H&N Flashcards
(210 cards)
1
Q
intraconal mass
A
melanoma - most common globe mass in adult, mushroom shape ⬆t2⬇t1, c+ retinoblastoma mets meningioma lymphoma vascular - haemangioma optic nn glioma pseudo tumor - mm and tendon cellulitis Graves - mm only
2
Q
extraconal mass
A
MOLD
mets
Others - rhabdomyosarcoma, lymphangioma (kids 1st decade, don’t involute like neck), plexiform neuro fibroma, pseudo tumor, haemangioma
Lacrimal gland/Lymphoma (DWI +, homogeneous c+)/LCH
Dermoid (anterior medial angle..fat containing)
3
Q
Lacrimal gland mass
A
lateral to globe
50% inflammatory - wegeners
50% neoplastic - lymphoma, pleomotphoc adenoma
4
Q
destructive lesion in mandible
A
Mets
myeloma
EG - older kids and young adults, pseudo tumor. punched out lyric erosion
severe peridontal infection
5
Q
glomus tumour
A
carotid body- ICa/ECA bifurcation. most common, middle aged. can be bilateral. assoc. NF1, TS, MEN II, VHL
glomus vagale- behind carotid, IJV goes back and ICa/ECa forward (not splayed). painless.
jugulare tympanicum - Arnold nn (X). between cochlear promintory and jug foramen
tympanicum - cochlear promontory and middle ear. arises Jacobs nn (IX) . most common middle ear tumour.
6
Q
J shaped sella
A
hydrocephalus mucopolysaccharides Achondroplasia pituitary mass idiopathic - 5% neuro fibroma toss Optic chasm glioma
7
Q
WM lesion HIV
A
vascular - rxt, vasculitis
Infection- PML (asymmetric, subcortical u fibres), HIV encephalitis, CMV (spares u fibres), toxoplasmosis, HSV, tb, cryptococcus
Demyelination, pres
Neoplasm - lymphoma, glomatosis cerebri
8
Q
BG lesion HIV…… VINT
A
Vascular - hypoxia, aa or deep vv infarct
Infection - crypotococcus, toxo
Toxic/metabolic- CO, drugs, osmotic Demyelination
Neoplasm - lymphoma, glioma
9
Q
HIV encephalopathy vs PML
A
PML - 3 Ps
peripheral, patchy, posterior
Encephalitis - symmetrical frontal atrophy
both have very little to no mass effect and no c+
10
Q
PHACE
A
Posterior fossa malformation Haemangioma Arterial anomalies Coarctation of aorta E. Occur anomalies
11
Q
Lymphangioma. what is it
A
benign lymphatic malformation of vascular origin
90% kids <2yo. h&n most common
lots of interconnecting cysts. homogeneous on CT fluid density.
Cavernoma (small microcysts), cystic hygroma (macrocysts), simple capillary and lymphovascular
12
Q
infantile haemangioma
A
benign vascular neoplasm
small or absent at birth, grows in first year then involutes
C+, intermediate/high T2, NO phleboloiths
associated PHACE
13
Q
salivary and parotid tumour
A
benign:
pleomorphic adenoma (most common parotid. also in salivary and Lacrimal. lobular low density/echo +/- ca+ & necrosis)
warthins (cystadenoma. bilateral and multifical, cystic/solid. assoc smoking and rxt)
other adenomas
Oncocytoma
Malig:
mucoepidermoid carcinoma ( most common parotid. sq cells)
adenoid cystic carcinoma (small. most common minor salivary. no sq. cells) Lymphoma
adenoca and scc
14
Q
Kimura disease
Castleman’s disease
A
Kimura. inflamm salivary, parotid and submandibulars. 20-40yo Asians
castlemans. lymphoid hyperplasia. young adults and kids (unifocal) or HIV (multifocal). thorax 》abdo》neck
15
Q
Nasal mass
A
Juvenile angio fibroma. exclusive to teenage males. sphenopalatine fossa. v. vascular (maxillary aa)
Nasopharygeal ca. 20s and >60yo peaks. Chinese, African kids. EBV and HPV assoc. fossa rosenmeuller
Inverting papilloma. sq. epithelium inverts into mucosa to give cerebriform appearance. Lat wall or max sinus. smokers
Polyp. lateral wall and roof. chronic irritation. can be up to 4cm.
16
Q
cholesteatoma vs cholesterol granuloma
A
granuloma is T1 high
cholesteatoma t1 low. don’t C+
17
Q
Piriform and vallecula
A
VP
Vallecula higher
Piriform lower
18
Q
Brachial cleft cysts
A
- EAC - posteroinferoir to pinna @ angle mandible. adj. to parotid.
- Tonsilar sinus - Most common.Tonsillar fossa mid SCM ant to mm, deep to ICA at level of mandible
- Piriform recess - Posterior triangle. posterior to margin of scm
- Piriform apex - lateral to thyroid
19
Q
Jaw cystic lesion associated with teeth
A
periapical cyst. root, unilocular. most common
dentigenous. crown of unerrupted. unilocular. young adult
amenoblastoma. expansile soap bubble 30-50yo. C+ nodule. unerrupted tooth. locally aggressive
keratocysts. expansile uni or multilocular soap. unerrupted tooth. cheesy debris within
20
Q
Jaw cystic lesion not associated with teeth
A
ABC. soap bubble <20yo SBC. post trauma EG. kids. aggressive FD. GG matrix Mets Brown tumour. hyperparathyroid. floating teeth (loss of dura lamina)
21
Q
globe mass. young
A
young:
Retinoblastoma (+/- ca+. <3yo. trilateral - bilateral retinoblastoma and pineal blastoma)
Fibroplasia. O2 damage to eye. asymmetric globe. hx premi
Phakoma. TS
22
Q
globe mass adult
A
melanoma
retinal detachment
haematoma
mets
23
Q
CADASIL
A
Cerebral autosomal dominant arteriopathy with subcortical infarcts
periventricular WM signal leukoencephalopathy with patch foci elsewhere of WM change/ infarcts
external capsule infarcts/signal is suggestive
Temporal pole signal changes are characteristic
can have an acute focus of infarct as hx is transient episodes of weakness, headaches and mood swings/changes
bilateral and reasonably symmetrical WM sig changes, infarcts patchy and asymmetric
24
Q
HSV 1 and 2
A
HSV 1 causes encephalitis
HSV 2 causes meningitis
HSV 2 more common in <10yo as get it from mum
25
mri changes in infarct
| T2, DWI, ADC
DWI within mins (cytotoxic oedema)
T2 increases in 3-6hrs
ADC reduces, but begins to normalize 7-10 days
?+/- mass effect and flow voids
26
acute infarct
embolism. AF, endocarditis, atherosclerosis, air or fat
thrombus. perforators (lacunar), acute plaque rupture
dissection. FLAIR high rim, crescent vessel. younger, trauma. vert aa intra>extra, ICS just above bulb most common place
Vasculitis. peripheral and multiple
Infection. TB vasculitis. also have basal subarach signal or tuberculoma
Moya Moya. 4 yo and 30yo. supraclinoid ICA puff of smoke on DSA
CADASIL. 30yo inherited stroke disorder with multiple strokes and leukomalacia/leukodystrophy
Transient Global amnesia. 24hr sudden memory loss that resolves. punctuate foci of high T2 posterior hippocampus. middle aged.
