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Head & neck Flashcards

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1
Q

Bad signs of acute subdural haematoma

4

A

Heterogeneity
Convexity
Inc Mass effect
SAH

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2
Q

Features of isodense SDH

Further imaging

A

Unexplained mass effect
Effaced sulci
“thick’ cortex”
WM buckling

Do contrast
MR diagnostic

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3
Q

Traumatic brain haematoma - ring enhancing lesion
Diagnostic aids/clues
4

A

Bilateral
Orbitofrontal
Haemosiderin ring
Other injuries

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4
Q

Diffuse axonal injury
Grading - 3
Deeper lesions worse prognosis

A

1 : lobar WM. Lesions bloom

2: involves corpus callosum typically splenium
3: Dorsolateral midbrain

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5
Q

Worrying features of skull fractures

7

A 
Overlies a dural sinus
Overlies MMA
Overlies eloquent cortex
Depressed > table width
Open/compound
Traverses ICA canal
Temporal bone # ( opacification of mastoid air cells)
Skull base # ( blood in sphenoid sinus)
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6
Q

Carotico-cavernous fistula CT findings

5

A 
Proptosis
Enlarged extra ocular muscles
Convex ipsilateral CS
Enlarged superior opthalmic vein
Retrobulbar fat stranding
Check Brain - venous infarcts
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7
Q

Early NCCT signs of stroke
3

Penumbra on PWI : at risk area

DWI : infarct core

A

Loss of GW differentiation : insular ribbon sign, BG effacement (less delineation)

Dense artery sign (30%) - asymm, correlates c Sx

Hypodensity

Subacute : gyriform CE

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8
Q

Distal Carotid artery dissection features

A

mid to distal ICA below cavernous segment
Bulb spared
NO false lumen
Subintimal haematoma ( do MRI T1 FS - methaemaglobin in wall)
DSA may be normal!

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9
Q

Proximal carotid artery dissection features

A 
Progression of aortic dissection
CCA
ICA extension uncommon
False lumen
May be asymptomatic
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10
Q

ICA dissection imaging signs

A 
location unusual for atherosclerosis ( bulb spared)
string sign
aneurysmal dilatation
occlusion
intimal flap may be seen
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11
Q

Amyloid angiopathy
features
B-amyloid peptide deposition

A

Lobar haemorrhage in elderly (15% >60y, 50%>70y)

Subcortical microhaemorrhages, spares BG cf HTN

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12
Q

Non traumatic ICH

causes

A 
Underlying lesion: tumour, AVM, cavernoma, aneurysm
Amyloid angiopathy
Dural sinus thrombosis
Hypertension
Coagulopathy
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13
Q

Hypertensive haemorrhage

locations & pattern

A

Putamen/EC - 60%
Thalamus - 15-25%
Pons/CBL - 10%
Lobar 5-15%

Acute focal haematoma
Subacute/ch microbleeds

CTA dot sign - active bleed

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14
Q

Cavernous malformation

features

A

Discrete collections of endothelial lined sinusoids

Vascular hamartoma

ICH risk - 0.15-1% annually

Sporadic- 75%, familial 10-30% ( fam cavernomatosis)

Angiographically occult

Associated DVA

COMPLETE haemosiderin rim

Variable SI locules

Popcorn appearance

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15
Q

Capillary telangiectasia in brain

A 
Brainstem
Ass with radiation
No T2 abnormality
Brush like Ca+
GRE blooming
Do not touch
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16
Q

Spetzler-Martin Grading AVM
Size
Eloquence
Venous drainage

A

<3cm - 1
3-6cm -2
>6cm - 3

Eloquence 1 - 0

Venous drainage superficial/deep

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17
Q

RF for intracranial aneurysms

9

A 
Smoking
Cocaine
Age > 50y
Female > Male
FMD
Anatomic variants eg trigem artery
Type IV Ehlers Danlos
NF 1
ADPCKD
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18
Q

Trigeminal artery vs Persistent fetal PCA

A

Trigeminal originates from CAVERNOUS ICA to BA

persist fetal from supraclinoid ICA (above sella)

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19
Q

PseudoSAH
causes
4

A

Cellular material ( infection, carcinomatosis, granulomatous etc, clean ventricles)
Iodinated contrast (myelogram, leak due to RF etc)
CSF Hypotension
Anoxia

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20
Q

Pseudopseudo SAH

A

Global anoxia/hypoxia due to dense venous stasis (white cerebellum, indistinct BG, no hydrocephalus)

CSF hypotension : ?crowded normal blood vessels, SD collections and large dural sinuses

No hydrocephalus

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21
Q

Idiopathic intracranial hypertension
( BIH, pseudotumour cerebri)
Features
RF

A 
Women
3rd decade
Obese/weight gain
May be drug induced(steroids)
Papilloedema
Headaches, visual obs, diplopia, pulsatile tinnitus

Look for secondary causes 
Empty sella
Flat post globe
Vert tortuous , distended ON sheath
Slit like ventricles - rare
Focal compression mid transverse sinuses (pseudostenosis)
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22
Q

Infarcts in young patients

4 main cause categories

Study These Flashcards
A

Cardiovascular: CHD, valve disease, LA myxoma

Prothrombotic: SCD

Inherited: vascular - neurocut, CADASIL ; metabolic : MELAS, homocystinuria

Acquired : dissection, NAI, moya-moya, systemic angiitis, migraines, OCP, street drugs

23
Q

Paediatric BG calcification

4 main

Study These Flashcards
A

Fahr’s

Hypo/hyper parathyroidism

MELAS - stroke like cortical lesions that cross vascular territories, parieto-occipital, inc lactate on MRS ( in normal brain regions)

