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Diagnostic Methods > Neuro Imaging > Flashcards

Neuro Imaging Flashcards

1
Q

What type of scan is usually first line for neuro due to fast scanning times and availability

A

CT

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2
Q

What is better seen on CT

A

Anatomy of the skull

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3
Q

On a non-contrast CT what usually shows up as white

A

Bone or blood

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4
Q

What type of MRI is considered standard and best for differentiating fat from water

A

T1

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5
Q

What type of MRI is most sensitive for detecting brain pathology

A

T2

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6
Q

Anatomical MRI is ____ weighted while functional MRI is ___ weighted

A

T1
T2

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7
Q

Water appears black on _____ weighted images and white on ____ weighted images

A

T1
T2

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8
Q

Which type of imaging is best for acute hemorrhage

A

CT

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9
Q

Which type of imaging is best for diffuse axonal injury

A

MRI

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10
Q

What is the study of choice in head trauma and more sensitive for detecting fractures

A

CT

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11
Q

What imaging is used as the initial study in strokes

A

CT

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12
Q

What imaging study is more sensitive for brain masses

A

MRI

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13
Q

What is usually used to evaluate for aneurysms

A

CT

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14
Q

When is contrast dye used?

A

When evaluating for intracranial mass or vascular pathology

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15
Q

What is the study of choice when tumor is being imaged

A

MRI brain with and without contrast

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16
Q

What kind of imaging uses contrast to provide pictures of the blood vessels (eval for aneurysms, vertebral artery injuries, or vascular malformations)

A

CT angiogram

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17
Q

When is MR angiography used

A

If the patient has decreased renal function, contrast dye allergy, pregnant or breastfeeding patients

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18
Q

What should you use to view skull fractures?

A

Bone windows

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19
Q

What type of skull fractures are more likely to occur in temporal and parietal bones?

A

Linear skull fractures

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20
Q

What kind of skull fracture is associated with underlying brain injury and results from a high energy blow to a small area of the skull?

A

Depressed skull fractures

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21
Q

What is the imaging study of choice for facial fractures?

A

CT

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22
Q

What is the most common type of orbital fracture?

A

Blow out fracture

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23
Q

What is a traumatic accumulation of blood between the inner table of the skull and the stripped off dural membrane?

A

Epidural hematoma

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24
Q

70-80% of EDHs are located where?

A

In the temporoparietal region

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25
Q

CT looks like a balloon, young person, bright red blood

A

EDH

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26
Q

Which type of hematoma cannot cross the suture line

A

EDH

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27
Q

Most EHDs are due to injury to which artery

A

Middle meningeal artery

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28
Q

High-density, extra-axial, biconvex lens-shaped mass lesion on CT. Found in the temporoparietal region.

A

Epidural hematoma

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29
Q

13 yo male patient presents to ED after falling off his bike and hitting the left side of his head. Parents report he passed out for a minute, but has been acting fine since. He reports headache. Within 5 minutes of talking to him, he starts to act sleepy, his words become confused, and you notice his left pupil is larger than the right. Dx?

A

EDH

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30
Q

False localizing sign where the patient will experience ipsilateral weakness due to midline shift of the brain stem shift forces in contact with the opposing tentorium

A

Kernohan’s notch

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31
Q

T or F: epidural hematomas are more common than subdural hematomas

A

False. Subdural are more common

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32
Q

Commonly occurs in elderly and looks like a banana on imaging

A

Subdural hematoma

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33
Q

Often seen in deceleration injuries such as car crashes or falls

A

Subdural hematoma

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34
Q

Hemorrhage into potential space between dura mater and arachnoid

A

Subdural hematoma

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35
Q

Which hematoma is associated with a high mortality rate

A

SDH

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36
Q

Bridging veins are usually the source of __________ hematoma

A

Subdural

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37
Q

Acute SDH appears _______ on non-contrast CT while chronic SDH appears _______ on CT ___ weeks after injury

A

White
Dark
3

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38
Q

84 year old female had a ground level fall 3 days ago after dialysis treatment and struck her head. No loss of consciousness. She has been complaining of headache since then. This morning she was not acting like herself and was very sleepy with slurred speech. Dx?

A

Subdural hematoma

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39
Q

72 yo female who has history of a fib and on Coumadin therapy tripped and fell while walking home. She hit her head on the lawn. What brain injury she most at risk for?

