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76 Cards in this Set
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Craniopharyngioma
Case findings: T2 and T1 weighted (pre-Gd): demonstrate a heterogeneous primarily cystic appearing mass in the suprasellar cistern Focal regions of decreased signal intensity, which may be secondary to calcifications Post-Gd T1 weighted axial, sagittal, coronal image: extensive, primarily peripheral enhancement with intermixed regions of increased and decreased signal Central region of signal void consistent with calcification Cystic regions within high SI on T1 high protein contrast Obstructive hydrocephalus Arise from neuroepithelial rests within Rathke's cleft Bimodal age distribution: MC pediatric age group, 2nd peak in 5th decade Present with headache from obstructive hydrocephalus Extremely heterogenous composed of intermixed cystic and solid components Intrasellar with suprasellar extension Calcifications (MC in pediatrics group) DDX: Germ cell tumor Optic glioma Epidermoid Meningioma Pituitary (macro)adenoma Parasellar Masses DDX “SATCHMO”: Sphenoid sinus tumor, sarcoidois Aneurysm, pituitary (macro)adenoma Teratoma Craniopharyngioma Hypothalamic glioma, Langerhans cell histiocytoma (EG) Meningioma, metastasis Optic glioma LC lesions: Germinoma Epidermoid Hamartoma (hypothalamic, tuber cinereum) Chordoma Arachnoid cyst Rathke’s cleft cyst |
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Diastematomyelia
Splitting of notochord during early development Complete, longitudinal division of the spinal cord (MC upper LS) May be bony or fibrous band between the two hemicords Each hemicord gives off nerve roots from its lateral aspect and each has a separate anterior spinal artery Associated with: Myelomeningocele Neurogenic and dermoid cysts Teratoma Lipoma DDX: Diplomyelia: true duplication of the spinal cord, rare |
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Septo-optic dysplasia (de Morsier Syndrome)
Case findings: Absence of septum pellucidum Coronal T1: hypoplasia of the optic chiasm Spectrum of holoprosencephaly: Alobar holoprosencephaly Semilobar holoprosencephaly Lobar holoprosencephaly Septo-optic dysplasia (most minor form) |
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Ependymoma
CT: Obstructive hydrocephalus Obliteration of the 4th ventricle Internal calcifications MRI: Presence of flow voids Mass extends laterally through the right foramen of Luschka Heterogeneous enhancement Marked mass effect on medulla and complete compromise of foramen magnum MC occur in 4th ventricle (arise from ependymal cells) MC present in children < 5 years old Slow growing, lobulated tumor that fills the ventricle and can extend out the exiting foramina (“plastic” lesion) Calcifications (50%) May demonstrate a large cystic component Inhomogeneous enhancement 3rd MC pediatric brain tumor (1st JPA, 2nd medulloblastoma) |
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Agenesis of the corpus callosum
Findings: High-riding 3rd ventricle Frontal horns C-shaped on coronal view Colpocephaly: dilated occipital horns Parallel orientation of lateral ventricles: median bundles of Probst do not cross hemispheres Associated with: Chiari II malformation Cephaloceles Dandy-Walker malformation CNS lipoma |
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Vein of Galen malformation
Case findings: Prominent dilatation of Vein of Galen, straight sinus, confluence of sinuses, transverse sinuses, and sigmoid sinus Turbulent flow within the malformed vessels produces a mixed signal intensity MRA: prominent Vein of Galen with multiple arteries leading to the malformation Type 1 (this case): Due to single or multiple arteries (usually choroidal or quadrigeminal arteries) flowing directly into the vein of Galen, resulting in a shunt that leads to high-flow CHF Type 2: Due to a parenchymal AVM in the thalamus or midbrain, which can present as developmental delay with ocular symptoms |
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Pituitary microadenoma
Clinical presentation: hormonal changes |
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Rathke's cleft cyst
Case findings: Axial T2: homogeneously increased SI within the sella turcica Coronal T1: decreased SI at the anterior aspect of the sella Coronal T1 post-Gd: lesion does NOT enhance lesion does not appear to be a part of the adenohypophysis or neurohypophysis Non-neoplastic, derived from embryonic remnants of Rathke's pouch Variable T1: due to variable protein content and/or hemorrhage |
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Axial T1 post-Gd
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Pineoblastoma (PNET)
Contains peripheral calcifications In contrast, germinoma (central) or teratoma (dispersed) calcifications Dense enhancement, subarachnoid spread MC in children and young adults Clinical: Parinaud’s syndrome: inability to gaze upward due to compression of the tectal plate Hydrocephalus due to compression of the cerebral aqueduct Pineal region mass MC germ cell tumor (50%): MC germinoma LC teratoma, embryonal cell carcinoma, choriocarcinoma, endodermal sinus (yolk sac) tumor Pineal cell tumor (25%): Pineoblastoma (child) Pineocytoma (adult) LC meningioma, metastases, arachnoid cyst, epidermoid, dermoid Intracranial germinoma Pineal germinoma: Hydrocephalus due to obstruction of the Sylvain aqueduct Parinaud’s syndrome: failure of upward gaze from compression of the superior colliculi Suprasellar germinoma: Diabetes insipidus due to involvement of pituitary infundibulum Visual disturbances from invasion of the optic chiasm Precocious puberty if a ß-HCG secreting tumor Hydrocephalus |
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Trigonocephaly
Case findings: Abnormal “wedge shaped” or “triangular” appearance to the frontal bone of the skull Premature closure of the metopic suture Craniosynostosis Scaphocephaly (dolichocephaly): premature closure of the sagittal suture long, narrow skull that looks "boat shaped" in appearance Brachycephaly: premature close of the coronal suture harlequin eyes (orbital enlargement due to coronal sutural synostosis) Plagiocephaly: isolated unilateral closure of a coronal or lamboid suture produces an asymmetrically shaped skull Oxycephaly (turricephaly): vertical development of the skull from premature closure of coronal and sagittal sutures Kleeblattschadel (cloverleaf skull): premature synostosis of multiple sutures (coronal, lambdoid, sagittal) Associated with: thanatophoric dwarfism, Pfeiffer’s syndrome Plagiocephaly with harlequin eye Unilateral coronal suture synostosis Results in an elevated sphenoid wing and distorted orbital shape |
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Cavernoma (cavernous angioma, cavernous malformation)