HIV

24
Q

MELAS

mitochondrial myopathy/angiopathy
encephalopathy
lactic acidosis
stroke-like episodes

Study These Flashcards
A

2nd decade
parieto-occipital
inc lactate in normal brain
progressive with periodic exacerbations

25
Pontine hyperintensity causes 4 main
Ischaemia Infection Neoplasm - glioma WM pathology: demyelination, myelinolysis, PML
26
Central pontine myelinolysis ( osmotic myelinolysis) alcoholics, malnutrition, Tx, burn spastic quadraparesis pseudobulbar palsy often rapidly progressive
non-inflammatory, non vascular acute destruction of myelin ``` Symmetrical T2/FL hyper Diff + No post CE batwing contour Spares corticospinal and peripheral tracts ``` Can have symmetrical extrapontine lesions : BG, thalami, midbrain
27
Posterior reversible encephalopathy syndrome clinical CT MRI - locations (5)
acute encephalopathy WM hyperintensity vasogenic oedema (no DWI unless non reversible component)) No CE ``` posterior fossa parietal occipital posterior frontal temporal ``` many associations! 10% have haemorrhage/infarcts
28
Mural nodule with cyst | intracranial
Juvenile pilocytic astrocytoma (CE wall) Pleomorphic xanthoastrocytoma Ganglioglioma Haemangioblastoma ( non CE wall, PF)
29
``` Pleomorphic xanthoastrocytoma Demo location RF prognosis ```
``` rare astrocytoma subtype children and young adults superficial cortical location Temporal most common Cyst with mural nodule minimal oedema good prognosis ```
30
Oligodendrogliomas
``` low grade and anaplastic younger patients better prognosis cf astro frontal lobe most common Cortical expansion cortical involvement Ca 2+ > 80% Can appear aggressive Variable CE ```
31
Intracranial tumours with Ca | 5
``` Oligodendroglioma Ependymoma Craniopharyngioma Choroid plexus tumour Meningioma ```
32
Intracranial chondrosarcoma | 4 features
v. rare Extra axial very well defined Do not have calcium
33
Intraparenchymal lesions with dural involvement | 2
Metastases Lymphoma V. rare for glioblastoma
34
Subependymoma vs central neurocytoma
attached to septum pellucidum Only neurocytoma enhances Neurocytoma v. vascular!
35
Tumours with CSF Dissemination | 5
``` PNET Medulloblastoma Pineoblastoma Ependymoma Choroid plexus Ca. ```
36
Mass lesions with diffusion restriction | 4
Epidermoid Abscess Mucinous adenoca mets Cellular tumours: lymphoma, PNET, meningioma
37
Tumour mimicking brain lesions 4
Radiation necrosis ( esp bilateral, non vascular) Tumefactive demyelinating lesion Pyogenic abscess Toxoplasma encephalitis
38
CADASIL Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopathy Demo RF
hereditary Small vessel disease causes stroke in young-middle adults earlier age of stroke onset inc frequency of migraine aura/hemiplegic migraine variable pattern of ischaemic WM lesions on MR involvement of temporal poles characteristic
39
Griesingers sign
Oedema of post auricular soft tissues due to thrombosis of mastoid emissary vein
40
Types of MS | 5
Clinically isolated Xd ( 85%) Relapsing-remitting Secondary progressive MS Benign MS ( 10-20%, relapsing ms with no long term disability) Primary progressive ( 15%) - steady progression without clear cut relapses)
41
MS characteristic locations
``` Juxtacortical Periventricular ( Dawsons) Infratentorial ( dentate) Spinal cord < 2 segments Visual pathways ```
42
Paraganglioma of neck types based on location | 4
Tympanic : glomus tympanicum Jugular foramen : glomus jugulare 2cm below skull base (nodose ganglion): glomus vagale, does not enter jug foramen. Carotid body tumour
43
Kallman Xd
M:F 5:1 Olfactory agenesis Hypogonadotrophic hypogonadism
44
Intrinsic malignancy of olfactory tract
Esthesioneuroblastoma ... v rare ...PNET malignancy ...two peaks - paed , > 50yrs
45
Olfactory sulcus | depth to rule out congenital anosmia
8mm
46
Vestibular Schwannomas arise in.. location..
Vestibular nerve only | At junction of neuroglial and schwann cells in IAC/porus 95% of time
47
Uncommon features of Vestibular Schwannoma
Almost totally cystic (larger tumours are solid/cystic) Medial (5%) in CPA cistern Associated peripheral arachnoid cyst
48
Pathognomonic feature of meningioma
focal enostosis ( bony spur) marks entrance of mengieal vascular pedicle
49
CSF like lesions in CPA | 5
``` Epidermoid Arachnoid Cystic schwannoma Post op secondary arachnoid VS with peripheral arachnoid cyst ```
50
Extension pattern of glomus tumours
tympanicum : bone between hypotympanum and jugular foramen Lateral : mastoid , salt/pepper appearance anterior : filling up middle ear, pars petrosum towards apex Intra/extra axial extension
51
Radiological features of glomus tumour CT MRI Angio Ddx
CT : enlargement of jugular foramen with bone erosion MR : intratumoral vessels Fixed extension patterns Angio : very vascular DDx : schwannoma, meningioma
52
H & N manifestations of Wegeners
``` Laryngeal involvement - usually subglottic stenosis ( circumferential thickening CE + non sp.) Sore throat Laryngitis OM, Sinusitis Saddle nose deformity ```
53
Sign of chronic VC denervation palsy on CT
posterior cricoarytenoid muscle atrophy | atrophy of muscles(fat replacement) adjacent to VC

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