus and has a convoluted ceribriform appearance? |
Inverted papilloma (10% can harbor SCC) |
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What nasal mass protrudes through the cribiform plate and has a dumbbell shape? |
Esthesioneuroblastoma
(octreotide positive) |
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Cyst arising from floor of mouth laterally? |
Ranula (from submandibular space) (plunging if below mylohyoid) |
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What is the most common salivary duct to form stones? |
Submandibular gland duct (Wharton's) |
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What is Ludwig's angina? |
Aggressive cellulitis in the floor of the mouth |
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What separates Level II from Level III cervical lymph nodes? |
Hyoid bone |
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What separates Level III from Level IV cervical lymph nodes? |
Inferior cricoid cartilage |
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Ddx for a parotid space mass? |
Pleomorphic adenoma Warthin tumor Mucoepidermoid carcinoma Adenoid cystic carcinoma Lymphoma |
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What type of salivary gland tumor likes perineural spread? |
Adenoid cystic carcinoma |
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Bilateral parotid gland lymphoma is associated with what condition? |
Sjogrens
(MALT lymphoma) (Dry eyes and dry mouth) (Honeycomb appearance of the gland) |
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Risk factor for SCC of the mouth in a young person? |
HPV (present with necrotic level II nodes) |
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What parotid tumors take up Tc99m? |
Warthins Parotid oncocytoma |
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What are the contents of the jugular foramen? |
9 10 11 Sigmoid sinus to jugular vein |
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What condition should you think of with bilateral colobomas? |
CHARGE (coloboma, heart, GU, ears) |
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Martini glass shaped increased density in the globe? |
Indicates retinal detachment Coats (no enhancement) - Retinal telangectasias, exudates Persistent hyperplastic primary vitreous (enhances) |
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Condition with bilateral optic nerve gliomas? |
NF-1 |
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What tumor causes tram-track enhancement around the optic nerve? |
Meningioma |
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What are the IgG4 orbit processes? |
Orbital pseudotumor Tolosa Hunt Syndrome (cavernous sinus) Lymphocytic hypophysitis (pituitary gland) |
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What are three important things to remember about orbital pseudotumor? |
Involves myotendinous insertions Lateral EOM is most often affected Painful |
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Most common cause for an enhancing soft tissue mass in the back of an adult eye? |
Melanoma (will be collar button shaped) |
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What are the locations for retinoblastoma? |
Unilateral: globe Bilateral: + other globe Trilateral: + pineal Quadrilateral: + suprasellar |
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Orbital masses with fluid-fluid levels? |
Lymphangioma |
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Orbital mass that distends with valsalva? |
Varix |
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What is the reason for pulsatile exophthalmos in NF-1? |
Spenoid wing dysplasia causing CC fistula |
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What is the order of involvement of the EOM in thyroid orbitopathy? |
IM SLOw IR, MR, SR, LR, SO |
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Infratentorial mass with toothpaste-like extension? |
Ependymoma |
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Hummingbird sign? |
Progressive supranuclear palsy (PSP) |
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Mickey mouse sign? |
Progressive supranuclear palsy (PSP) |
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Hot cross bun sign of the pons? |
Multiple system atrophy (MSA) |
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Most common lobe for a DNET? |
Temporal |
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What are some of the manifestations of NF1? What gene is involved? |
17q
Optic glioma Plexiform neurofibroma Sphenoid wing dysplasia Lisch nodules Pheochromocytoma Renal AML Wilms Moya moya |
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Baby with optic nerve hypoplasia, absent septum pellucidum, schizencephaly. Pregnancy complicated by CMV. Diagnosis? |
Septo optic dysplasia |
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What are some of the manifestations of VHL? |
Hemangioblastoma (brain and retina) Pheochromocytoma Endolymphatic sac tumor Choroid plexus papilloma Renal AML Pancreatic cysts Clear cell RCC |
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Baby with optic nerve hypoplasia, absent septum pellucidum, schizencephaly. Pregnancy complicated by CMV. Diagnosis? |
Septo optic dysplasia |
