Neuroradiology

Question 1

What is a complication of administering gadlonium as a contrast agent in patient with renal dysfunction?

Answer 1

Nephrogenic systemic fibrosis

Question 2

Hyper/hypodense are used to describe features in which imaging modality?

Answer 2

CT

Question 3

Signal intensities are used in which imaging modality?

Answer 3

MRI
T1 white matter white, grey matter grey
T2 bright CSF but fat also (WW2 water is white in T2)

Question 4

Which contrast is used in CT?

Answer 4

iodine

Question 5

Which contrast is used in MRI?

Answer 5

gadolinium

Question 6

Which imaging is used to ID penumbra?

Answer 6

CT perfusion

Question 7

Patient is outwith 4.5hr for thrombolysis but has identified a penumbra region on CT perfusion scan. What should you do?

Answer 7

thrombolysis- the timing of the window is not absolute. If patient was <4.5 hr but has no penumbra then you wouldn’t thrombolyse due to concern over haemorrhagic transformation

Question 8

What are the two types of haemorrhagic transformation?

Answer 8

petechial haemorrhage

intraparenchymal haemorrhage

Question 9

Which haemorrhagic transformation has worse prognosis?

Answer 9

intraprenchymal haemorrhage

Question 10

One risk factor for haemorrhagic transformation?

Answer 10

thrombolytic therapy

anticoagulant therapy

Question 11

80 year old man with hyperdense region in thalamus and has history of HTN presents with confusion and right sided weakness. What do you do?

Answer 11

monitor in ward (there would be an underlying potentially serious cause in a younger patient)

Question 12

40 year old with hyperdense region in parenchyma indicative of atraumatic intracranial haemorrhage. What is a primary cause?

Answer 12

HTN/CAA= Cerebral amyloid angiopathy

Question 13

40 year old with hyperdense region in parenchyma indicative of atraumatic intracranial haemorrhage. List two secondary causes of this

Answer 13

coagulopathy
vasc malformation
tumour
recreational drugs
vasculitis
(therefore need to investigate underlying cause in a younger patient)

Question 14

What is the difference between haemorrhage caused by HTN and CAA on imaging

Answer 14

haemosiderin distribution is more central in HTN and peripheral in CAA

Question 15

What is the shape of extradural haemorrhage on CT scan?

Answer 15

bi-convex/lentiform shape

Question 16

What is the swirl sign?

Answer 16

non-contrast CT appearance of acute extravasation of blood into a haematoma, for example an intracerebral haemorrhage, extradural haematoma or subdural haematoma. It represents unclotted fresh blood which is of lower attenuation than the clotted blood which surrounds it

Question 17

What is the main type of aneurysm that causes SAH?

Answer 17

saccular

Question 18

Name two types of anuerysms that cause SAH

Answer 18

saccular (majority), fusiform, dissecting

Question 19

Where do lesions appear in MS?

Answer 19

periventricular
spinal cord
infratentorial
juxtacortical

Question 20

Which criteria is used in MS?

Answer 20

MacDonald’s

Question 21

What is the most common cause of encephalitis?

Answer 21

herpes simplex virus I (HSC1)

Question 22

What is the treatment of viral encephalitis?

Answer 22

aciclovir, therefore suspiscion of viral encephalitis, treat with aciclovir right away before imaging

Question 23

Name one change seen typically in brain scan of alzheimer’s disease patient

Answer 23

hypoperfusion in parietal lobe

loss of volume in mediotemporal lobes