Case findings: Axial T1 and T2 precontrast and post contrast axial and sagittal T1 images Precontrast T1: mass in pons which is heterogeneously hyperintense T2: areas of hypointensity within the mass mixed with hyperintensity No enhancement Vascular malformation consisting of endothelial lined sinusoidal spaces without normal intervening brain Angiographic occult lesion Popcorn-like lesions that have mixed signal intensity due to hemorrhage in different stages of evolution |
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Chiari II malformation
Case findings: Herniation of cerebellar tonsils Small posterior fossa 4th ventricle displaced caudally and elongated Tectal beaking Hydrocephalus Other findings (not shown): Varying degrees of cerebellar dysplasia Cervical medullary junction may be kinked Interdigitation of gyri due to a hypoplastic falx or fenestrated falx Agenesis of the corpus callosum Associated with: myelomeningocele (MC in the lumbar spine) |
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Bilateral closed-lip schizencephaly
GM-lined clefts that extend through the entire hemisphere from the ependymal lining of the lateral ventricles to the pial covering of the cortex Types: closed and open lip Associated with absent cavum septum pellucidum |
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Juvenile pilocytic astrocytoma (JPA)
Case findings: Low T1 and high T2 cystic mass in the right cerebellar hemisphere, with a moderate amount of mass effect on the 4th ventricle and cerebellum Homogeneous enhancement of a mural nodule in the superior aspect of the mass MC infratentorial neoplasm in pediatric age group DDX: Child: medulloblastoma, ependymoma Adult: hemangioblastoma (flow voids due to hypervascularity) |
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Herpes encephalitis
Case findings: Region of edema and abnormal signal in right insula and temporal lobe No abnormal enhancement MC affects mesotemporal lobe Extends into the insular cortex with sparing of the putamen DDX: Infarct Infiltrating glioma (low-grade) |
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Dermoid
Case findings: Extra-axial mass in the mesial right frontal lobe, contiguous with the interhemispheric fissure T1 heterogenous signal within the mass No significant enhancement Midline lesions in the suprasellar, subfrontal, posterior fossa, or peripineal regions Little vascularity no enhancement Complication of rupture chemical meningitis DDX of high T1 and T2 lesion: Craniopharyngioma Chronic hemorrhagic lesion Dermoid Cholesterol cyst or granuloma Rathke’s cleft cyst |
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Gray matter heterotopia
No enhancement Follow GM signal on all pulse sequences DDX: Tuberous sclerosis: subependymal nodules do not follow GM signal LC leptomeningeal metastasis |
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Paraganglioma (glomus tumor, chemodectoma)
Case findings: Heterogeneously enhancing mass deep to SCM and parotid gland and lateral to carotid sheath at the level of the mandible Carotid bifurcation appears normal and the carotid sheath is displaced anteriorly No regional lymphadenopathy identified MR: early, intense enhancement and salt and pepper appearance DDX: Paraganglioma (carotid body tumor) Neurogenic tumor Salivary gland tumor Lymphadenitis Metastasis Hypervascular tumor Originate from extra-adrenal neuroendocrine tissues Have a chemoreceptor function and are located near nerves and vessels Classified according to site of origin: Carotid body tumor: CCA bifurcation Glomus jugulare: jugular foramen (presents with pulsatile tinnitus) Glomus tympanicum: cochlear promontory Glomus vagale: carotid space near nodose ganglion of the vagal nerve |
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Glomus tympanicum
Case findings on NCCT: ST mass in left middle ear, adjacent to the cochlear promontory No bony destruction Ossicles are unremarkable, ICA normal Arise from the cochlear promontory in the middle ear Seldom erode bone, hypervascular Need to identify association with the ICA or jugular vein 10% of glomus tumors are multiple Middle ear masses Vascular: Glomus tympanicum Aberrant internal carotid artery Dehiscent jugular bulb Other: Cholesteatoma Rhabdomyosarcoma Adenocarcinoma (rare) |
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Hydranencephaly
Case findings: Near complete absence of the cerebral hemispheres, replaced by fluid Sparing of the tissues supplied by the posterior circulation Cerebral hemispheres are replaced by CSF and nearly absent Thalami and cerebellum are preserved Brainstem is usually atrophic Etiology is likely vascular in nature, involving bilateral carotid artery insults in utero DDX: Severe hydrocephalus: presence of a thin rim of cortex around massively dilated ventricles indicates hydrocephalus rather than hydranencephaly Holoprosencephaly (alobar type) |
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Axial T2-weighted
Axial FLAIR Axial DWI |
Central pontine myelinolysis (CPM)
Case findings: Areas of increased T2 and restricted diffusion in the pons Represents cytotoxic edema DDX: Central pontine myelinolysis Ischemia Multiple sclerosis Encephalitis Infiltrating glioma |
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Cryptococcosis
Case findings: Multiple areas of calcification Enhancement of meninges in the basal cisterns bilaterally MC CNS mycotic infection DDX basilar meningeal enhancement: MC TB, fungal (cryptococcus), pyogenic( MC on convexity), cysticercosis Lymphoma, leukemia, carcinomatosis Neurosarcoidosis Hydrocephalus: result of meningeal scarring Punctate hyperintensities, representing dilated perivascular spaces or cryptococcomas MC seen in BG, thalami and midbrain on T2-weighted MR images CT: may show cystic nodules with an enhancing capsule and central core Contrast enhancement of meninges and cryptococcomas may or may not occur and is frequently absent in AIDS CECT: nodular cystic lesion with enhancing capsule and central core in the subcortical left mesial parietal region |
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Mondini deformity
Case findings: Bilateral cochlear abnormalities with 1.5 turns versus normal 2.75 turns Bilateral enlarged vestibule (measuring 4.0mm at maximum bilaterally) Enlarged right vestibular aqueduct large vestibular aqueduct syndrome (LVAS) Interscalar septum or osseous spiral lamina is incomplete, resulting in a confluent apical and middle cochlear turn Strong association between a large vestibular aqueduct and deficits in the cochlear modiolus LVAS: also referred to as an enlarged endolymphatic duct and sac syndrome (LEDS) because the vestibular aqueduct is an indication of an enlarged endolymphatic duct and sac Vestibular aqueduct is enlarged if it measures greater than 1.5 mm at the midpoint Large vestibular aqueduct syndrome (LVAS) Dilatation of the vestibular aqueduct (arrow) Deficiency of the cochlear modiolus (arrowhead) |
