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Neuro Flashcards

1
Q

Cause of CN3 (occulor motor) palsy

A

Think posterior communicating artery aneurysm

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2
Q

Cranial nerve 6 (abducens) palsy

A

Think raised ICP (downward displacement of the brainstem = stretching of the 6th CN.

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3
Q

Brain myelination progression order

A

Inferior to superior
Posterior to anterior
Central to peripheral

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4
Q

What is the last part of the brain to myelinate?

A

Subcortical white matter

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5
Q

What parts of the brain are myelinated at birth?

A

Brainstem
Posterior limb internal capsule

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6
Q

How does the corpus callosum form?

A

Front to back
i.e. Rostrum to Splenium

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7
Q

Wide spaced vertical ventricles, dilation of the occipital horns, intracranial lipoma. Diagnosis?

A

Agenesis of the corpus callosum

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8
Q

Vermis (cerebellar) hypoplasia, cystic dilatation of the 4th ventricle, lambdoid inversion of the torcular. Diagnosis?

A

Dandy Walker malformation

Spectrum of disease.
Mega cisterna magna (normal cerebellum and posterior fossa)
to Classic DWM (tiny cerebellum, expanded posterior fossa).

MCM -> Blake Pouch -> Variant DWM -> Classic DWM

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9
Q

Large lateral ventricle on one side, with ipsilateral hamartomatous overgrowth of that cerebral hemisphere. Diagnosis?

A

Hemimegalencephaly

(Ramussen’s encephalitis = BIG ventricle, SMALL cerebral hemispehere)

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10
Q

Types of holoprocencephaly?

A

Lobar - <50% focal fusion of the anterior brain.

SemiLobar - >50% fusion of the anterior brain.

ALobar - Zero midline cleavage. Single ventricle.

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11
Q

What are the different types of Lissenchephaly?

A

Lissencephaly (Type 1) - failure of grey matter migration. Agyria (no gyri), thick cortex, “figure of 8” shaped brain.

Lissencephaly (Type 2) - overmigration of grey matter. Cobblestoned thickened cortex. Associated with congenital muscular dystrophy.

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12
Q

What is Double cortex band heterotopia?

A

Disorganised under migration of grey matter. Double cortex appearance, normal/mildly simplified gyri. Second layer of grey matter seen around the ventricles.

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13
Q

What is periventricular nodular heterotopia?

A

Under migration of grey matter. Nodular grey matter deposited around the periventricular region.

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14
Q

Cleft in the brain extending from ventricle to the surface filled with CSF. The cleft is lined with grey matter. Diagnosis?

A

Schizenchephaly (OPEN LIP) - Congenital split brain, lined with grey matter.

If cleft is not filled with CSF, but still lined with grey matter, then its closed lip schizencephaly.

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15
Q

Cleft in the brain extending from ventricle to the surface filled with CSF. The cleft is NOT lined with grey matter. Diagnosis?

A

Porencephaly - aquired split brain, usually secondary to vascular insult resulting in encephalomalacia. NOT lined with grey matter.

If cleft is lined with grey matter then it’s shizencephaly.

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16
Q

Define Chiari 1 malformation

A

Cerebellar tonsils >5mm below the level of basion-opistion

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17
Q

Features of chiari 2 malformation

A

Myelomeningocele
Low lying cerebellar tonsils and torcular
Thinned corpus callosum
Tectal beaking

If also has occipital encephalocele = Chiari Type 3

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18
Q

Patient with urinary incontinene, confusion, and ataxia. CT head shows ventricles out of proportion to atrophy, and upward bowing of the corpus callosum. Diagnosis?

A

Normal pressure hydrocephalus.

“Wet, Wacky, Wobbly”
Urinary incontinence, confusion, ataxia.

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19
Q

Type of oedema that comes secondary to infarction?

A

Cytotoxic oedema - INTRAcellular fluid secondary to malfunction of the Na/K+ pump. Tends to favour grey matter, causing loss of grey-white matter differentiation.

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20
Q

Type of oedema that comes secondary to tumour/infection?

A

Vasogenic oedema - EXTRAcellular fluid. Oedema tracking through the white matter. Spares the grey matter.

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21
Q

Alcoholic, low Na which is rapidly corrected. Now encephalopathic, low GCS, quadraparesis.
MRI shows T2 bright in central pons. Restricted diffusion in central pons.
Diagnosis?