A

Subdural hematoma

40
Q

SDH clinical presentation (small-moderate)

A

Small bleed, asymptomatic or mild headache, confused, mild weakness on contra lateral side, sleepy

41
Q

SDH clinical presentation (severe)

A

Obtunded, contralateral hemiplegia, dilated/fixed contralateral pupil

42
Q

Symptoms will start within ____ hours of injury for acute SDH, ____ days for subacute SDH, and ________ or longer in chronic SDH

A

72
3-20days
3 weeks or longer

43
Q

MCC of subarachnoid hemorrhage

A

Trauma

44
Q

MCC of spontaneous subarachnoid hemorrhage

A

Ruptured aneurysm

45
Q

Thunderclap headache, altered level of consciousness, unchallenged rigidity, cranial nerve palsy or neuro deficit, hx of smoking or Htn

A

Subarachnoid hemorrhage

46
Q

Most frequent CNS aneurysm

A

Berry aneurysm

47
Q

Gold standard test for SAH and alternative choice

A

CTA head
MRA as alternative if pt can’t have contrast

48
Q

_________ develops from a congenital weakening of the arterial wall, usually at the Circle of Willis

A

Berry aneurysm

49
Q

Treatment for traumatic SAH vs aneurysmal SAH

A

Traumatic- monitor in ICU, consider external ventricular drain
Aneurysmal-nimodipine, BP control, daily sodium level, daily transcranial Doppler, surgical clipping/coiling

50
Q

Acceleration/deceleration forces diffusely injure axons deep to cortex, most often from MVA

A

Diffuse axonal injury

51
Q

Study of choice for DAI

A

MRI

52
Q

You see loss of normal differentiation between gray and white matter, effacement of normal sulci, ventricular compression and herniation on brain imaging. What should you be concerned for?

A

Cerebral edema

53
Q

Common injury following trauma that is often due to shearing of small intracerebral vessels

A

Coup

54
Q

Acceleration/deceleration injuries that occur when the brain is propelled in the opposite direction and strikes inner surface of the skull

A

Contrecoup

55
Q

What do you see on a CT of someone with intraparenchymal hematoma

A

Multiple small, well-demarcated areas of high attenuation within parenchyma surrounded by a ring of hypo-attenuation, compression/shift of ventricles is common

56
Q

_______________ is often secondary to large IPH and or SAH

A

Intraventricular hemorrhage

57
Q

What is an acute loss of neurologic function that occurs when blood supply to an area is lost or compromised

A

Stroke

58
Q

What are the uses for CT for a stroke patient

A

Determine if there is another cause of the neuro impairment, identify presence of blood to differentiate ischemic vs. hemorrhagic, identify and characterize the infarct

59
Q

Thromboembolic disease secondary to atherosclerosis

A

Ischemic stroke

60
Q

What is the timeline for CT findings for ischemic stroke

A

12-24 hrs- indistinct area of low attenuation in a vascular distribution
>24 hrs- better circumscribed with mass effect
72 hrs- contrast enhancement occurs when mass effect is waning or gone
>4 weeks- no mass effect, well-circumscribed low attenuation lesion with no contrast enhancement

61
Q

What are signs of acute stroke on CT

A

Insular ribbon sign, obscured lentiform nucleus, dense artery sign

62
Q

Which CVA vascular distribution is most common and has the most significant symptoms

A

MCA

63
Q

Most hemorrhagic strokes are related to _________ and occur in the __________

A

Hypertension
Basal ganglia

64
Q

Freshly extravasated whole blood will be seen as _________ on non-enhanced CT and becomes ________ for about 3 days. After the 3rd day the clot _________ in density. After ____ months only a small hypo density may remain.

A

Increased density
Denser
Decrease
2 months

65
Q

What is the most common primary supratentorial, intro-axial mass in adults

A

Astrocytomas/Gliomas

66
Q

Which intracranial tumor is classified as WHO Grade IV and has the worst prognosis

A

Glioblastoma Multiforme

67
Q

Glioblastoma multiforme is more common in _________

A

Males ages 65-75

68
Q

You get a CT back that shows a tumor with necrosis, tumor infiltrates surrounding brain tissue, crossing the white matter of the corpus callosum, and produces vasogenic edema and mass effect. What should you be concerned about?