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Fibrous dysplasia (FD)
Case findings: Ground-glass appearance Enlargement or thickening of the skull base Disease patterns: Craniofacial form: hypertelorism, cranial asymmetry, facial deformity (leontiasis osseae) Cherubism: jaw is broad and protruding, maxilla and mandible involvement is symmetric Monostotic form Polyostotic form McCune-Albright syndrome: sexual precocity in girls, polyostotic FD, cutaneous pigmentation (café-au-lait spots – coast of Maine) |
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Central neurocytoma
Case findings: Large enhancing mass with calcifications Trapping of the occipital and temporal horns of the left lateral ventricle Large mass involving the lateral and 3rd ventricles Associated hydrocephalus Isodense to brain with fine to course calcification Moderate enhancement Abuts or is attached to the septum pellucidum DDX intraventricular mass: Central neurocytoma Intraventricular oligodendroglioma (can appear identical) Ependymoma Intraventricular meningioma Astrocytoma Subependymoma Germ cell tumor Colloid cyst Choroid plexus papilloma |
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Multiple sclerosis
CT: Areas of periventricular hypointensities, particularly in the left frontal region MR: Patchy plaque-like hyperintensities on T2 and FLAIR in the periventricular and subcortical WM of the cerebral hemispheres Lesions are hypointense on T1 images Ring enhancement of some of the plaque-like lesions in the frontal lobes (acute plaque) Dawson’s fingers: represent lymphocytic infiltration along periventricular medullary veins Ovoid hyperintense plaques classically seen perpendicular to the axis of the lateral ventricles on fluid sensitive sequences (T2 and FLAIR) Acute lesion: may have a "target" appearance Hyperintense center representing demyelination with a slightly less hyperintense periphery representing vasogenic edema Rim of hypointensity separates these two regions Contrast enhancing lesions may be acute lesions Multifocal white matter lesions Multiple sclerosis Acute disseminated encephalomyelitis (ADEM) Lyme disease AIDS Progressive multifocal leukoencephalopathy (PML) Neurosarcoidosis Vasculitides Small vessel ischemic disease |
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Capillary hemangioma
Case findings: Mass in the right infratemporal fossa with a second mass is linked to the first mass by a thin anterior extension, involving primarily the lateral aspect of the right orbit Intraorbital mass is predominantly extracoronal with some intraconal extension No associated bony destruction US: multiple areas of vascular flow with pulsatility within right ocular mass MC vascular tumor of the orbit in children Does not present at birth, but almost always develop by 6 months In contrast, vascular malformations such as lymphangioma and AVM are present at birth with slow progressive growth into adulthood Orbital tumor in child (< 2 years-old) Orbital cellulitis Orbital dermoid Capillary hemangioma Rhabdomyosarcoma Lymphangioma Neuroblastoma |
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Sinus pericranii
Case findings: Towne's view: well-circumscribed lytic appearing lesion in the inferior lateral aspect of the skull US: large hypoechoic structure with vascular flow that communicated through the skull to the transverse sinus MR: vascular channel in the right occipital region traversing the calvarium Congenital or acquired Epicranial blood-filled nodule of the scalp that is in communication with an intracranial dural sinus through dilated diploic veins of the skull Connects the intracranial and extracranial venous systems Present in the pediatric age group as a focal swelling on the scalp MC in the frontal region DDX: Lipoma Subcutaneous cyst |
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Neurosarcoidosis
Case findings: Areas of meningeal enhancement are identified in multiple CSF spaces, specifically the CP angle, interpeduncular fossa, optic chiasm, and sylvian fissures Marked enhancement is noticed across the anterior aspect of the brain stem and pons Classic: Chronic basilar leptomeningitis with involvement of the hypothalamus, pituitary stalk, optic nerve and chiasm Parenchymal sarcoid nodules Wide spectrum of additional MR findings: White matter and periventricular hyperintensity mimicking multiple sclerosis Hydrocephalus Atrophy Extra-axial masses Spinal cord parenchymal masses |
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Osteopetrosis
Case findings: Bones are extremely dense CXR: sandwich vertebral bodies and a large posterior mediastinal mass (extramedullary hematopoesis) CT of the head: thickened skull DDX: Osteopetrosis Pyknodysostosis Renal osteodystrophy SCLEROSIS-GENERALIZED R.S.M.O.P.M.M.P.F. (Regular Sex Makes Occasional Perversions Much More Pleasurable and Fantastic) Renal osteodystrophy Sickle cell disease Myelofibrosis Osteopetrosis Pyknodysostosis Mastocytosis Metastasis Pagets Fluorosis |
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Cavernoma (cavernous angioma, cavernous malformation)
CT: Hyperdense lobular mass in dorsal pons and midbrain containing calcifications Associated edema and evidence of recent hemorrhage Several bilateral cortical and subcortical hyperdense lesions are seen in the frontal and parietal lobes, compatible with cavernomas MRI: Large hemorrhagic angioma in the brain stem with fluid-fluid levels Characteristic low-signal hemosiderin artifact on GRE Composed of endothelial-lined sinusoidal spaces NOT separated by normal neural tissue, as seen in other vascular malformations (e.g., telangiectasia) May have residual or recurrent hemorrhage within cavernomas MC supratentorial (80%, temporal and frontal lobes Pons and cerebellar hemispheres are the most common infratentorial locations MC deep cortical WM, BG, corticomedullary junction MR: popcorn lesion complex core of mixed signal intensities representing various stages hemorrhage Differentiate from simple hemorrhage: cavernomas do not collapse into slit-like cavities, but rather maintain their rounded shape. simple hemorrhages often collapse Differentiate from tumors: cavernomas have complete hemosiderin rings, tumors usually do not Condition tends to be hereditary (AD, MC in Hispanics) with multiple bilateral cavernomas |
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Subacute combined degeneration