A

Osmotic demyelination syndrome

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22
Q

Alcoholic. Confusion, ataxia, seizures, and spasticity.
CT head shows hypoattenuating regions of the corpus callosum.
MR shows T2 hyperintensities in the corpus callosum.
Diagnosis?

A

Marchiafava-bignami disease - demyelination of the corpus callosum.

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23
Q

Acute symptoms of headache, dizzyness, memory loss.
CT shows low density in the globus pallidus.
MR shows T2/FLAIR high signal in globus pallidus.
Diagnosis?

A

Carbon monoxide poisoning

Carbon monoxide causes “Globus warming”

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24
Q

Headache, dizziness, optic neuritis, vomiting.
CT shows low density in putamen bilaterally.
MRI shows high T2/FLAIR signal in the putamen.
Diagnosis?

A

Methanol poisoning

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25
Previous chemoetherapy. Bilateral asymettric subcortical white matter oedema within the occipital lobe. Does not restrict on DWI. Diagnosis?
PRES (Posterior Reversible Encephalopy Syndrome)
26
Post chemotherapy. New confusion. MRI shows bilateral diffuse, confluent high T2/FLAIR signal in the subcortical white matter centrum semiovale. Diagnosis?
Methotrexate induced leukoencephalopathy
27
IVDU. New cerebellar ataxia, and pseudo bulbar symptoms. MRI shows symmetrical "butterfly" high T2 signal in centrum semiovale, posterior limb internal capsule, and deep cerebellar white matter. Diagnosis?
Heroin induced leukoencephalopathy (Chasing the dragon)
28
Common locations for MS white matter lesions?
Juxtacortical Corpus callosum Periventricular Infratentorial Basal ganglia rare.
29
McDonald Diagnostic criteria for MS?
>1 lesion disseminated in space (juxtacortical, Corpus callosal, periventricular, infratentorial). >1 lesion disseminated in time - >1 month Active lesions enhance on MR Old lesions do not enhance (both are T2 bright)
30
Female patient, 37 y/o, presents with seizure. MR brain shows large ring enhancing lesion with incomplete ring sign. Minimal mass effect for the size of the lesion. Diagnosis?
Tumefactive Demyelination.
31
15 y/o presents with seizure after having a vaccine. MR shows multiple "incomplete ring" enhancing lesions, sparing the calloso-septal interface. Diagnosis?
ADEM - Acute Disseminated Encephalomyelitis.
32
60y/o presents with dementia like symptoms. MRI shows multiple, small, confluent high T2 signal in centrum semiovale sparing the subcotical U fibres. Diagnosis?
Subcortical Arteriosclerotic Encephalopathy (small vessel dementia) CADASIL - cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy - presents at a younger age due to hereditary nature.
33
5 year old present with progressive impariment of motor/cognitive function. MRI shows high FLAIR signal in parieto-occipital white matter sparing subcortial U fibres, and extends across the corpus callosum. Diagnosis?
Adrenoleukodytrophy. (ALD)
34
18 month old, convulsions, loss of vision, muscle rigidity. MRI shows high FLAIR signal in the periventricular white matter in a "tiger stripe" pattern. Diagnosis?
Metachromatic Leukodystrophy.
35
Infant with large head, has progressive quadrapaerisis and seizure. MRI shows high FLAIR signal in the frontal white matter bilaterally. Diagnosis?
Alexander disease
36
Ashkenazi Jewish infant with big head. Bloods show elevated NAA. MR shows diffuse high FLAIR signal throughout the white matter involving the subcortical U fibres. Diagnosis?
Canavan disease
37
Infant with a small head. MRI shows high FLAIR signal in the centrum semiovale and periventricular white matter, with parieto occipital predominance. Diagnosis?
Krabbe leukodystrophy
38
MEN 1
Pituitary Parathyroid Pancreatic
39
MEN 2a
PMP Pheochromocytoma Medullary thyroid tumour Parathyroid hyperplasia
40
MEN 2b
Pheochromocytoma Medullary thyroid cancer Mucosal neuroma Marfanoid features
41
Patient with cerebellar ataxia, autonomic dysfunction, and parkinsonism. MRI T2 shows cruciate high signal within the pons, high signal in middle cerebellar peduncles, and cerebellum. Diagnosis?
