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CORE: Neuro > Intro > Flashcards

Intro Flashcards

1
Q

Describe ventricular anatomy

A

lateral ventricles (frontal, temporal, occipital horns; body, atrium/trigone) => 3rd ventricle => cerebral aqueduct => 4th ventricle => foramen of Luschka/lateral or foramen of Magendie (midline) ==> obex/opening to spinal canal

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2
Q

parts of the third ventricle

A

chiasmatic/supraoptic recess, infundibular recess, suprapineal recess, pineal recess, cerebral aqueduct, and massa intermedia

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3
Q

massa intermedia

A

interthalamic adhesion

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4
Q

CSF is produced by?

A

choroid plexus – located in body/temporal horn of lateral ventricles, roof of 3rd/4th

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5
Q

CSF volume

  • ventricle
  • subarachnoid space
A

150: 25 + 125 mL

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6
Q

CSF production in a day

A

~500 mL/day

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7
Q

CSF absorption

A

arachnoid granulations and lesser extent by lymphatic system/cerebral veins

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8
Q

cytotoxic edema

A

cell swelling by damaged Na K ATPase ion pumps

most commonly due to infarct, restricted diffusion

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9
Q

vasogenic dema

A

interstitial edema, increased capillary permeability

common with neoplasm, infection, infarct

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10
Q

interstitial edema

A

imbalances in CSF flow, commonly due to obstructive hydrocephalus

transependymal flow of CSF, periventricular

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11
Q

subfalcine herniation

A

cingulate gyrus slides under falx; compression ACA

contralateral hydrocephalus from foramen of monro obstruction

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12
Q

transtentorial herniation

A

DOWNWARD:
medial temporal lobe slides under tentorium

ipsilateral CN3 paresis, compression PCA, duret hemorrhages, compression contralateral cerebral peduncle

UPWARD: superior transtentorial herniation of vermis due to posterior fossa mass effect

obstructive hydrocephalus from aqueductal compression

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13
Q

cerebellar tonsillar herniation

A

displaced through foramen magnum, compression of medulla

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14
Q

communicating hydrocephalus

A

venticular enlargement, no obstructing lesion

subarachnoid hemorrhage or normal pressure hydrocephalus

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15
Q

noncommunicating hydrocephalus

A

obstructive lesion

3rd ventricle colloid cyst
posterior fossa mass obstructing 4th ventricle

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16
Q

intra vs extra-axial:
beneath pia
meninges/subarachnoid

A

intra-axial

extra-axial

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17
Q

perimesencephalic cisterns/basal cisterns

A

suprasellar, prepontine, interpeduncular, ambient, quadrigeminal

surround midbrain/pons

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18
Q

T1 shortening signal

T2 shortening signal

A

bright

dark

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19
Q

brain lesions demonstrate pathologic prolongation of longitudinal recovery

A

T1 dark, T2 bright

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20
Q

causes of T1 hyperintensity

A

gadolinium, fat, protein

melanin, mineralization, slow-flow blood, calcium, paramagnetic stages of blood (intra/extracellular methemoglobin)

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21
Q

causes of T1 hypointensity

A

paramagetic states of blood (except hyperacute blood, extracellular methemoglobin), calcification, fibrous lesion, highly cellular tumors, vascular flow voids, muscin

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22
Q

FLAIR

A

T2 weighted signal with suppresion of water based on T1 characteristics

white matter darker than gray matter

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23
Q

PD sequence

A

conventional spin echo proton density

highest signal to noise ratio

useful to evaluate MS, demyelinating plaques in posterior fossa

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24
Q

diffusion weighted images

A

DWI/ADC

brownian motion of water; signal lost with increases (pathologic processes)