Case findings: Increased T2 signal in CS (seen from skull to T4) Axial images show increased T2 signal within the posterior columns with a small amount signal changes in the lateral columns Spinal cord manifestation of vitamin B12 deficiency Increased T2 in the posterior columns followed by the lateral spinal tracts MC in cervical and upper thoracic spinal cord No enhancement after Gd No significant expansion of the spinal cord MRI findings for SCD: Increased T2 signal within the posterior columns initially which extend to the lateral spinal tracts Although not specific, if the MRI findings are confined to the cervical/upper thoracic spinal cord without trauma consideration of SCD should be included in the differential Long-tract lesions of the spinal cord Demyelinating process (e.g., MS) Subacute combined degeneration Post-traumatic change Arterial venous malformation Neurosarcoidosis Lyme disease |
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Warthin’s tumor (papillary cystadenoma lymphomatosum)
Case findings: Bilateral heterogeneous parotid masses Right parotid gland has a region that is partially calcified Satellite masses adjacent to both parotids 2nd MC benign tumor of the parotid (MC pleomorphic adenoma) MC bilateral tumor of the parotids Increased risk with smokers, age > 50 years Uptake of mTc-99m pertechnetate Well circumscribed, smooth margin May have cystic component CT: Small, ovoid smoothly marginated masses on the posterior aspect of the parotid glands Multiple lobules, well circumscribed smooth margins 10% with calcifications, 10% bilateral MRI: Looks similar to pleomorphic adenoma T2: large areas of decreased signal may seen as well as cystic areas Parotid masses Pleomorphic adenoma (MC benign) Warthin’s tumor (2nd MC benign, MC bilateral) Lymphoepithelial cyst (Godwin’s tumor, benign) Mucoepidermoid tumor (MC malignant) Malignant degeneration of Warthin’s Tumor Malignant mixed tumor Squamous cell carcinoma Adenocarcinoma Lymphoma PAROTID SPACE/PRE STYLOID PARAPHARYNGEAL SPACE PLEASE WATCH OUT for HEMANGIOMAS Benign: Pleomorphic adenoma Warthins Oncocytoma Hemangioma Malignant: Minor salivary gland tumors Lymphoepithelial cyst Unilocular or septated thin-walled fluid-containing structure Thought to originate from intra- or periparotidal lymph nodes, arising from intranodal salivary inclusions May be solitary or multiple Associated with HIV Pleomorphic adenoma MC in the parotid gland LC in the submandibular gland and minor salivary glands Well circumscribed, but may be lobulated Malignant transformation: will show infiltration into the surrounding structures |
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Axial T1-weighted
Sagittal FLAIR Coronal T1-weighted post Gd |
Rathke cleft cyst
Case findings: Anterior pituitary mass with superior extension into suprasellar cistern High intensity on FLAIR and T1 (high cholesterol or fatty acid content) No direct evidence of contrast enhancement No mass effect Benign epithelium-lined intrasellar cysts believed to originate from remnants of the Rathke pouch Well circumscribed sellar mass (anterior pituitary) that may extend into suprasellar region DDX: Craniopharyngioma Pituitary adenoma Epidermoid Arachnoid cyst May have differing attenuation based on cystic component Simple cyst: difficult to distinguish from arachnoid cyst or epidermoid Complex cyst: may be indistinguishable from a craniopharyngioma or pituitary adenoma SELLAR LESIONS (You keep your computer, either MAC or PC in the sellar) PC OR MAC? Pituitary adenoma/apoplexy Craniopharyngioma Mets/meningioma Abscess/Aneurysm Cysts—Rathke’s cleft |
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Moyamoya
Case findings: Narrowing of supracliniod ICA, MCA and ACA Lenticular striate arteries bilaterally are prominent Extensive WM volume loss and gliosis seen in the periventricular white matter, likely secondary to ischemic changes (high FLAIR and T2 signal) DDX: Moyamoya Atherosclerosis Radiation vasculopathy Angiography, CTA or MRA: Puff of smoke: Numerous collaterals supplying ACA and MCA distribution Anastomosis between leptomeningeal and dural meningeal arteries Stenosis or occlusion of supraclinoid ICA MRI: Findings associated with chronic ischemic changes including atrophy, glisosis, and prominent ventricles Bilateral stenosis or occlusion of the supraclinoid (ICA) that extends to the proximal portions of the ACA and MCA Presence of parenchymal, leptomeningeal, or transdural collateral vessels that supply the ischemic brain Cause strokes or seizures in children Associated with: Sickle cell disease Fibromuscular dysplasia Neurofibromatosis |
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Arteriovenous malformation
CT: Area of increased attenuation with several punctate calcifications (extra axial) MR: Area of serpiginous low signal (flow voids) Angiogram: Direct arterial supply from branches of left ACA and left PCA Superficial venous drainage into cortical veins draining medially along the occipital lobe into the superior sagittal sinus and some deep into the vein of Galen inferiorly Congenital anomalies of blood vessel development Result from preservation of direct communication between arterial and venous channels without an intervening capillary network Nidus: tangle of abnormal vessels representing the site of primitive communication EXTRA AXIAL MASS “MAD SALE” Mengioma Abscess Dural metastasis—prostate/breast Sarcoidosis Abscess/AVM Lymphoma Epidermoid/dermoid ADULT SUPRATENTORIAL WHITE MATTER LESIONS “OLD MAN” Oligodendroglioma Lymphoma Dermoid Metastasis Astrocytoma Neuronal tumors SUPRATENTORIAL INTRA-AXIAL TUMORS IN A CHILD “TAPE” Teratoma Astrocytoma PNET Ependymoma |
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Meningioma
Case findings: Extradural, dural based, enhancing lesion in the left CPA cistern that is isointense to GM Mass extends along the posterior margin of the petrous bone Mass displaces the ICA anteriorly Tumor mass invades the temporal bone Homogeneous contrast enhancement CP ANGLE “SLow GAME” Schwanomma: V and VII Lymphoma/lipoma Glomus tumor Aneurysm Meningioma/Metastasis Epidermoid/Ependymoma CPA mass Acoustic vestibular schwannoma Meningioma Epidermoid inclusion cyst Arachnoid cyst Aneurysm Choroid plexus papilloma Ependymoma Trigeminal schwannoma Glomus jugulare tumor Metastasis |
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Langerhans cell histiocytosis (LCH)
Case findings: Heterogeneous right parietal mass eroding through both the inner and the outer table of the skull Large bony lesion is seen elevating the galea aponeurotica and causes significant surrounding meningeal/dural reaction SKULL LESION “MEL TORME” Metastasis EG Lymphoma TB Osteomyelitis Radiation Mets Epidermoid Lytic skull lesion-in kids Langerhans cell histiocytosis Metastatic lesion Fibrous dysplasia Tuberculosis Osteomyelitis Epidermoid/dermoid Leptomeningeal cyst (post-traumatic) Myeloma (rare in children) |
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Suprasellar germinoma
