Brain Masterclass

Question 1

first line imaging in the brain?

Answer 1

CT

Question 2

contrast enhanced vs non contrast enhanced CT in brain?

Answer 2

grey and white matter better differentiated in contrast enhanced

Question 3

suprasellar cisteren?

Answer 3

star shaped dark area which sits more forward in brain CT

where the circle of willis sits

Question 4

quadrigeminal cistern?

Answer 4

half circle shaped dark area in middle of brain

sits behind brainstem and suprasellar cistern

Question 5

learn midline slice MRI>

Answer 5

...
featues 
- thalamus
- midbrain
- pons
- medulla
- caudate nucleus
- cingulate gyrus
- frontal lobe
- parietal lobe
- occipital lobe
- anterior and posterior lobe of cerebellum

Question 6

difference between cerebrum and cerebellum

Answer 6

gyri are finer in cerebellum (foliae)

Question 7

T1 weighted?

Answer 7

fluid is black

better for seeing anatomy

Question 8

T2 weighted?

Answer 8

fluid is white

better for seeing pathology

Question 9

purely frontal lobe stroke?

Answer 9

executive function

Question 10

visual disturbance and vertigo are features of a stroke where?

Answer 10

posterior circulation

occipital lobe or cerebellum

Question 11

main 3 causes of ischaemic stroke?

Answer 11

embolism
thrombosis (plaque rupture etc)
vertebral artery dissection

Question 12

common source of stroke in cerebellar circulation?

Answer 12

vertebral > basillar > posterior inferior cerebellar areries

Question 13

why is imaging used in stroke even it is a clinical diagnosis?

Answer 13

management

- different is ischaemic or haemorrhagic etc

Question 14

window for thrombolysis in ischaemic stroke?

Answer 14

6 hours

Question 15

is contrast used in CT for stroke?

Answer 15

no

Question 16

is thrombolysis given is established stroke is found (7 hours - 1 day+)?

Answer 16

no

Question 17

early findings on CT?

Answer 17

hyperdense segment of a vessel and matching features

Question 18

finding s within first few hours?

Answer 18

loss of grey white matter differentiation
hypoattenuation of deep nuclei
cortical hypodensity with associated parenchymal swelling with resultant grey matter engulfmant

Question 19

within a few more hours what is seen?

Answer 19

hypoattenuation and swelling become more marked resulting in a significant mass effect
larger dark area

Question 20

with even more time?

Answer 20

gliosis occurs appearing as a region of low density with volume loss
darker, slighly smaller and more defined area than earlier hypoattenuation

Question 21

acute blood and clots appears like what on CT?

Answer 21

white

Question 22

2 types of intracranial haemorrhage?

Answer 22

intra-axial
- intra-parenchymal
- e.g burst lobe/lobar haemorrhage
- often causes midline shift
extra-axial
- outside of brain tissue
- extra-dural haemorrhage
- subdural haemorrhage
- subarachnoid haemorrhage

Question 23

classic place for hypertensive bleed?

Answer 23

basal ganglia
thalamus
etc

Question 24

main signs of subarachnoid haemorrhage?

Answer 24

white star shaped area in middle of brain

blood may collect around circle of willis, in sulci or in ventricles

Question 25

what is done if subarachnoid blood is found in absence fo trauma?

Answer 25

CT angiogram to look for berry aneurysm

Question 26

complications of subarachnoid haemorrhage which usually cause death rather than the haemorrhage itself?

Answer 26

hydrocephalus vasospasm infarction

Question 27

sign of early hydrocephalus?

Answer 27

enlarged temporal horns

Question 28

first test for brain mass?

Answer 28

CT

Question 29

which type of tumour will enhance the most?

Answer 29

higher grade

Question 30

how can oedema (e.g from a brain tumour) be differentiated from blood from haemorrhage/

Answer 30

oedema doesn't go all the way out to periphery (wedge shaped)

Question 31

which type of brain tumour generally has lots of oedema?

Answer 31

metastatic

Question 32

how does coning cause death?

Answer 32

compresses clivus against pons and medulla disrupting cardio and resp centres

Question 33

level of conus medullaris?

Answer 33

L1 | in thecal sac

Question 34

presentation of spinal cord compression?

Answer 34

``` back pain with red flags - malignancy history - major trauma - thoracic/radicular pain - constant, progressive, non-mechanical pain - systemically unwell loss of power and sensation in lower limbs urinary retention ```

Question 35

investigations in spinal cord compression?

Answer 35

urgent MRI | CT can show fractures or gross malalignment but wont show cord

Question 36

signs of extra-dural haemorrhage on imaging?

Answer 36

biconvex lens shape often overlying temporoparietal region bound by fissures in brain

Question 37

features of sub-dural haemorrhage on imaging?

Answer 37

often from shaking baby or falls in elderly wont cross the midline semilunar shape on CT subacute = isodense (looks same as brain) chronic = hypodense (darker)