Multi system atrophy (Hot cross bun sign + autonomic dysfunction)
42
What runs through the cavernous sinus?
CN 3, 4, 5 (V1+2), 6, and the carotid artery
43
What travels through superior orbital fissure + inferior orbital fissure?
Superior orbital fissure - CN 3, 4, V1, 6 Inferior orbital fissure - V2
44
What are the Parkinson plus syndromes?
Dementia with Lewy bodies Multisystem atrophy Progressive supra nuclear palsy Cortico-basal degeneration
45
Patient with abnormal eye movements, instability and falls. MRI head shows midbrain atrophy with sparing of the pedicles, and flattening of the superior aspect of the midbrain. Diagnosis?
Mickey mouse sign Hummingbird sign Progressive supranuclear palsy.
46
Patient with alien limb syndrome, asymmetric movement disorders has an MR brain showing asymmetric cortical atrophy, basal ganglia atrophy, and atrophy of the corpus callosum.
Corticobasal degeneration
47
Patient presents with glioblastomas and intestinal polyps. What is the diagnosis?
Turcot syndrome
48
16 year old boy with progressive dementia symptoms. MRI shows eye of tiger sign with high signal around the globus pallidus. Diagnosis?
PKAN - Hallervoden Spatz
49
What is dolichoectasia and it's associated diseases?
Dilated and ectatic intracranial vessels. Most commonly vertebro-basilar or internal carotid. Can cause compression of cranial nerves. Associated with Marfans, Ehlers-Dahnlos
50
What is the most common CNS metastases in a child?
Neuroblastoma.
51
What are the cortically based tumours?
P-DOG Pleomorphic xanthoastrocytoma DNET Oligodendroglioma Ganglioglioma
52
What are the imaging appearances of pleomorphic xanthoastrocytoma?
Supratentorial Cyst with enhancing nodule.
53
How can you tell the difference between pleomorphic xanthoastrocytoma, pilocytic astrocytoma, and haemangioblastoma?
All 3 appear as cyst with enhancing nodule. Pleo - Supratentorial, in temporal lobe Pilocytic - Posterior fossa in kids Haemangioblastoma - Posterior fossa in adults, VHL
54
Typical radiological appearance of a DNET?
Paediatric temporal lobe lesions T2 Bright and Bubbly appearance Minimal enhancement
55
Typical radiological appearance of an oligodendroglioma?
Typically occurs in adults Calcification - ribbon like Frontal lobe predominant Expands the cortex
56
Typical radiological appearance of a ganglioglioma?
Typically found in temporal lobe in teenagers. Typically presents with seizures. Mixed solid cystic appearance. Can have bony remodeling
57
What are the intraventricular lesions?
Intraventricular lesions are messy MESS-C - Medulloblastoma - Ependymoma - Subependymoma - SEGA - Central neurocytoma
58
How do you differentiate between an ependymoma Vs medulloblastoma?
Both classically 4th ventricle tumours. Ependymoma arises from the floor of 4th ventricle, squeezing out of it (toothpaste sign). Calc + haemorrhage - enhance heterogeneously. Medulloblastoma arises from the roof of 4th ventricle, protruding into it. Enhance more homogenously.
59
Which tumour is most likely to metastases to the spine? Ependymoma or medulloblastoma?
Medulloblastoma - metastases Need to image rest of spine
60
What condition are Subependymal Giant Cell Astrocytomas associated with?
Tuberous sclerosis.
61
Where are SEGAs typically located?
At the base of the lateral ventricles near the foramen of Munro. Hydrocephalus is commonly present.
62
What age group do SEGAs appear in Vs Subependymoma?
SEGAs appear in children Vs Subependymoma appears in adults.
63
What is the classical imaging appearance for a Central neurocytoma?
Cystic "Swiss cheese" appearance. Interventricular lesion. Tend to calcify a lot (like oligodendroglioma) Internal haemorrhage is common.
64
Name two brain tumours that classically calcify?
Oligodendroglioma Central neurocytoma
65
Classic imaging appearance for a choroid plexus papilloma?
Cauliflower appearance. Hydrocephalus due to excess CSF secretion Homogeneous enhancement
66
Classic imaging appearances of a meningioma?
Extra axial (CSF cleft sign) Classically have a dural tail
67
What is the most common CP angle masses?
Vestibular Schwannoma (75%) Meningioma (10%) Epidermoid (5%) Dermoid
68