27
artery of percheron
single aa supplying thalami from PCA
infarct of medial thalami and rostral midbrain
often not seen on MRA or CTA
28
lateral medullary syndrome
| ddx
vertigo, falling, facial pain and horners
vertebral aa or PICA infarct
```
DDX
wallerian degen
Demyelination. adem, Ms
vascular. capillary or cavernous
brainstem glioma. kids
```
29
TGA
| Transient Global amnesia
self limiting over 24 hours
hight T2 posterior hippocampus (just behind temp horn on axial)
middle aged
30
Medial thalami high T2 ddx
aa percheron
tip of basilar syndrome. occlusion at tip
bilateral int cerebral vv thrombus
any cause of BG signal. CO, BGL, hypoxia, osmotic Demyelination, wilsons, cjd
31
multifocal infarct
vasculitis. peripheral
encephalitis (ie tb)
emboli (do echo. RA, AF)
CADASIL. usually starts temp lobes and spares occipital and orbitofrontal
MELAS. cortical and brainstem. Posterior parietal and occipital.
32
MELAS
Mitochondrial myopathy
Encephalopathy
Lactic acidosis
Stroke like episodes
Lesions usually posterior and cross vascular territories
BG lesions +/- Ca+ also
recurrent stroke like episodes.
33
CADASIL
Cerebral AD Arteriopathy with Subcortical Infarct and Leukoencephalopathy
diffuse subcortical WM and lacunar high T2!!
multiple lacunar infarcts
temporal lobes!! also paramedian anterior frontal and eternal capsule all classic
34
Venous infarct
No vascular territory
peripheral
gyriform and heterogenous
check. mastoiditis, sinusitis, preg, dehydration, low BP, hypercoag
35
cavernous sinus thrombosis
high density C- with filling defects or lack of flow void on post C+
Do MRV
sx. CN 3 palsy, exopthalmous
Sinusitis, orbital infection, dental abscess, hypercoag state, compression of sinus (tumour, trauma)
36
Carotico-cavernous fistula
C+ of cav sinus and ICA at same time
enl. sup ophthalmic vv
enl. ocular mm
exopthalmous
due to trauma (typically 2 weeks after), ruptured aneurysm, collagen deficiency or FMD
37
Herniation
subfalcine
Uncle
Tonsil
Subfalcine. ACA infarct
Uncle. PICA PCA CN 3 duret
Tonsil. Hydrocephalus. >5mm adult. >7mm child
38
SAH
```
aneurysm
vascular malformation
trauma
vasculopathy
perimesencephalic. ? venous, around midbrain and Pons
```
vasospasm 3-7/7
39
multiple aneurysms
Adult PCKD
Amyloid angiopathy. >60yo
Congenital collagen vascular. Marfan, ehlers danlos, FMD
Infection, emboli (septic)
ddx. Multiple cavernous malformations, DSI, small vessel HTN (Basal ganglia)
40
vascular malformations
high flow:
Dural AVM or AV fistula
low flow:
Cavernoma (assoc with cap telengectasia and venous malformations) angio occult
Capillary telengectasia. Pons > cortex > cord
Venous. palm tree
41
HTN bleed locations
BG > Pons > thalamus > cerebellum
42
ICA variants
```
HOT Pepper
Hypoglossal
Otic
Trigeminal. most common. prepontine cistern
Proatlantic
```
43
HSV/HHV
HHV is mesial temporal lobe. reactivation
HSV in neonates is whole brain with sparing medial temp and inferior frontal. haem uncommon. + skin lesions and dissemination systemic. HSV II
HSV kids/young adults. Limbic, medial temp, insular cortex and Inferolateral frontal. Asymmetric bikateral. BG spared. +/- oedema and haem. DWI + but < infarct.
44
Temporal lobe signal
HSV encephalitis. bilateral. asymmetric. BG spared
Post ictal
MCA infarct. unilateral. BG involved
Limbic encephalitis. autoimmune paraneoplastic (SCLC, testes, ovarian, breast, thymus). Bilateral asymmetrical. BG involved
Mesial temp sclerosis. vol loss
Viral encephalitis. HSV, EBV, VZV Status epilepticus Post rxt
Lesions. DNET, oligo, Ganglioglioma, PXa, astrocytoma, Lymphoma, Glomatosis cerebri. extensive >3 lobes.
45
Pachymeningeal/Dural C+
Infection, tumour, Post op, Hypotension, Sarcoid, TB, Venous thrombus
Infection. Strep. post op. check skull base post trauma or paranasal sinus/mastoiditis
Hypotension. slumped cerebellum, tonsillitis herniation, Dural sinus distended. check CSG leak, Dural tear
Venous thrombus. hyperdense
Sarcoid/Tb. basal, CN 3,4, 6. Sarcoid can Ca+. Tb +/- vasculitis (BG infarct), tuberculoma (infratent kids, corticomedullar adults)
Tumour. Primary or 2ndry
-Primary. Meningioma, en plaque (adj hyperostosis, no erosion). Haemagiopericytoma (No Ca+, erodes bone, spoke wheel "+ central flow void). Solitary fiborous tumour (lobular and well cx. T2 &T1 is to mm)
-2ndry metz. Drop mets, breast, prostate, lymphoma. Check cisterna CN 5 and Intracanal CN 7 and 8.