A

Glioblastoma multiforme

69
Q

T or F: There are usually multiple metastases in the brain, but they can be solitary

A

True

70
Q

Metastases are typically _________or ________ on non-enhanced CT. With IV contrast, it can enhance in a pattern of ____________

A

Hypodense or isodense
Ring-enhancement

71
Q

What are the most common primary malignancies to produce brain lesions

A

Lung cancer, breast cancer, melanoma

72
Q

What is the most common extra-axial mass

A

Meningiona

73
Q

Meningioma arises from _________, often attached to dura with a “____________”

A

Arachnoid
“Dural tail”

74
Q

Meningiomas usually occur in what group of people

A

Middle-aged women

75
Q

Multiple meningiomas may be associated with _____________

A

Neurofibromatosis type 2

76
Q

On CT, greater than half of ___________ are hyper dense, may contain calcification and enhance markedly with contrast

A

Meningiomas

77
Q

The most common symptom of acoustic neuroma is ___________

A

Hearing loss

78
Q

What kind of mass occurs most commonly along the course of the eight cranial nerve within the internal auditory canal

A

Acoustic neuroma (schwannoma)

79
Q

What is the most sensitive imaging study for acoustic neuroma

A

MRI

80
Q

What kind of tumor is often benign, presents with vision changes, and may be associated with hormonal disturbances

A

Pituitary tumor

81
Q

Large ________ tumors often displace the optic nerves and look like a snowman

A

Pituitary tumors

82
Q

Obstructive extra-ventricular hydrocephalus with dilation of the fourth ventricle

A

Communicating

83
Q

Obstructive intraventricular hydrocephalus where the fourth ventricle is normal in size

A

Noncommunicating

84
Q

A 60 year old patient presents to the ER with urinary incontinence, loss of balance, and confusion. Their brain CT shows enlarged ventricles with flattened sulci. What is the diagnosis?

A

Normal pressure hydrocephalus (“wet, wobbly, wacky”)

85
Q

T or F: atrophy implies loss on gray matter only

A

False. It implies loss of gray AND white matter

86
Q

Why do the ventricles dilate in patients with cerebral atrophy?

A

Because the loss of normal cerebral tissue produces a vacant space.

87
Q

What is the study of choice for MS

A

MRI

88
Q

MS lesions have a predilection for what areas

A

Periventricular area, corpus callosum, and optic nerves

89
Q

You look at your patient’s T2 weighted MRI and see lesions that produce discrete, globular foci of high signal intensity. What do these findings indicate?

A

MS

90
Q

22 yo male was using an electric scooter when he crashed and fell off. His friends report he struck his head, was unconscious for a minute and then was able to get up. He was not wearing a helmet. He is currently in the ER and is alert and oriented and able to move his face and extremities. He tells you he is getting sleepy. What is on the ddx? What imaging do you order?

A

Epidural hematoma, CT?

91
Q

55 yo male found down and unresponsive. He is intubated and in the ICU when you arrive. His wife tells you that he had been complaining of horrible headache an hour before she found him. He has taken some ibuprofen with no relief. What is on the ddx? What would you order for imaging?

A

Subarachnoid hemorrhage, Non-contrast CT head

92
Q

75 year old female with new onset right sided weakness. She ran out of her BP meds a few days ago. Her BP is currently 179/113. The right side of her face is droopy and she has difficulty moving her right arm. What do you suspect? What do you order?

A

Ischemic stroke, Head CT first for rapid results, then. MRI

93
Q

41 yo male with a cc of a worsening headache. It usually gets better with Tylenol, but has been more persistent over the past few weeks. Denies any recent trauma. His medical history is significant for hypertension and hyperlipidemia. He has borderline diabetes. His BP is 134/85. Dx?

A

Meningioma

94
Q

Classic presentation of EDH

A

Brief loss of consciousness during accident, but then they recover and appear relatively normal for several hours before getting rapid onset neuro deterioration

95
Q

Symptoms of EDH

A

Obtundation, ipsilateral dilated or blow pupil, contralateral weakness, nausea and vomiting, seizure, increased ICP (htn, bradycardia, irregular respirations)

96
Q

T or F: less than 20% of EDH patients actually experience a lucid period between the trauma and subsequent neuro deterioration

A

True

Diagnostic Methods (5 decks)

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