CSF is dark

25
differential for restricted diffusion
acute stroke, bacterial abcess, cellular tumors (lymphoma, medulloblastoma), epideroid cyst, herpes encephalitis, CJD cruetzfelt jakob disease
26
DWI vs ADC signal with reduced diffusion
DWI bright, ADC dark DWI: reduced diffusion will be hyperintense (less Brownian motion, less loss of signal)
27
T2 shine through
DWI images are T2 weighted so T2 hyperintense signals will shine through on DWI
28
b-value in MRI
higher b-value -> more contrast, detects reduced diffusivity
29
GRE/T2*
susceptible to signal loss from magnetic field inhomogeneities 180 degree rephasing pulse is omitted
30
blooming artifact
hemosiderin, calcium produce inhomogeneities in magnetic field; makes small lesion conspicuous
31
differential diagnosis of multiple dark spots
hypertensive microbleeds, cerebral amyloid angiopathy, familial cerebral cavernous malformations, axonal shear injury, multiple hemorrhgic metastases
32
MR spectroscopy
chemical composition of brain may help determine radiation necrosis vs recurrent tumor, glioblastoma v metastasis
33
MR spectroscopy: glioblastoma vs mets
glioblastoma: gradual transition abnormal to normal metastasis: abrupt transition
34
ratios of specific compounds
NAA decreases and choline increases with tumors order: Cho, Cr, NAA
35
canavan disease MR spectroscopy
elevated NAA
36
lactate doublet MR spectroscopy
high grade tumors (anaerobic metabolism)
37
Hunters angle
line connecting tallest peaks should point up; normal spectrum
38
perfusion MR
brain imaged repeatedly with gadolinium injection gadolinium causes magnetic field distrubance which transiently decreases image intensity T2* images useful for stroke and tumors
39
what causes parenchymal enhancement
disruption of BBB infection, inflammation, neoplasm, trauma, vascular etiologies
40
BBB is formed from?
astrocytic foot processes of brain capillary endothelial cells
41
what parts of the brain do not have BBB
choroid plexus, pituitary gland, pineal gland, tuber cinerium (inferior hypothalamus, controls circadian), area postrema (inferior of 4th ventricle, controls vomiting)
42
vascular enhancement in brain
localized increased blood flow vasodilation, hyperemia, neovascularity, AV shunting
43
sources of extra-axial enhancement
dura (pachymeninges) | arachnoid (leptomeninges)
44
ddx for periventricular enhancement
CNS lymphoma, infectious ependymitis (CMV), primary glial tumor, MS
45
CNS lymphoma on imaging
hyperattenuating on CT restricted diffusion due to cellularity low T2 signal centrally necrotic in immunocompromised patients
46
ddx gyriform enhancement
herpes encephalitis, meningitis, subacute infarct, posterior reversible encephalopathy syndrome
47
nodular intra-axial enhancement
metastatic disease
48
subcortical gray white junction enhancement with edema
hematogenously disseminated mets
49
posterior fossa disease: mets
venous dissemination of mets via retroclival venous plexus
50
ddx rim enhancing lesion
MAGIC DR | mets, abscess, glioma, infact, contusion, demyelinating, radiation
51
pachymeningeal/dural enhancement
falx, tentorium, cavernous sinuses covered by dura dural enhancement on MRI is indication of dural edema, not BBB breakdown
52
ddx of pachymeningeal enhancement
intracranial hypotennsion, postoperative, post lumbar puncture, meningeal neoplasm (meningioma), granulomatous disease (sarcoid, TB, fungal disease)
53
ddx leptomeningeal enhancement
meningitis, leptomeningeal carcinomatosis, viral enchephalitis, slow vascular flow
54
fine linear vs thick nodular enhancement in meningitis
fine/linear: bacterial or viral nodular: fungal
55
leptomeningeal carcinomatosis neoplasms
MOCLEGG | medulloblastoma, oligodendroglioma, choroid plexus tumor, lymphoma, ependymoma, glioblastoma, germinoma
56
mets that cause leptomeningeal carcinomatosis
lymphoma, breast
57
ddx of FLAIR hyperintensity
meningitis/leptomeningeal carcinomatosis subarachnoid hemorrhage pt on oxygen or propofol; increased subarachnoid FLAIR
58
slow flow of peripheral vessels
moya moya

CORE: Neuro (21 decks)

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