46
Leptomeningeal/pial C+
Ventriculitis. Thick C+ ventricle wall with IV debris
Infection, neuro cutaneous, haem, tumor, ruptured dermoid
Infection. Viral, bacterial, Tb (basal), Cryptococcus ( + foci BG)
Neuro cutaneous. surge webber
Haem. SAH, Superficial siderosis (recurrent SAH with haemosiderin depo, dark on SWI)
Tumour. Leukaemia, seeding, mets (breast, prostate, melanoma)
Ruptured dermoid. Fat in Subarach space.
47
WM disease, High T2
Vascular, Infection, Neoplasm, Demyelination
Vascular.
- Small vessel disease
- vasculitis. FMD, Tb, Moya moya
- CADASIL. Stokes with leukodystrophy
- PRES. Loss of autoreg with high BP. 3 patterns, watershed, parieto-occ, sup frontal
Infection.
- PML. Asymmetric. 4Ps. Periventricular, Patchy, Peripheral subcortical, Posterior. JC virus Demyelination. CD4 <100
- HIV encephalitis
- CMV
Sever hypoglycemia
Fahrs disease. chronic encephalitis with seizures. kids. unilateral vol loss with High T1 WM. no C+
Neoplasm.
- Lymphoma
- Glomatosis cerebri. little mass effect. >3lobes
Demyelination.
- MS. No thalami involved
- ADEM. Patchy, +/- thalami. less periventricular. Infection or immunization 2wk ago
48
MS Macdonalds criteria
Dissemination in time and place
Time. 1. new lesion form previous, 2. Asymmetric C+ lesions
Place. T2 bright. 1. Periventricular, 2. Juxta cortical, 3. Infratent, 4. Spine
49
MS varients
Tumefactive. Aggressive large >3cm lesions. C shape C+
Marburg. Extensive Tumefactive. death <1yo
Balo. Target demyleinating lesion
Devics. Bilateral optic nn oedema with spinal foci >3 levels Susac. corpus callosum only
50
DDx WM patch lesions/MS
1. Prominent perivascular space
2. Vascular. Small vessel disease. Infarct. Vasculitis. RCVS (Reversible cerebrovascular Syndrome, 20yo beaded COW angio Thundercats headache).
3. Infection. Encephalitis (HSV, HIV, PML, Viral), Lyme disease
4. Tumour. Glomatosis (GbM)
5. ADEM. responds to steroids
6. Central pontine myelinosis. 2nd to rapid Na+ correction. Central Pons
7. Chemo/rxt. Acute. patchy mass like c+ with oedema. Chronic. atrophy
9. PRES. Occ, parietal and brainstem watershed
51
Dermoid cf epidermoid
D. Midline, lobular, fat +/- Ca+. NO DWI. Rupture 》 Subarach fat and aseptic meningitis
E. Off midline..dirty CSF. DWI +, no C+, no Ca+
52
Vasogenic vs cytotoxic oedema
V. VW, WM finger like projections. leaky BBB. DWI -
| C. GM and WM. Faulty Na+/K+ pump. DWI +. Ischaemia
53
Focal vol loss brain
Alzhiemers. Hippocampal 》temporal lobe 》Parietal and frontal
Picks. Front temporal <40yo. Occ spared
Parkinson. Generalized atrophy. Reduce BG T2
Progressive Supranuclear Nn Palsy. Tectum, GP, frontal and midbrain atrophy. Midbrain <1/4 Pons sag. Hotcross bun T2 Midbrain
Huntington. Caudate head atrophy with sq. frontal horns
54
Hydrocephalus
Obstructive. Disproportionate enl depending on where obst is
1. tumour
2. aqueduct stenosis
3. haemorrhage
4. ventriculitis
5. colloid cyst
Non obstructive.
1. reduced reabsorption CSF (haem, meningitis)
2. Increased production CSF(Choroid plexus, ependymoma)
3. Increased venous pressure. Vv galen malformation, vv obstruction
55
HIV WM Lesion
Vascular, Infection, Neoplasm
Vascular
1. Rxt
2. Vasculitis
3. PRES
Infection. CD4 <100
1. PML. 3Ps. Patchy asymmetric, posterior, peripheral. Multifocal high T2
2. Toxoplasmosis. Corticomedullar junction and BG. more widespread than CMV. Can mimic lymphoma
3. CMV. Periventricular thin T2 /rim c+
4. Cryptococcus. 1. gelatinous soap bubble pseudo cyst mass parenchymal, 2. BG small cryptococcomas with peripheral c+. 3. basal meningeal C+. look at cheat for nodules or mass
5. Aspergillus, candida. Haem and stroke
Neoplasm. Lymphoma. cross midline, periventricular. can be heterogenous with c+ rim in immunocompromised
56
congenital infection
TORCH
Toxoplasmosis. more widespread than CMV. Focal Ca+. BG, periventricular and cortex
CMV. Periventricular ca+. Extensive if weakly inter utero inf
Rubella. Microcephaly. Parenchymal ca+
HSV. diffuse WM and GM
57
inherited WM diseases
Periventricular WM high T2 》 Vol loss
1. Lysosomal. Metachromatic leukodystrophy. diffuse symmetric WM 2-3yo
2. Peroxisomal. Adrenoleukodystrophy. adrenal insufficiency, leukodystrophy and testicular small. posterior symmetric WM
3. Mitochondrial. Leigh (Central GM and brainstem high T2. death <2yo). MELAS (<40yo multiple strokes with parieto-occ WM
4. Amino acid. Canavan (Big head size, jeez, death <2yo yo, spares BG), CADASIL (strokes and leukodystrophy. starts temp 》widespread but spares Occ and cortex) Krabbe disease. AR WM disease. Periventricular and deep grey matter. <2yo and adult onset.