Case findings: Round hyperdense lesion in suprasellar region Heterogeneous suprasellar mass with low signal relative to gray matter on T1WI and FLAIR Indistinct hyperintense margins on FLAIR are likely due to surrounding edema Homogeneous enhancement, except for a focal area of hypointensity, possibly a cyst or an area of necrosis Lesion is exophytic towards the 3rd ventricle and encases bilateral carotid arteries, although, flow voids are intact Mass effect with superior displacement of the optic chiasm Germinoma is MC germ cell tumor Location: pineal > suprasellar > basal ganglia/thalamus CT: Iso-hyperdense, round/lobulated, well-marginated mass MR: T1 hypointense, T2 isointense to hyperintense Homogeneous enhancement Large germinoma can be heterogeneous due to necrosis Suprasellar mass in child Germinoma: almost always with diabetes insipidus at presentation Benign teratoma: heterogeneous (solid, cystic, contains fat and calcium) with no enhancement Malignant teratoma: rare, tends to contain no fat or calcium, homogeneous enhancement Craniopharyngioma: cystic, calcify, high T1WI Astrocytoma: increased signal relative to brain, rarely have DI Langerhans cell histiocytosis: Thickening and enhancement of infundibulum Only 5% with DI at diagnosis Bone involvement Suprasellar mass in adult (SAaTCHhMmO) Sarcoidosis Aneurysm, pituitary adenoma Teratoma/Germinoma (Diabetes Insipidus) Craniopharyngioma: bimodal age (children and 5th decade) Histiocytosis X (LCH), hypothalamic glioma, Hamartoma of the Tuber Cinerium. Meningioma, metastasis Optic glioma EG (Histiocytosis X-LCH) Intracranial germinoma Pineal germinoma: Hydrocephalus due to obstruction of the Sylvain aqueduct Parinaud’s syndrome: failure of upward gaze from compression of the superior colliculi Suprasellar germinoma: Diabetes insipidus due to involvement of the pituitary infundibulum Visual disturbances from invasion of the optic chiasm Precocious puberty if a ß-HCG secreting tumor Hydrocephalus INFUNDIBULAR MASS “MEET GIRLS” Metastasis Eosinophillic granuloma Germinoma/germ cell tumors (Parinaud Syndrome) Infection/inflammation (hypophysis) DuRal–(think of dural-based conditions) Lymphoma Sarcoid |
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Hemimegalencephaly
Case findings: Hemimegalencephaly of the right cerebral hemisphere and cerebellum Right cortex is thick and smooth, consistent with lissencephaly Gray-white junction is blurred Right lateral ventricle is enlarged with periventricular high T2 consistent with gliosis Polymicrogyria of the left hemisphere Hamartomatous overgrowth of one cerebral hemisphere Affected portion of the brain has little function and serves as a seizure focus Hemispherectomy is indicated for intractable seizures only if the unaffected cerebral cortex is normal |
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Chordoma
Case findings: Large right parasellar iso-hypodense lesion with a thin hyperdense rim, and inhomogeneous contrast enhancement Anterior clinoid, petrous apex and part of the sphenoid bone are eroded. MR: lobulated mass with low T1 and high T2 and marked homogenous enhancement Terminology Abbreviation: Clival chordoma (CCh) CCh: Rare malignant tumor of clivus arising from remnants of cranial end of primitive notochord Imaging Findings Best diagnostic clue: Destructive midline mass centered in clivus with high T2 signal intensity 35% arise in skull base around spheno-occipital synchondrosis Sagittal images show tumor "thumb" indenting anterior pons Calcification, hemorrhage & mucoid areas show as heterogeneous hypointensity "Honeycomb" enhancement pattern secondary to intratumoral areas of low signal intensity DDX clivus lesion: Chondrosarcoma Nasopharyngeal malignancy (e.g. squamous cell carcinoma) Distant bone metastasis Meningioma Osteomyelitis (including Gradenigo's syndrome: infection of the petrous apex) Myeloma Histiocytosis DDX sacral lesion: Giant cell tumor Metastasis from occult primary neoplasms (RCC, thyroid carcinoma) Skull Base by location Midline Craniopharyngioma Chordoma Paramedian Carotid aneurysm Chondrosarcoma Lateral (GW of sphenoid) Meningioma Metastasis Dermoid Glomus Epidermoid Cholesterol cyst Always Include Mets Myeloma Lymphoma |
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Mycotic aneurysm
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Arteriovenous malformation
Abnormal network of arteries and veins with no intervening capillary bed MC solitary No intervening brain tissue Does not displace brain tissue unless hemorrhage present (no mass effect) Adjacent parenchymal atrophy from vascular steal and ischemia Calcification (25%) Vascular malformations Arteriovenous malformation (AVM): Parenchymal (pial) malformation Dural AVM and fistula Mixed pial, dural AVM Capillary telangiectasia: Dilated capillaries with normal intervening brain parenchyma MC pons, associated with cavernoma Cavernous malformation (cavernoma, cavernous angioma) Developmental venous anomaly: venous angioma Vein of Galen malformation Venous varix |
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Cavernous malformation
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Developmental venous anomaly (DVA, venous angioma)
Dilated medullary veins draining into large transcortical vein MC adjacent to frontal horn Angiography: medusa head on venous phase |
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Amyloid angiopathy
MC normotensive older patients (> 60) Affects small and medium-sized cerebral cortical and leptomeningeal vessels Foci of hemorrhage at corticomedullary junction Spares subcortical and deep WM, BG and cerebellar vessels Susceptibility artifacts on GRE |
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Gliomatosis cerebri (diffuse cerebral gliomatosis)
Case findings: expanded hemisphere, with sulcal effacement and ventricular compression, with an inhomogeneous diffuse hyperintensity on T2-weighted images mainly involving white matter Infiltrative nature rather a distinct tumor mass MC causes expansion of WM but may involve cortex Contrast enhancement is not usually seen until late in the course of the disease DDX: Leptomeningeal gliomatosis may mimic leptomeningeal carcinomatosis Demyelinating lesion DDX Leptomeningeal Enhancement “SICHI” as in Sick patient Subarachnoid hemorrhage Inflammatory (sarcoid) Carcinomatosis (breast, prostate) Hypotension Infectious (Herpes-temporal region, HIV, PML) “LATE VIDEO” as in late to return the videos to Blockbuster because he/she forgets Lymphoma ADEM (Acute Disseminated Encephalomyelitis) Trauma Elderly non-specific Vasculitis (sarcoid) Infection (Herpes, HIV, PML) Demyelinating -MS Ecclampsia Others-radiation treatments |
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Brain stem glioma
