CNS Flashcards by abdelathiem adel

Pilocystic astrocytoma
Modality
We must take biopsy

pre & post contrast CT
MRI T1 brain axial with IV contrast
RT infratentorial intraaxial cystic lesion with mural enhancement
No need for biopsy !!!

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CT brain axial with contrast
Ring enhanced lesion in left frontal lobe with contralateral vasogenic edema
Dx :

Can also be described as :

Typical for Glioblastoma
Lt glioblastoma

Heterogenous enhanced mass in corpus callosum

Ring enhanced lesion with vasogenic edema
“ check for subfalcine herniation “

Next step is biopsy

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Brain tumour
With bilateral ring enhanced lesion in corpus callosum surrounded by vasogenic edema
Dx :
Sign :

Glioblastoma
Butterfly sign

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Malignant cells invade the BBB
Or abscess

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Meningioma
Most common site :
Type of enhancement:

Parasagital “ at cerebral convexities
Homogenous enhanced mass
“ may contain calcium “

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Rat tail sign
Claw sign
+ broad base

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Meningitis
Meningioma

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Meningioma
Extra or Intra axial ?

Extra axial

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If meningioma surrounded by vasogeniv edema =

Malignant meningioma

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Calcium way of appearance on
CT
MRI

CT : white as skull
MRI : mass appear heterogenous

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Differences between ring enhanced lesions in the brain :

Abscess
Thin regular wall , multiple : adjacent to each other

Glioblastoma : single thick irregular wall

Metastasis : single in cerebellum , multiple : away from each other

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Suspect brain metastasis
Next step is :

CXR ; the commonest tumour is lung cancer

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CT brain axial with IV contrast
Multiple enhanced lesions , one of them shows ring enhancement located in the cerebellum & basal ganglia
Dx is :

Metastasis

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Acoustic shwannona
Arise from …..

Myelin sheath of the 8th Cranial nerve

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Left CPA enhanced extra axial mass
History of sensorineural deafness
Dx :

Acoustic neuroma

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Pre & post contrast CT brain axial
Show heterogenous enhanced extra axial mass
Ddx :

Acoustic shwannoma
Meningioma
Ependymoma
Neuroepithelial cyst

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Heterogenous enhanced mass at CPA
Can be

acoustic shwannoma
meningioma “ with Calcium “

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The most common intracranial malignancy in adults is ………

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Brain metastasis

Pituitary adenoma
Can be
Micro …
- non enhanced
- dx by ….
Most common disturbance …..

Macro ….
-enhanced
-dx by ….
- complain of ………

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Micro <1cm
MRI only
Secondary amenorrhea

Macro >1cm
CT or MRI
-no hormonal alteration
Pressure symptoms = high ICP compressing carotid arteries & optic chiasma “ bitemporal hemianopia

Large homogenous enhanced mass occupying sella turcica
Ddx :
Dx :

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Pituitary macroadenoma , meningioma

Dx : pituitary macroadenoma

Large mass occupying sella turcica with mass effecy on optic mass

MRI T1 brain axial with IV contrast
Describe acute bacterial meningitis

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Leptomeningeal enhancement , hydrocephalus

Leptomeningeal enhancement with pus
Dx : bacterial meningitis complicated by empyema
Modalities used :

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MRI T1 axial with IV contrast
MRI diffusion weighted image

MRI T1 axial brain with IV contrast
Basal enhancement witg microabscesses.
Dx :

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Tubercuolous meningitis

Describe viral meningitis :

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CT axial brain with IV contrast
Hypodense edema , sulci effacement

Describe Brain abscess : Management :

CT brain axial with IV contrast ring enhanced lesion in RT frontoparietal lobe surrounded by vasogenic edema Antibiotic & drainage

Ring enhanced lesion in brain Abscess Or Tumour “ metastasis”

Absecess close to each other Metastasis away from each other

CT = no hge > exclude ...... Ischemic stroke = Early “ before 6 hours :........ 6-12 hrs : ......

Hemorrhagic stroke CT normal Dense artery sign : cytotoxic edema lead to Sulci effacement ; poor differentiation between grey & white

Dense artery Sulci effacement indicate :

Hyperacute ischemic stroke

Hyperacute I S : Describe

CT brain axial without Iv contrast Dense artery sign , sulci effacement Finding follow right middle cerebral artery territory

Acute ischemic stroke describe

Wedge shaped edema follow Lt middle cerebral artery territory

Encephalomalacia follow MCA terrirory

Lt chronic ischemic stroke No need for Treatement

Diagnosis of ischemic stroke within 30 min from onset of symptoms can be done by :

Diffusion weighted imaging

Forms of hemorrhagic stroke : - - - -

Intraventricular hemorrhage Subarachnoid hemorrhage Acute parenchymal hemorrhage Acute pontine hemorrhage

Most common cause of hemorrhagic stroke : Other causes :

HTN At basal ganglia Arteriovenous malformation rupture Cancer Berry’s aneurysm Bleeding disorder

H/O of chronic headache Carotid angiogram Digital subtraction angiogram Dx of .... Complications:......

Arteriovenous malformation Rupture & hemorrhagic stroke

Berry aneurysm can be diagnosed with ........ Complication ......

Digital subtraction angiogram DSA Rupture & hemorrhagic stroke

CT brain axial without IV contrast Hyperdense parenchymal hemorrhage occupying left basal ganglia Dx : Most like cause :

Left acute parenchymal hemorrhage Hypertension

Hyperdense hge occupying the sulci Dx :

Subarachnoid hge

Parenchymal hemorrhage with vasogenic edema Most like the cause is :......

Cancer

Hyperdense hge occupying the pons

Acute pontine hemorrhage

Most common sites of diffuse axonal injury :

Junction between white & grey matter Corpus callosum Basal ganglia Brian stem

Brain contusion appear as Can be

Hemorrhagic foci always acute Coup , counter coup or both

Diffuse axonal injury diagnosed by : Hypointense dots

MRI T2 star Appear as hypointense dots

Signs of acute ischemic stroke

Dense artery sign Poor differentiation between grey & white matter Sulci effacement

CNS Flashcards

(44 cards)