58
C+ rim
MAGIC DR
```
Mets
Abscess
GbM
Infarct
Contusion
Demyelination. C shape
Radiation necrosis
```
59
cortical signal
Gyriform. T1 high chronic. T2 high acute
1. Cortical laminar necrosis. cerebral hypoperfusion (BG also), hypoxia, status epileptic (medial temp lobes), hypoglycemia (Occ bilateral also), anaemia
2. Meningitis
3. Early CJD
4. Encephalitis
5. Neoplasm. Oligodendroglioma, DNET, Ganglioglioma
60
DWI +
Acute isch stroke
- ADC normalizes in 7/7
- DWI normalizes in 2/52 Infection. abscess, empyema or herpes (cf glioma), cjd
Mass, non malig. epidermoid, Choroid plexus cyst, rxt necrosis
Neoplasia. lymphoma, medulloblastoma, PNET, germ cell, pineoblastoma, meningioma (mild)
Demyelination. MS, osmotic demyelination, DAI, status epilepticus, hypoglycaemia, wernikes
Cytotoxic oedema (usually isch)
61
Corpus Callosum lesion
```
GBM. butterfly
Lymphoma
Lipoma
MS
Radiation necrosis. No C+
```
62
BG high T1
Manganese. hepatic encephalopathy, TPN. Ca+. hyper and hypo parathyroid or pseudohypo Toxic. HIE, CO, hyperglycaemic episode Congenital. Farhs, wilsons, NF 1 hamartoma
Haem or Haem infarct. HTN
63
BG High T2
Bilateral.
1. Hypoxia
2. Osmotic Demyelination
3. Wernikes
4. CO1
5. BGL decrease
6. CJD
7. Venous thrombus. deep cerebral vv
Unilateral.
1. Keto acidosis
2. Hepatic encephalopathy
64
Ca mass. Can My Dear Old Elephants Age Gracefully
```
Meningioma
Oligodendroglioma
Ependymoma
Astrocytoma. GBM
Craniopharyngioma kid Vascular. avm, aneurysm, sturge webber TS subependymal nodules Tuberculoma ......
Mets. adenoca, post Rx
Pineal germinoma or Germ cell tumor
Chordoma. rings and arcs. central locatn
dermoid. Fat
DNET. cortical, medial temporal, kids. bunch of grapes
Central neurocytoma. IV bubbly attach septum Pell
Choroid plexus papilloma
```
65
Temporal bone #
Transverse. sensorineural. Labyrinth. Facial nn
| Longitudinal. Ossicle. Tympanicum membrane (develop cholesteatoma later)
66
Mastoiditis complications
Coalescent. Infection causes resorption of bone
》Abscess, meningitis, Vv thrombus
Bezold abscess. Mastoiditis erodes laterally into SCM and trapezius
》Jug vv thrombus
67
haemorrhagic mets
```
melanoma
chorioca
RCC
Thyroid
Primary. GBM or oligodendroglioma
```
68
hyperdense mass
tumour.
-meningioma
-medulloblastoma
-lymphoma
-Craniopharyngioma
-ependymoma
-melanoma
aneurysm
colloid cyst
haematoma <10/7
69
brain cysts
arachnoid
epidermoid. dirty CSF. dwi+
porencephalic. c/w ventricles or subarach space. gloss 2nd insult IU
neuroglial. CSF density that doesn't c/w vent or subarach. epithelial lined. frontal lobes > anywhere else neural axis
IV ependymal
choroid plexus
70
dark T2
ca+ or haem
cavernoma
mets 2nd haem
ca+ tumour
solitary fibrous tumour. looks like meningioma but dark on T2
71
Cortical based signal
```
oligodendroglioma
DNET. bubbly in temp lobes
ganglioglioma
non tumour.
- HSV enceph
- post ictal
-cerebritis
-infarct
```
72
Supra sella Para sella mass
SATCHMO Sphenoid sinus mass. Mucocele, chordoma, SCC.
Sarcoid Aneurysm.
Adenoma (pituitary macro) Teratoma Craniopharyngioma
Hypothalamic glioma
Hamartoma tuber cinerum
Histiocytosis (LCH)
Meningioma Mets
Optic glioma
73
multiple cavernomas
rxt, HHT, familial multiple cavernoma malformation sx, blue rubber blew naevus sx
74
transient lesions of splenium
epilepsy, ADEM/MS, DAI, hypoglycemia, PRES.
75
DDX gullian barree
viral neuritis or chemical neuritis
76
epidural haematoma
over anticoagulation, trauma, LP, AVM, pregnancy, tumour Posterior to thecal sac. blooms. do angio if ?avm
77
diffuse marrow infiltration
T1 VB should be greater than mm or disc. if not:
- Red marrow conversion (athletes, smokers), not as low - Mets. patchy. breast, prostate. - Leukaemia
- Myelodysplasia. look at spleen - Thalassemia. kids, extramedullary Haematopoiesis
- CML
78
Thickened fulim
Cons ends t12/l1 - Lipoma, tethered, arachnoiditis, gullian barre,CIPD
79
Extradural lipomatosis
obesity or steroids.
80
OPLL
dish, Ank spon
81
Vasculitis by aa size
Large. Giant cell (>60yo), Takayasu (<60yo) Med. PAN, kawasaki, FMD Small. IgA, Microscopic polyangitis, EG with polyangitis Variable. Bechets DDX. RCVS or Moya moya
82
cerebellar atrophy
etoh, msa, long term anticonvulsant (thick skull also), post rxt, superficial siddherosis, farhs (bg Calc also).