Case findings: 4th ventricle is compressed and pushed backward and basilar artery may be encased T1 hypointense and T2 hyperintense with distortion of the brain stem DDX brain stem lesion: Inflammatory lesion: tuberculoma Metastasis Demyelinating plaque Cavernoma, vascular malformation Infarction |
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Colloid cyst
Intraventricular, neuroepithelial cyst MC at anterosuperior aspect of 3rd ventricle between columns of the fornices Hyperdense on CT High SI on T1 and low SI on T2 Complication: positional headaches from intermittent hydrocephalus from obstruction of adjacent foramina of Monro May result in sudden death DDx for Interventricular Lesions 3 Carat GEMS Colloid cyst Central Neurocytoma (adults) Choroid Plexus Papilloma (children) Giant Cell Astrocytoma Ependymoma Meningioma/Medulloblastoma/Mets Subependymoma |
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Dysembryoplastic neuroepithelial tumor (DNET)
MC clinical presentation is partial complex seizure MC young adults Uncommon, slow-growing superficial hemispheric lesion Cortical location, MC temporal lobe Skull remodeling with erosion of inner and middle table Heterogeneous signal: cystic and solid components DDX Cortical Based Lesions “TIGER TIM” Trauma Infarct Gangliogioma/glioma Encephalitis Radiation Tubers Infection—toxoplasmosis Metastasis |
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Axial T1-weighted
Axial T1WI with fat saturation |
Dermoid
Dermoid: Contains squamous epithelial keratin AND dermal appendages Epidermoid: Contains ONLY squamous epithelial keratin (derived from ectoderm) 5x more common than dermoid Midline lesion Complication: chemical meningitis from rupture with spread of fatty components into the subarachnoid spaces and ventricles Location Most often in sellar/parasellar/frontonasal region Posterior fossa; midline vermis & 4th ventricle Intraventricular within tela choroidea in lateral, 3rd, or 4th ventricles Extracranial sites = spine, orbit Ruptured: Subarachnoid/intraventricular spread of contents Ruptured dermoid with spread in subarachnoid space Incidental arachnoid cyst T1 hyperintense mass (previous slide) Inhomogeneous T2 signal ranging from hypointense to hyperintense |
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Epidermoid
Epidermoid: Contains ONLY squamous epithelial keratin (derived from ectoderm) 5x more common than dermoid Dermoid: Contains squamous epithelial keratin AND dermal appendages Location: basal subarachnoid spaces, suprasellar cistern, 4th ventricle and CPA cistern Encases vessels and nerves DDX: Arachnoid cyst (negative on DWI) Epidermoid (positive on DWI) |
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Hamartoma of tuber cinereum (hypothalamic hamartoma)
Clinical presentation: Precocious puberty Gelastic seizure (laughing attacks) Congenital heterotopia of GM located in the tuber cinereum of the hypothalamus or maxillary bodies T1: isointense to GM T2: hyperintense Does not enhance and are not calcified DDX: Hypothalamic glioma (enhances) |
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Lymphoma
Primary lymphoma: MC NHL Parenchymal location: MC basal ganglia, periventricular deep WM, corpus callosum Metastatic lymphoma: Either dural-based or leptomeningeal When parenchymal, are usually associated with leptomeningeal disease CT: hyperdense T2: isointense to GM (dense cell packing) Restricts on DWI Dense homogeneous enhancement May be ring-like with AIDS Meningeal enhancement in secondary lymphoma Classic: fine feathery enhancement along VR spaces AIDS and lymphoma: Ring-like enhancement Large necrotic masses, may be multiple Calcification Classic: deep mass with homogeneous intensity similar to GM, dense contrast enhancement, minimal edema Responds to steroids: becomes negative on DWI DDX: Neurosarcoidosis: focal-enhancing parenchymal mass with enhancement along the perivascular spaces, and adjacent meningeal enhancement Glioblastoma (GBM): involves corpus callosum Metastasis: corticomedullary junction, multiple lesions Toxoplasmosis (AIDS): multiple lesions with ring enhancement Growth patterns: Masses in deep periventricular WM or GM Diffusely meningeal or periventricular ependymal involvement Diffusely infiltrative DDX: demyelinating disease, gliomatosis cerebri Intraspinal Spread along VR perivascular spaces |
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Neurosarcoidosis
CNS manifestation: Parenchymal: homogeneously enhancing isolated or multiple nodules, or as a ring-like enhancement around iso-hyperintense nodules Meningeal DDX: Multiple sclerosis: periventricular and subcortical white matter abnormalities, but NO enhancement (unless active demyelinating plaques) Vasculitis: extension into periaqueductal region represent ischemia associated with vasculitis or infiltration of subependymal sarcoid granulation tissue Chronic meningitis (fungal, TB) Meningeal carcinomatosis Lymphoma DDx for Leptomeningeal Enhancement “SICHI” as in the patient is sick Subarachoid Hemorrhage Inflammatory = Sarcoid Carcinomatosis (Prostate, Breast, Lung) Hypotension Infectious (Herpes, HIV, PML) |
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Oligodendroglioma
Peak 4th and 5th decades, rare in children Large slow growing tumor MC frontal lobe Coarse calcifications common Infiltrative lesions with poorly defined borders Calcified Tumors “Old Elefants Age Gracefully And like Peanuts” Oligo Ependymoma Astrocytoma GBM PNET |
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Sturge-Weber-Dimitri
Encephalo-trigeminal angiomatosis, may NOT be inherited Facial neveus flammeus, affects CN V dermatome Leptomeningeal venous angiomatosis Hypertrophy of choroid plexus Anomalies of venous drainage in the brain Cortical atrophy with tram-track calcification (gyral calcification) Angiography: abnormal bridging draining veins are not well developed, absent cortical veins prominent deep (medullary) veins, enlarged choroidal veins Eye: buphthalmos (“ox eye”) – congenital glaucoma, enlarged globe Chronic cerebral ischemia (abnormal cortical BBB) results in gyral (pial) enhancement Epi-cortical enhancement: result of slow flow in superficial veins Dyke Davidoff Masson (DDM) Sturge Weber is just one cause, any cause of cerebral childhood atrophy can result in DDM Cerebral hemiatrophy with homolateral hypertrophy of the skull and sinuses Widened diploic space, enlarged paranasal sinuses, gyral enhancement |
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Tuberous sclerosis (Bourneville's disease)
Case findings: subependymal calcified tubers Forme fruste: 5x MC than classic form Angiofibroma Face: adenoma sebaceum Ash-leaf macule: pointed at one end, oval at the other end (Lance-Ovate shape) Nail bed: ungual angiofibroma (DDX: subungual glomus tumor) Renal AML, LAM (chylothorax rare), cardiac rhabdomyoma, CNS: cortical tubers, subependymal nodules, subependymal giant cell astrocytoma in foramen of Monro Subependymal giant cell astrocytoma T1-weighted: focal, round, enhancing lesion of the anterior 3rd ventricle at the foramen of Monro resulting in obstructive hydrocephalus |