What condition are Schwannoma associated with?
NF 2
69
How can you differentiate between a dermoid Vs an epidermoid CPA angle mass?
Dermoids are classically midline + contain fat Epidermoids are classically off midline + restrict avidly
70
What is the classical imaging appearances of an AT/RT?
Typically occur in the posterior fossa. Aggressive large heterogenous mass with necrosis
71
Which low grade tumours classically enhance?
GPS Ganglioglioma Pilocytic astrocytoma SEGA
72
Classic imaging features of primary CNS lymphoma?
Periventricular Crosses the corpus callosum Homogeneously enhancing
73
What causes gelastic seizures?
Hypothalamic hamartoma
74
What are the pineal lesions?
GPPP Germinoma (most common) Pineal cyst Pineocytoma Pineoblastoma
75
Typical imaging appearances of a germinoma?
Pineal lesion Heterogeneous mass containing fat and calcification.
76
Classic imaging features of a pineoblastoma?
PineoBLASToma - "Exploded" calcification Highly invasive compared to pineocytoma
77
Classic imaging features of adult Toxoplasmosis CNS infection?
Ring enhancing lesion with LOTS of oedema
78
Classical imaging features of an Adamantinous Craniopharyngioma?
Supra sella lesion. - Cystic. - Peripheral calcification. - Mostly seen in children. (Papillary craniopharyngioma is solid, with no calc, in adults)
79
What are the differences between Adamantinous Craniopharyngioma and Papillary craniopharyngioma?
Both are suprasellar lesion Adamantinous are cystic with peripheral calcification, seen in kids. Papillary are mainly solid, with no calc, seen in adults.
80
What are the leukodystrophies from frontal predominance to occipital predominance?
Alexander disease - frontal Canavan disease - Diffuse subcortical U Metachromatic - Periventricular, tigroid Krabbe - Centrum semiovale and occipital ALD - Parieto Occipital
81
What is CADASIL?
CADASIL - cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy - Severe small vessel disease that presents at a young age due to hereditary nature.
82
How can you differentiate choroid plexus papilloma from choroid plexus carcinoma?
Choroid plexus papilloma enhances homogeneously Choroid plexus carcinoma enhances heterogeneously
83
Where do CNS hemangioblastomas occur?
Posterior fossa Supratentorial (in VHL patients)
84
Imaging features of optic nerve gliomas
Enlargement of the optic nerve Enlargement of the optic canal Kinking of the optic nerve T2 bright
85
Typical imaging appearance of vestibular schwannoma
CPA angle mass Low T1 Heterogeneous High T2 Intense heterogeneous enhancement
86
How does vein of Galen malformation typically present?
Neonatal high output cardiac failure Obstructive hydrocephalus
87
Where does diffuse axonal injury typically occur
Grey white matter junction
88
Most common brain metastases in adult?
Long Runs? Be My Guest. 1. Lung 2. Renal 3. Breast 4. Melanoma 5. GI
89
What is Pick's disease?
Frontotemporal atrophy Typically in young men Type of tauopathy
90
Classic imaging appearance of Huntington's disease
Caudate head and putamen atrophy with compensatory dilatation, of the frontal horns of lateral ventricles. High signal within caudate and putamen
91
Suprasellar lesions?
SATCHMOE S - sarcoid A - aneurysm T - teratoma, TB C - craniopharyngioma, chordoma, cleft cyst (rathke) H - hypothalamic hamartoma/glioma M - meningioma, metastases O - optic nerve glioma E - Eosinphilic granuloma, epidermoid/dermoid
92
Imaging features of CNS cytomegalovirus.
High T2 oedema typically in a PERIVENTRICULAR distribution. No enhancement. Can affect the whole neuro axis.
93
What is diastematomyelia?
Split cord malformation Splitting of the distal spinal canal with a bony cleft, resulting in two spinal cords.
94
What is Moyamoya disease?
Idiopathic, non inflammatory, not atherosclerotic, vascular occlusive disease. Seen in kids. Present with hemispheric ischaemic strokes, and watershed infarcts
95
How can you age subdural haematoma based on MRI blood signal?
TYPE - TIME - T1 SIGNAL - T2 SIGNAL: Oxy Hb - Immediate - Iso - Iso Deoxy Hb - 1-2 days - iso - low Intracellular Met Hb - 2-7 days - high - low Extracellular Met Hb - 7-28 days - high - high Hemosiderin - chronic - low - low TLDR: T1 signal only becomes high after a couple days T2 signal only becomes high after a week