83
hyperdense mass
- tumour. meningioma, medulloblastoma, lymphoma, Craniopharyngioma, ependymoma, mets (melanoma, rcc, thyroid). - haematoma - giant aneurysm - colloid cyst
84
cystic brain lesion
arachnoid, neuroglial (epithelial lines and doesn't cw ventricles or csf), Porencephalic (glosis 2nd insult, cw vents), epidermoid (dirty csf), cryptococcus (gelatinous bg, soap bubble, cxr mass), abscess, tumefactive MS, neurocistercycosis (multiple stages)
85
tumours that ca+
old elephants age gracefully. oligodendrocytes, ependymoma, astrocytoma, GBM.
extra axial. meningioma, chordoma (centre), chondrosarcoma (off centre), Craniopharyngioma
86
dark on t2/CT hyper
ca+ or haem. cavernoma, solitary fibrous tumour, tumor that haem or ca+, lymphoma, medulloblastoma, neuroblastoma
87
cortical based tumour
DOG P - oligodendroglioma (frontal lobes, rare in kids)
- ganglioglioma (<30yo, temp lobe bubbly, c+, ca+)
- DNET. (kids and young adults, cystic bunch grapes, no c+ ) - pxa (temp lobe cyst + nodule)
- non tumor. cerebritis, herpes simplex, post ictal, infarct, encephalitis, haem, abscess
88
supratent tumor adults
Glioma. atrocytoma (<20yo, NF 1), GBM (most common) oligodendroglioma (frontal, cortical, ca+) Ependymoma (intra axial supratent, extra axial infratent) choroid plexus papilloma (cauliflower and c+). atrium.
mets. (most common. g/w junction)
lymphoma (solid homogeneous periventricular or cc, 60yo if immunocompetent, otherwise immunocompromised )
89
supratent tumour kids
Astrocytoma, ependymoma (frontal lobe, can be massive), Atrt (v aggressive), Craniopharyngioma (cystic/solid + ca+), germ cell (germinoma or teratoma <2yo), ganglioglioma (well cx, peripheral, cystic with nodule), PNET (supratent medulloblastoma, DWI, large and heterogenous, neonates)
90
infratent tumor adults
haemangioblastoma (VHL, cystic with nodule, dwi),
mets (most common)
astrocytoma (bigger nodule than haemangioblastoma) lymphoma extra axial. ependymoma (c+), subependymoma (no c+), Choroid plexus (4th vent adults, atrium kids), Dural mets
91
infratent tumour kids
Brainstem glioma, ependymoma, medulloblastoma, astrocytoma, haemangioblastoma
92
sella mass
find pituitary. if can't ?pit adenoma.
- pit macro adenoma. >10mm. asymmetric or convexed pit. don't c+ with rest of pit. +/- apoplexy. expand to supra sella as dumbell. look for cav sinus invasion, ICA or cn2 encasement
- pit micro. more likely to be hormonal active. - meningioma - Craniopharyngioma. cystic/solid. crank oil. adenomatous kids, papillary adults. ca+ kids.
- chordoma (central), chondrosarcoma (off central/clivus) - Mets (rare, breast) - Germinoma - lymphoma
- Hamartoma tuber cinerum (ectopic gm)
- glioma.
93
pituitary mass not tumour
pituitary cyst, pituitary apoplexy (rapid increase in size, fluid fluid level), rather cleft cyst, lymphocytic hypophysitis (post partum, male with dm, c+, low T2),LCH, ICA aneurysm
94
enlarged pituitary stalk
lch. kids and dm neurosarcoid. optic pathway and floor 3rd vent infection. Tb, meningitis tumour. Germinoma, glioma hypothalamus, cns lymphoma, leukaemia, mets
95
cavernous sinus mass
CN 3, 4, V1, V2 and 6, sns plexus and ICA Schwannoma, meningioma, extn of nasopharyngeal mass, aneurysm, carotico-cavernous fistula, cavernous sinus thrombus, invasive sinusitis, sarcoidosis, tolosa hunt sx (extends from superior orbital fissure)
96
clivus mass
osteoma, chondrosarcoma, plasmacytoma (low to iso t2), intraosseous lymphoma, h&n mass going into clivus
97
pineal mass
tectal glioma,
Aqueduct stenosis cystic. pineal cyst, pineocytoma, epidermoid, teratoma (fat/cystic/ca+) germ cell tumor. Germinoma (most common, kids and young adults, Hyperdense on ct, +afp), teratoma (fat, ca+, cystic) pineocytoma (older adults, slow growing), pineoblastoma (larger, blast ca+, heterogeneous, kids. check for retinoblastoma) hamartoma (nf 1)
98
Intraventricular mass
oligodendroglioma, lymphoma, mets, central neurocytoma, Choroid plexus papilloma, AV malformation, ependymoma, subependymoma, SEGA
99
Intraventricular calcification
Choroid plexus papilloma, meningioma, ependymoma, medulloblastoma, mets, haemagngioblastoma
100
subdural hygroma
over shunting, trauma (arachnoid tear), intracranial hypotension.
101
CPA mass
SAMES Schwannoma of VII or VIII, arachnoid, aneurysm, meningioma, epidermoid, skull based tumour or infection.
102
petrous apex mass
congen- cholesterol granuloma, cholesteatoma, Mucocele, cephalocele inflammatory. petrous apicitis, OM, inflammation pseudotumor, Wegeners tumour. meningioma, paraganglioma, Schwannoma, chondrosarcoma, chordoma, endolymph sac tumour, mets, plasmacytoma, lymphoma, LCH, rhabdomyosarcoma Vascular. carotid aneurysm, intraosseous Dural AVF Osseous. fibrous dysplasia. pagets
103
T1 bright
haem, fat (dermoid, lipoma, teratoma, meningioma with fatty degen), melanin (melanoma, also T2 bright), protein (colloid cyst), thrombus
104
multiple small enhancing lesions
Mets, tb, sarcoid
105
flow voids in lesion
avm, haemangiopericytoma, haemangioblastoma, haem tx of infarct (will dwi also)
106
bubbly multicystic Intraventricular lesion
Choroid plexus cyst, central neurocytoma, neurocistercycosis, ependymoma, subependymoma, epidermoid cyst
107
Corpus callosum
GBM (butterfly), lymphoma, mets, germinoma, lipoma Non neoplastic. Dai, demyelination (MS, PML, PRES) Other causes high CC. status epilepticus, hypoglycaemia, encephalitis, drug toxicity, stroke (unusual to be bilateral)
108
Temporal lobe epilepsy
Mesial temp sclerosis, ganglioglioma, oligo, astrocytoma, Cavernoma, cortical dysplasia, heterotopia
109
Brainstem expansion in kids
Glioma, tb (most common world wide), rhombic encephalitis (autoimmune or listeria), ADEM/ms, infarct, haematoma, Fasi (nf1)
110
intra parenchymal haem
common. htn, trauma, vascular malformation, aneurysm, prematurity, stroke, amyloid angippathy, coagulopathy, tumour
uncommon. venous infarct, eclampsia or pres, septic emboli, vasculitis, encephalitis, cocain/drugs
111
wm lesions with cortical involvement
pres, ADEM, ms, encephalitis, osmotic demyelination, seizure
112
multifocal patchy wm and gm oedema
viral encephalitis (hsv1), Ischaemia (watershed or embolic), status epilepticus, limbic encephalitis (paraneoplastic), infiltrating neoplasm (GBM or glomatosis cerebri)
113
diffuse lobar lesion, esp temp
isch/infarct, HSV 1, glomatosis cere, limbic encephalitis, status epilepticus, ADEM, vasculitis
114
Bilateral infarct
emboli, Venous thrombosis, basilar aa distal (rostrum midbrain, thalami and PCA) aa percheron (medial.thalami or midbrain)
Non infarct mimics. Osmotic demyelination (brainstem and bg), wernikes encephalopathy (mammilary, 3rd vent), global hypoxia, Co poisoning.