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Cortical dysplasia
Case findings: Thick, broad, gyri on coronal FLAIR Diffuse high T2-weighted signal in the occipital cortex Focal or generalized malformations of the cerebral cortex Junction of the grey/white matter is indistinct Types: Lissencephaly Smooth brain surface, caused by a paucity of gyri on the surface of the brain Complete agyria: synonymous with complete lissencephaly Focal cortical dysplasia: schizencephaly Generalized focal transmantle dysplasia: large area of brain with broad irregular gyri and sulci with areas of hyperintense and isointense gray to white matter Lissencephaly T2-weighted: complete absence of cerebral gyri |
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Gray matter heterotopia
Case findings: multiple irregular nodules in the subependymal region in the ventricular walls Collection of GM in ectopic locations secondary to arrest of radial migration of neurons May be isolated or seen with structural abnormalities Types: Subependymal heterotopia Focal subcortical heterotopia Band heterotopia Heterogeneous masses isointense to cortical GM on all sequences DDX: Subependymal nodules in tuberous sclerosis Band heterotopia on the right Area of dark signal running between the white matter and the cerebral cortex above the anterior horn of the right lateral ventricle Ipsilateral ventricular malformation |
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Choroid plexus papilloma
Case findings: Angiography: hypertrophy of anterior choroidal artery and precocious blush of the tumor nodule Inhomogeneously isointense on T1 and hyperintense on T2 Marked contrast enhancement MC located trigone in children and 4th ventricle in adults CT: isodense with marked enhancement MR: well delineated, usually isointense intraventricular mass that enhances markedly Angiography: dilated choroidal arteries feeding the tumor and marked capillary stain |
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Spinal cord ependymoma
Intramedullary spinal cord tumor: MC ependymoma, astrocytoma LC hemangioblastoma Focal enlargement of the spinal cord with low T1 and high T2 signal Spine adult: MC ependymoma Spine child: MC astrocytoma Spinal cord astrocytoma DDx Intradural/Intramedullary “AHEM, MIGHT I help you?” Astrocytoma Hemangioblastoma Ependymoma Mets MS Infection/myelitis Granulomatous – sarcoid Hemorrhage Trauma Intradural/Extramedullary “DAMN VASCULAR HEMATOMA” Dural mets AVM/arachnoid cyst Meningioma NF/Schwanomma Vascular Hematoma Extradural/Extramedullary “SMALL HEAD” Synovial cyst Mets/Meningioma/Schwanomma AVM Lymphoma Leukemia Hematoma Epidural Abscess Adenopathy Disk Bulge Herniation—Extrusion/Protrusion Free Fragment |
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Spinal cord AVM
Case findings: MR: large, serpiginous vascular structures with "flow void" are seen in the subarachnoid space Selective spinal angiography: main arterial feeders to the relatively small, glomerular nodule are anterior and posterolateral spinal artery, and prominent venous drainage (3rd image) Mechanism: compression by dilated vessels, chronic ischemic arterial steal and venous hypertension True AVM: congenital in origin Dural AVF: acquired and secondary to an inflammatory process that leads first to venous thrombosis and subsequently to a direct fistula |
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Spinal cord AVF
Case findings: MR: serpiginous vascular defects are seen in the opacified subarachnoid space Spinal angiography: Fistula at the level of the dura of the neural foramen (arrowheads) Enlarged spinal veins (arrows) Contrast enhancement with a patchy appearance without clearly defined margins within the abnormal signal area Due to venous engorgement and perivascular edema in dilated intramedullary venous capillaries, subjected to an abnormally high pressure |
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Warthin's tumor
Case findings: Bilateral multiple parotid gland rounded lesions which are iso- to hyperintense on T2, hypo- to isointense on T1, and suppress with FLAIR sequences DDX: Warthin’s tumors Lymphoepithelial cysts (if HIV+) Intraparotid lymphadenopathy If unilateral, consider Pleomorphic adenoma Mucoepidermoid carcinoma Lymphoma Sarcoidosis Represent heterotopic salivary gland ductal epithelial tissue trapped within intraparotid lymph nodes Rare cases can degenerate into cancer MC bilateral In the absence of HIV, bilateral lesions are Warthin’s tumors until proven otherwise HIV+: lymphoepithelial cysts Overall, pleomorphic adenoma is MC parotid lesion PAROTID SPACE/PRE STYLOID PARAPHARYNGEAL SPACE “PLEASE WATCH OUT for HEMANGIOMAS” Benign: Pleomorphic adenoma Warthins (only parotid bilateral tumor) DDx: Benign Lymphoepithelial Lesions-HIV Sjogren's Oncocytoma Hemangioma Malignant: Minor salivary gland tumors |
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Sinus pericranii
Case findings: Small, oval-shaped flow-void within the mid-anterior parietal scalp Lesion communicates with superior sagittal sinus and an adjacent dilated scalp vein abnormal communication between intracranial and extracranial venous systems Small, oval-shaped, CSF-containing lesion, which likely represents meningocele DDX lytic skull lesion in a child: Congenital anomaly (sinus pericranii) Eosinophilic granuloma (LCH) Fibrous dysplasia Hemangioma Infection Metastases Congenital or acquired Epicranial blood-filled nodule of the scalp that is in communication with an intracranial dural sinus through dilated diploic veins of the skull Connects the intracranial and extracranial venous systems Present in the pediatric age group as a focal swelling on the scalp MC in the frontal region, midline Soft and mobile mistaken for a lipoma or subcutaneous cyst |
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Meningioma
Case findings: Enhancing mass adjacent to left anterior clinoid process with eccentric suprasellar extension to the left and left inferior extension into the cavernous sinus Mass envelops left cavernous ICA inferiorly, the supraclinoid ICA superiorly, and the left optic nerve Mass is isointense to GM and enhances homogenously DDX enhancing perisellar mass: Meningioma (of anterior clinoid process) Sarcoid Metastatic disease Craniopharyngioma Aneurysm Macroadenoma Sarcoma arising from skull Parasellar Mass “MCAT” Meningioma/metastasis Cavernous carotid fistula Aneurysm Trigeminal Schwannoma/Tolosa-Hunt Tolosa-Hunt Terminology Idiopathic inflammatory pseudotumor, Tolosa-Hunt syndrome, hypertrophic cranial pachymeningitis, plasma cell granuloma Mixed inflammatory infiltrate involving meninges usually without associated orbital pseudotumor Imaging Findings Best diagnostic clue: Enhancing, infiltrating meningeal mass Intracranial involvement in absence of orbital disease is rule (> 90%) Enhancing mass thickens focal area of meninges |
