Lecture

Question 1

Three categories of intradural tumors

Answer 1

Intradural intramedullary, intradural extramedullary, cauda equine tumors

Question 2

Most common intramedullary tumors

Answer 2

Ependymom and astrocytoma (pilocytic, low grade fibrillary)

Question 3

Intra-medullary processes that can mimic neoplasms (4)

Answer 3

1. vascular malformations
2. infections
3. demyelination
4. radiation changes.

Question 4

Common pathological subtypes of ependymoma (2)

Answer 4

1. cellular

2. myxopapillary

Question 5

E;pendymoma appearance on imaging (4)

Answer 5

1. multi-segmental expansion of spinal cord
2. isointense on T1 and hyperintense on T2
3. hemosiderin deposition is common.
4. intense sharply defined enhancement patterns.

Question 6

Pathological subtypes of astrocytoma (2)

Answer 6

1. fibrillary (grade II through IV)

2. pilocytic (I) (54%)

Question 7

True or false: astrocytoma cannot involve the entire cord

Answer 7

False

Question 8

Disease associated with hemangioblastoma

Answer 8

Von Hippel-Lindau syndrome

Question 9

Common locations of hemangioblastoma (2)

Answer 9

Thoracic and cervical

Question 10

Appearance of hemangioblastoma (4)

Answer 10

1. expansile spinal cord mass
2. prominent flow voids
3. cyst and syrinx formation
4. intensely enhancing pial-based mural nodule or solid mass. (ie usually not in center of cord***)

Question 11

Common intradural tumors (2)

Answer 11

1. Nerve sheath tumors (schwannoma, NF)

2. meningioma

Question 12

True or false, most intradural tumors are malignant

Answer 12

False

Question 13

Classic findings of intradural extramedullary tumors

Answer 13

widening of the ipsilateral subarachnoid space

Question 14

Two subtypes of nerve sheath tumors

Answer 14

1. schwannoma (sporadic, NF2)

2. neurofibroma (NF 1)

Question 15

Origin of nerve sheath tumors

Answer 15

Sensory nerve roots

Question 16

Most common location of nerve sheath tumors

Answer 16

Lumbar > thoracic = cervical

Question 17

Appearance of nerve sheatlh tumors on imaging

Answer 17

1. isointense on T1 and hyperintense T2
2. Common cystic degeneration and hemorrhage
3. intense and sharply defined enhancement

Question 18

Intradural metastases aka….

Answer 18

drop metasteses

Question 19

Two common cauda equina tumors

Answer 19

1. Nerve sheath tumors

2. ependymoma (myxopapillary)

Question 20

Desribe pre-styloid parapharyngeal space

Answer 20

Composed primarily of fat. Shaped like an inverted pyramid (widest at top)

Question 21

Contents of pre-styloid paraphryngeal space (3)

Answer 21

1. Fat
2. CN V3
3. ectopic salivary gland

Question 22

Lesions of the pre-styloid paraphryngeal space (4)

Answer 22

1. Lipoma (rare)
2. schwannoma
3. salivary gland neoplasm
4. inflammation/abscess

Question 23

Contents of the post-styloid parapharyngeal space (5)

Answer 23

1. carotid artery
2. jugular vein
3. CN IX, X, XI, XII
4. sympathetic plexus
5. lymph nodes

Question 24

Lesions of the post styloid parapharyngeal space (5)

Answer 24

1. pseudoaneurysm
2. jugular v. thrombosis
3. schwannoma
4. paraganglioma
5. lymphadenopathy

Question 25

Where is vagus relative to carotid in post styloid parapharyngeal space?

Answer 25

Posterior

Question 26

Salt and pepper appearance on MR

Answer 26

Paraganglioma. Bright from enhancement, dark from high vascular flow voids.

Question 27

Conents of parotid space (4)

Answer 27

1. Parotid gland 2. parotid duct 3. CN VII 4. lymph nodes

Question 28

Lesions of parotid space (4)

Answer 28

1. salivary gland neoplasms/cyst 2. duct dilatation, infection/abscess 3. schwannoma 4. lymphadenopathy.

Question 29

Contents of the masticator space (3)

Answer 29

1. mandible 2. muscles of mastication 3. CN V3

Question 30

Lesions of the masticator space (4)

Answer 30

1. Infection/abscess 2. Venous vascular malformation 3. ? 4. ?

Question 31

How does a retropharyngeal space lesion displace muscles?

Answer 31

Longus colli and capitis muscles displaced posteriorly | If forward, lesion usually in prevertebral space

Question 32

Separates prevetertebral and paraspinal spaces

Answer 32

Transverse processes.

Question 33

From which artery does the middle meningeal artery arise?

Answer 33

Maxillary artery

Question 34

Which foramen does middle meningeal enter through

Answer 34

Foramen spinosum

Question 35

Artery supplies the caudate and where do they come from

Answer 35

Medial lenticulostriate from A1

Question 36

Artery that supplies the posterior limb of the internal capsule

Answer 36

Anterior choroidal artery (off of internal carotid)

Question 37

First artery arising from the ICA after it passes through the dura

Answer 37

Ophthalmic artery

Question 38

Artery that supplies the medial temporal lobes

Answer 38

Posterior cerebral artery

Question 39

Supplies head of caudate, anterior lentiform nucleus, anterior internal capsule

Answer 39

Recurrent artery of Heubner

Question 40

True or false: does fenestration increase the likelihood of aneurysm?

Answer 40

True

Question 41

Single ACA is called?

Answer 41

Azygous ACA

Question 42

True or false: azygous ACA increases likelihood of aneurysm?

Answer 42

True

Question 43

True or false: hypoplastic ACA increases likelihood of aneurysm

Answer 43

False

Question 44

DVA

Answer 44

Developmental venous anomaly

Question 45

Which other vascular lesions is a/w DVA?

Answer 45

Cavernous malformation.

Question 46

Grisel's syndrome

Answer 46

Non traumatic atlantoaxial subluxation due to hematogenous seeding of the CV junction through pharnygovertebral veins after URI, retropharyngeal abscess or other head/neck infection.

Question 47

Deposition of calcium of longus colli with secondary inflammation and retropharyngeal effusion

Answer 47

Acute calcific prevertebral tendinitis.