115
multiple swi
htn, amyloid angiopathy, cavernomas, vasculitis, DAI, rxt, haem mets (melanoma, thyroid, rcc, chorio), infection (cysticercosis, tuberculoma, fungal, septic emboli)
116
gyriform ca+
sturge webber, avm, cortical tubers, laminar necrosis post infarct, meningoencephalitis, rxt/chemo
117
unilateral megaencephaly
NF1, McCune Albright, TS, hemimegaencephaly neuronal migration abno
118
BG ca+
Metabolic. hypoparathyroid (most coomon), pseudo, hyperparathyroid and hypothyroid Infection. TORCH, Tb, cysticercosis Toxic. anoxia (birth injury), Co, lead, rxt or chemo Congenital. Farhs, NF 1, TS
119
BG low t2
iron deposition - Neuro degenerative (Parkinson, alzheimer) - Metabolic (Leigh - dead by 2yo, wilsons, shy drag MSA ) - Demyelination. MS - Insult. chronic hepatic encephalopathy, toxins, childhood hypoxia
120
T2 hyperintense top 3 adult and child
adult. Co, osmotic demyelination, wilsons, hypoxia, Venous infect, cjd child. Co, wilsons, hypoxia
121
BG infarct
atherosclerosis, htn, vasculitis, moya moya, Venous sinus thrombus (deep system)
122
Bilateral thalami abno
Vascular. Lacunar infarct, aa percheron, basilar tip, int. cerebral vv, straight sinus, vasculitis, PRES Infection. ADEM/MS, encephalitis (measles, japanese), varients CJD
Metabolic. Osmotic demyelination, wernikes, Co, wilsons, haemachromatosis, methanol
123
hydrocephalus obstruction causes at arachnoid and skull base
Arachnoid. haem, infectious meningitis, carcinomatosis meningitis, chemical meningitis (arachnoiditis, fat, intra thecal meds)
Skull base. chiari, Achondroplasia, dandy walker cyst, arachnoid cyst Unknown. normal pressure hydrocephalus
124
Ependymal/Subependymal C+
Neoplasia. Lymphoma, GBM, ependymoma, CSF seeding Ventriculitis. Pyogenic bacteria, CMV (aids), Tb Sturge webber sx
125
Subependymal nodules
TS, heterotopic gm
126
Leptomeningeal high FLAIR
SAH, meningitis, mets, ruptured dermoid
127
Leptomeningeal C+
Vascular. Subacute infarct, sturge webber Infection. Viral or bacterial meningitis, tb Inflamm. Sarcoid, Wegeners, LCH Mets. Haematogenous lung, breast or melanoma, CSF seed or brain 1*, lymphoma
128
Pachymeningeal C+
Intracranial hypotension. CSF leak post sx or trauma, shunt, spontaneous Infection. Bacterial, fungal, listeria or Tb, subdural empyema or extradural abscess Neoplasia. Mets to dura, lymphoma, meningioma Inflamm. Sarcoid (nodular), rheumatoid
129
Prominent Dural ca+
Physiological Metabolic. hyperparathyroid or long term dialysis Basal cell naevus sx
130
Cerebellar atrophy top 3
etoh abuse, anticonvulsant (calvaral thickening), paraneoplastic sx MSA less common
131
MSA categories
Olivopontocerebellar, cerebello-olivary atrophy and Friedreich ataxia (spinocerebellar)
132
C+ or enhancing cranial nerves
Schwannoma, mets, lymphoma, ms, sarcoid, perineum al invasion (V3 and VII). ** with perineural invasion look for foramen enl and denervated mm
133
Moya moya
primary idiopathic, NF1, rxt, Sickle cell, downs syndrome
134
Absent septum pellucidum
CHESS Chiari, holproencephaly, encephalocele, Septo optic dysplasia, schizencephaly
135
Agenesis corpus callosum
chiari, dandy walker, encephalocele, holprosencephaly, isolated, lipoma, trisomy 18, 13, 15
136
Lytic skull lesion. Mt Hole
Mets, Tb, Histiocytosis (LCH), leptomeningeal cyst (growing #), Epidermoid
137
Chiari
1. downward tonsils >5mm, syrinx, klipell feil. 2. myelomeningocele, CC dysgenesis, hydrocephalus, syrinx 3. 2 plus encephalocele
138
DAI 3 locations
GW junction, Posterior body and splenium CC, dorsolateral pons
139
3 patterns fungal CNS
Basal meningeal +/- hydrocephalus Vasculitis (aspergillosis) +/- thrombosis and haem infarcts Parenchymal invasion/mass
140
Cryptococcus vs candida
Cryptococcus is gelatinous pseudocyst in VR spaces Candida is multiple micro abscesses
141
cavernoma vs cap telengectasia
Cavernoma has no normal brain tissue between. also assoc with DVA
Cap telengectasia is assoc with Xrt and HHT
142
3 features of neurosarcoid
Pachy/leptomeningeal c+ Periventricular WM high T2 Facial nn, optic nn or pit stalk c+
143
3 lesions intracranial NF 1
Hamartomas. FASI Gliomas/astrocytoma Plexiform neurofibroma esp CNs
144
3 vascular lesions assoc with NF 1
AVM/Aneurysm, Moya moya, coarctation
145
4 TS CNS manifestations
Cortical and subcortical tubers Subependymal nodules SEGA Heterotopic GM
146
4 non CNS TS manifestations
cardiac rhabdomyoma renal aml, rcc or Oncocytoma Osseous hpoa pulmonary LAM
147
4 non CNS VHL
Renal cysts, bilateral RCC Adrenal phaeo (bilateral) Pancreatic cysts or serous cystadenoma Endolymph sac tumour
148
4 most common Intra medullary spinal mass