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Orbital pseudotumor
Case findings: Poorly defined mass at insertion of left optic nerve Intraconal fat streaking DDX: Orbital pseudotumor Tolosa-Hunt Syndrome Lymphoma Graves Sarcoid Orbital infection/abscess Case findings: Poorly defined mass at insertion of left optic nerve Intraconal fat streaking DDX: Orbital pseudotumor Tolosa-Hunt Syndrome Lymphoma Graves Sarcoid Orbital infection/abscess Extraconal DDx “LIMP + RHABDO” Lymphoma Infection Mets Pseudotumor Rhabdomyosarcoma Intraconal DDx “LIMP + HEMANGIOMA” Lymphoma Infection Mets Pseudotumor Hemangioma EXTRAOCULAR MUSCLES LIMP + GRAVES Lymphoma Infection Metastasis Pseudotumor Graves OPTIC NERVE LIMP + GMN Lymphoma Infection Metastasis Pseudotumor Glioma Meningioma Neuritis |
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Colloid cyst
Case findings: CT Oval hyperdense mass in 3rd ventricle No hydrocephalus MRI Circumscribed midline oval mass in 3rd ventricle Mass is isointense on T1 and mixed signal on T2 No enhancement DDX: Colloid cyst Meningioma Ependymoma Giant cell astrocytoma Central neurocytoma Intraventricular, neuroepithelial cyst MC at anterosuperior aspect of 3rd ventricle between columns of the fornices Hyperdense on CT High SI on T1 and low SI on T2 Complication: positional headaches from intermittent hydrocephalus from obstruction of adjacent foramina of Monro May result in sudden death |
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Thyroid ophthalmopathy
Case findings: Prominence of post-septal fat with stranding Rectus muscles are enlarged, with sparing of lateral rectus No focal mass present Thyroid ophthalmopathy (other findings) Normal muscle insertions on the globe Increased orbital fat (producing exophthalmos) "Stretching" of optic nerve from exophthalmos Lacrimal gland enlargement (edema) Eyelid enlargement (edema) Distended superior ophthalmic vein Conal lesions affecting EOM Thyroid ophthalmopathy: bilateral, painless Orbital pseudotumor: unilateral, painful Cellulitis Metastasis Carotid-cavernous fistula, thrombosis, or dural malformation Lymphoma Trauma (hematoma, swelling) Myositis Acromegaly Tolosa-Hunt syndrome Painful ophthalmoplegia Etiology is indolent granulomatous inflammatory process of anterior cavernous sinus, superior orbital fissure, and orbital apex |
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Cerebral amyloidoma
Case findings: Lesion in the left edge of periventricular WM extending into the left lateral ventricle Smaller lesions in the left insular cortex and dorsal pons Lesions were T1 bright, T2 dark, and enhanced Enlarged ventricles Not shown: No significant foci of restricted diffusion seen PET shows no abnormal areas of metabolic activity DDX: Lymphoma Metastatic melanoma Cavernous malformation Hemorrhage Cerebral amyloidoma Primary: associated with multiple myeloma Secondary: occurs with chronic infection, inflammation, neoplasm, chronic hemodialysis MC manifest by cerebral amyloid angiopathy cause intracranial hemorrhage Focal amyloid (amyloidoma) is LC and is independent of systemic amyloidosis T1 hypo/isointense with WM, hypointense T2, heterogenous enhancement Multiple Brain Lesions MAILMAN Metastasis Angiomas—Vascular malformations/Amyloidosis Infarction/infection Lymphoma Multiple sclerosis Abscesses/Amyloidosis NF spots (remember the esoteric diagnoses) |
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Neuroblastoma (metastatic)
Case findings: Destructive extra-axial lesion of the right greater sphenoid wing Large exophytic component extending into anterior and middle cranial fossa Axial compression on right hemispheric structures Heterogeneous enhancement DDX extra-axial mass involving bone (in a toddler): Metastatic neuroblastoma Metastatic rhabdomyosarcoma Ewing tumor Osteosarcoma Lymphoma, leukemia |
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Arteriovenous malformation
Case findings: MRI: multiple large serpiginous flow-voids within the right parietotemporal lobe MRA: multiple middle cerebral feeding arteries and a draining vein DDX: Arteriovenous malformation Highly vascular neoplasm (e.g., anaplastic astrocytoma or GBM) MC solitary unless seen in association with other syndromes (Osler-Weber-Rendu) Direct communication of arteries to veins with no intervening capillary bed AVM often contain: Gliotic brain from vascular steal phenomena Old blood products from prior hemorrhage Angiography: Enlarged arteries and veins with AV shunting Early draining veins |
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Von Hippel-Lindau (retinocerebellar angiomatosis)
Case findings: Multiple cystic lesions the cerebellum with solid mural nodulesRi Right globe enhancing vascular lesion Small enhancing extra-axial cervical spine nodule at C2-C3 level MC CNS hemangioblastomas Retinal angiomatosis Renal cell carcinoma Renal adenoma and hemangiomas can also occur Pheochromocytoma, often bilateral Pancreatic cystadenoma or adenocarcinoma Cystadenoma of the epididymis Liver hemangiomata and adenomas Paraganglioma Cysts in virtually any organ Terminology Autosomal dominant familial tumor syndrome with hemangioblastomas (HGBLs), clear cell renal carcinoma, cystadenomas, pheochromocytomas Imaging Findings Best diagnostic clue: 2 or more CNS HGBL or 1 HGBL + retinal hemorrhage A hemorrhage in the right globe can be seen on the routine coronal T1 weighted scan. This should raise the suspicion for retinal angioma, a common finding in patients with VHL that can be overlooked if the orbits are not closely scrutinized. |
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Trigeminal nerve schwannoma
Case findings: Mass associated with mesencephalic cistern portion of trigeminal nerve Mass enhances homogeneously Trigeminal nerve is the 3rd MC MC acoustic and then facial nerves May demonstrate cystic change associated with more aggressive behavior CP Angle DDx “SLow GAME” Schwanomma: V and VII Lymphoma/lipoma Glomus tumor Aneurysm Meningioma/Metastasis Epidermoid/Ependymoma |
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Colloid cyst
Intraventricular, neuroepithelial cyst MC at anterosuperior aspect of 3rd ventricle between columns of the fornices Complication: positional headaches from intermittent hydrocephalus from obstruction of adjacent foramina of Monro Intraventricular Lesions 3 Carat GEMS (found in the ventricles) Colloid cyst Choroid Plexus Papilloma Central Neurocytoma Giant Cell Astrocytoma Ependymoma Meningioma/mets Subependymoma |