Ependymoma (think NF 2) Astrocytoma (think NF 1 if child) Mets (lung, breast, lymphoma, melanoma) Haemangioblastoma (think VHL)
149
Infective causes of optic neuritis
HSV, HIV, toxo
150
Posterior fossa tumour that ca+ in kids
Ependymoma 80% Medulloblastoma 20% JP Astrocytoma v rare
151
PML
Patchy, peripheral and periventricular Subcortical u fibres, frontal and parietal, brainstem and BG spares optic nn, cortex and spinal cord
152
wernickes encephalopathy
High T2 mod thalami, periaqueduct and mammilary bodies
153
aggressive h&n mass
rhabdomyosarcoma, lymphoma or scc
154
3 major dementia distribution
Alzheimer. temporal and parietal. spares BG and cerebellum Lewy body. Alzhiemers plus pronounced occipital Multi infarct. Asymmetric cortical and BG
155
tethered cord. look for
chiari II and meningocele or lipomeningocele
156
Cerebral vv thrombus haemorrhagic territories
Initially subcortical WM Venous infarct involves WM, leptomeningeal and cortex Deep GM = Int cerebral vv Temporal lobes = Vv labbe Parasagital = SSS
157
3 metals that are t1 bright
Calcium. fahrs Copper. wilsons Manganese
158
subcortical WM infarct crossing many territories
CADASIL Emboli. unilateral ICA, bilateral heart
159
VB lesions. CALL HOME
Chordoma (rings and arcs), ABC (expansile with thins sclerotic edge), Leukaemia, Lymphoma, Haemangioma, Osteoid osteoma/Osteoblastoma, Mets/Myeloma/Plasmacytoma (minibrain), EG
160
Destructive VB process involving 2 adj VBs
Discitis/OM or chrodoma
161
Sacral mass
Teratoma (child), chordoma, chondrosarcoma, osteosarcoma, GCT, ewings, abc
162
Increased VB T1
Fatty marrow (increased age, osteoporosis, rxt, haemangioma, pagets, modic 2) Haemorrhage
163
Ivory VB
Mets (prostate, breast, carcinoid), pagets, lymphoma, mastocytosis (big spleen and liver, lung nodule or sb thickening), chronic infection (loss IV disc ht)
164
Rugger jersey
renal osteodystrophy, osteopetrosis, pagets
165
VB plana
MELT. Mets/Myeloma, EG, Lymphoma/Leukaemia, Tb/Trauma
166
Bullet VB
Achondroplasia, Mucopolysaccharidosis, downs, hypothyroidism
167
H VB
sickle cell, thalassemia, gauchers, osteoporosis, OI
168
Posterior VB scalloping
Dural ectasia. NF, Marfan, ehlers danlos Increased intraspinal pressure. syrinx, comm hydrocephalus, intramural lesion
Congenital. Achondroplasia, Mucopolysaccharidosis, OI
169
Ca+ IV disc
CPPD, haemachromatosis, Hyperparathyroid, ochronosis (wafer like ca+)
170
Atlantoaxial pannus
RA (doesn't ca+), CPPD, gout and HADD (all ca+)
171
Extra Dural mass
Epidural space. abscess, haematoma, lymphoma, mets, lipomatosis VB. Haemangioma, chordoma, 1 bone tumour, mets, myeloma, lymphoma Disc. herniation or sequestration Ligament. OPLL, flurosis Nn roots. Schwannoma (also intradural), neurofibroma Facet joint. synovial cyst L4-5 or L5-S1 Paraspinal. nn sheath tumor, Desmoid (deep fibromatosis), sarcoma, lymphoma, neuroblastoma, extramedullary Haematopoiesis
172
causes extramedullary Haematopoiesis
Haemolytic anaemia (sickle cell and thalassaemia), myelofibrosis, lymphoma, leukaemia, gauchers
173
Intradural extramedullary
Nn sheath. Schwannoma, neurofibroma (Nf 1) Mets - solitary, sugarcoated nodular or thick roots Meningioma (nf 2, thoracic) Lymphoma Paraganglioma Dermoid/ epidermoid, teratoma, lipoma, arachnoid cyst Empyema (subdural) Vascular. AVM/AVF, varices
174
High T1 Intradural
epidural lipomatosis, lipoma, dermoid, teratoma. all fat suppress Subacute haem, melanoma
175
Intramedullary lesions cord
*** expand the cord and narrow SAS Neoplasm. Ependymoma, astrocytoma, haemangioblastoma, mets Demyelination. MS or ADEM, transverse myelitis (>2VB) Inflamm. Sarcoid, SLE, Tb Trauma. Oedema, contusion Vascular. ischaemia/infarct (central and long segment), AVM, Cavernoma, contusiin
176
Multiple intramedullary lesions
Demyelination/MS, sarcoid, haemangioblastoma in VHL, mets
177
Neoplasm of fullim
Myxopapillary ependymoma, haemangioblastoma, Astrocytoma, Mets
178
Transverse myelitis
Demyelination. MS, ADEM, Neuromyelitis optica (>3vb + optic nn), Idiopathic transverse myelitis (>2/3 cross-section and >2 VBs) Collagen vasc disease. Autoimmune vasculitis or SLE (Central cord 4-5 segments), RA, sarcoid Infection. HSV, CMV Vit B or foliate def AVM Paraneoplastic. Auto antibodies against cord
179
Posterior column lesions
MS, contusion, B 12 or Pernicious anaemia, folate def , copper def, hsv, NO toxicity
180
ocular ca+ adult and child
adult. senile at mm insertion, drusen, ptisis bulbi child. retinoblastoma (check pineal and pit), neuroblastoma met, coats (t1 and T2 high), toxo, CMV, detachment (retinal V, Choroidal )(...)
181
intraocular mass
Neoplasia
- retinoblastoma. most common kids. ca+ - melanoma
- Mets . breast, lung
- lymphoma
Vascular
- Haemangioblastoma VHL
- Haemangioma - Lymphangioma - Hamartoma. sturge webber , TS, NF, VHL Trauma
- haematoma
- retinal or Choroidal detachment Infection
- CMV
- Posterior scleritis. can be nodular and mistaken for mets Pseudotumor
182
Big globe
glaucoma, staphyloma (focal defect off centre posterior due to sclera defect), intraocular mass, NF, Marfan, sturge webber, Coloboma (central bulge at disc)
183
Small eye
Trauma, ptisis bulbi, surgery, rxt, torch in utero, diabetic mother, retinopathy of premi, foetal etoh
184
Extra conal lesion
bone/dura. mets (prostate), Fibrous dysplasia, LCH, pagets, meningioma, osteoma, abc
ST. infective-Mucocele, haematoma, abscess.
Inflamm- pseudotumor, sarcoid, wegners (look for sinus disease), Neoplasia- lymphoma, mets, rhabdo, dermoid/epidermoid Vascular. capillary or cavernous haemangioma, lymphatic Malformation Nn. Schwannoma, neurofibroma
185
orbital cyst
epidermoid/dermoid dacrocystocele mucocele encephalocele lymphangioma
186
ocular mm enl
thyroid. I'm slow pseudotumor Wegeners or sarcoid myositis 2nd sinusitis haematoma carotocavernous fistula or thrombus lymphoma or mets
187
tram track optic nn (or doughnut)
Meningioma of nn sheath, pseudotumor, sarcoid, mets, lymphoma, increased intracranial pressure
188
polyps
Sinonasal. multiple, bilateral, expand sinuses and enl ostia. peripheral c+
Antrochoanal. start max sinus and extend through osteum into nasal cavity or nasopharynx. widen osteum Mucous retention. round, dependent in max sinus. Mucocele. smooth walled expansile mass filling sinus. peripheral rim c+. bone remodeling and thinning
189
nasal septum perforation
Wegeners, cocain, inhaled steroids, detective tumour
190
destructive sinonasal lesion
Neoplasia. - SCC often T2 low. - Lymphoma. midline - Adenocarcinoma - esthesioneuroblastoma. dumbell mass with waist on crib plate - inverted papilloma. cerebri form. starts lateral nose.
- Mets - Sarcoma. rhabdo in kids Non neoplastic. fungal sinusitis, Wegeners, Mucocele, pseudotumor, cocaine
191
Congenital nasal mass
Dermoid cyst. fat containing +/- sinus tract Nasal dermal sinus. from nasal tip. bifid crista Gali
Nasal glioma. ST mass with fibrous connection to intracranial contents Cephalocele Haemangioma. well defined, T2 high with avid c+ Chana atresia. membranes or bony Piriform aperture stenosis. anterior narrowing
192
Middle ear mass
Otitis media, cholesteatoma (epidermoid), cholesterol granuloma, glomus tympanicum (paraganglioma) or jugular, facial nn Schwannoma, mets, meningioma
193
Petrous apex lesion
common. trapped mucocele, cholesterol granuloma, mets uncommon. cephalocele (cw meckels), endolymph sac, chordoma, Schwannoma, paraganglioma, plasmacytoma, eg
194
Pharyngeal mucosal space mass
thornwaldt cyst, cephalocele tonsillitis hyperplasia (c+ septa), mucosal retention cyst, tonsillitis abscess pleomorphic adenoma salivary glands, scc, lymphoma, adenoid cystic ca, adenocarcinoma, rhabdomyosarcoma, mets
195
Neck nodes level
1. ant to submandibulars gland 2. posterior to SMG above hyoid 3. hood to cricoid 4. below cricoid
196
supraglottic, glottic, subglottic
division is true vocal cords subglottic have worse prognosis
197
laryngeal mass
scc, chondrosarcoma, minor salivary gland tumour Wegeners or sarcoid invasive lesions laryngocele rxt
198
enhancing nodes
castle man's, thyroid ca, Kaposi, lymphoma
199
calcified nodes
Tb, fungus, sarcoid, silicosis, thyroid ca, mucinous adenocarcinoma, post rxt lymphoma
200
necrotic neck nodes
Mets from scc and papillary thyroid, tb scrofula
201
H&neck vascular masses
Haemangioma. - infantile. present at birth - Congenital. grow 1st yr. involute Vascular malformation. - High flow. AVM or AVF. flow voids - Low flow. Capillary, cavernous (phleboliths, no flow void ) lymphatic ( macro or micro-no phleboloiths or flow void)
Haemangioma is vascular tumour (not malformation)
202
Bilateral or multiple parotid lesions
sjogrens, benign lymphoepithelial lesion of HIV, parotiditis, sarcoid, warthins, lymphoma, mets
203
Retropharyngeal space mass
ICA kissing aa, haemangioma, LN, abscess, lipoma, fibromyxoma (ovoid), scc, lymphoma
204
anterior neck mass cystic
thyroglossal duct cyst, brachial cleft, necrotic LN, dermoid, thymic cyst
205
enlarged thyroid
multinodular goiter, hashimotos, Graves (homog), ridel (hypoechoic), thyroid ca, lymphoma
206
Benign vs malignant thyroid nodule
benign. cystic, hyperechoic, hypo rim, peripheral egg shell Calc or comet tail malignant. hypoechoic, predominantly solid, I'll defined margins, no halo, microcalc, central vascularity, LN
207
haemangioma signal and us
lobular mass well cx with high T2, low T1, avid c+ and no fat sat Echogenic on us
208
Hemimegaencephaly
Sturge webber, rasmussen encephalitis, dyke Davidoff mason sx (+ thick skull and falcine displacement).
209
midline nasal septum defect
cocaine, steroid spray, trauma, wegeners
210
ant vb scalloping
aaa, lymphadenopathy, tb