96
Typical MRI appearance of a Rathke Cleft Cyst?
Congenital intrasellar lesion found in kids. 60% have suprasellar extension T1 - 50% high, 50% low due to protein content T2- 70% high Gd - No enhancement An intracystic nodule is present in 75%
97
Where are germinomas typically found
Pineal gland Suprasellar Periventricular
98
Typical imaging findings for cerebral abscess
Thin enhancing rim of uniform thickness. Double rim sign: - outer low signal rim (fibrous capsule), inner high signal rim (enhancing capsule)
99
What are the types of hypothalamic hamartomas?
Sessile - attached to mammillary region, near mammillary bodies Pedunculated - attached to the tuber cinereum and projects into the suprasellar cistern
100
How to differentiate between spinal schwannoma Vs neurofibroma?
Both are low T1 and high T2 Schwannoma displaces nerve roots Neurofibroma encases nerve roots Neurofibroma - target sign (central low signal)
101
How does syringomyelia normally present?
Cape like loss of pain and temperature sensation along back and upper arms
102
What are the intradural but extramedullary tumours?
No More Spinal Masses Neurofibroma Meningioma Schwannoma Metastases
103
Typical imaging findings of CNS amyloidosis?
Cortical, sub cortical and cerebellar micro-haemorrhages, sparing the basal ganglia.
104
How can you tell the difference between amyloid micro-haemorrhage Vs hypertensive micro-haemorrhage?
Hypertensive micro-haemorrhage typically affects the basal ganglia whereas amyloid micro-haemorrhage spares the basal ganglia
105
MRI brain findings of Wilson's disease?
High T2 signal in basal ganglia
106
Clinical presentation of Wilson's disease?
Parkinsonism, ataxia and gait abnormalities.
107
Acute stroke findings on MRI?
T2 bright Restricted diffusion ADC values pseudo-normalise as time progresses (~2 weeks)
108
Most common viral encephalitis?
Herpes simplex virus encephalitis
109
Typical findings in HSV encephalitis?
Involvement of: - Fronto-temporal lobes. - Insular cortex. - Limbic system. Haemorrhage is frequent.
110
Imaging findings in Wernicke's encephalopathy?
High T2 signal: - mammillary bodies - thalamus - periaqueductal grey matter
111
What is Lhermitte-Duclos disease?
Dysplastic cerebellar gangliocytoma Associated with Cowden disease
112
Typical imaging findings for Dysplastic cerebellar gangliocytoma
Thickening of the cerebellar cortex (Tigroid cerebellum) High T2 signal. No enhancement. Dysplastic cerebellar gangliocytoma = Lhermitte-Duclos disease. Associated with Cowden syndrome
113
What is Dysplastic cerebellar gangliocytoma associated with?
Cowden syndrome
114
What is progressive multifocal leukoencephalopathy?
AIDS related with low CD4 count Demyelinating disease that affects the subcortical FRONTAL and PARIETO-OCCIPITAL lobes.
115
Intradural, intramedullary spinal neoplasms?
Energetic Astronauts Have Lively Parties Ependymoma (60%) Astrocytoma (33%) Hemangioblastoma Lymphoma Paraganglioma
116
Spinal ependymoma imaging appearance?
Location cervical or upper thoracic spine (75%), within the central cord Symmetrical widening of the cord with associated syrinx Haemorrhage causing "cap sign" T1 - iso T2 - high Gd - strong enhancement
117
What are spinal ependymomas associated with?
NF2
118
Spinal cord astrocytoma imaging appearance?
Location cervical and thoracic spine Eccentric as they originate from cord parenchyma. Poorly defined margins T1 - iso T2 high Gd - patchy enhancement
119
Astrocytoma is associated with which condition?
NF1
120
How to differentiate between spinal cord ependymoma Vs astrocytoma?
Ependymoma adult Astrocytoma kids Ependymoma centrally located within cord Astrocytoma eccentrically located within cord Ependymoma diffuse enhancement Astrocytoma patchy enhancement
121
What do cortical tubers look like on MRI?
Cortical and subcortical high T2 signal. Rarely enhance.
122
What is gliomatosis cerebri?
Growth pattern if diffuse glioma that involves at least 3 lobes.
123
What is Lissencephaly type 2 associated with?
Congenital muscular dystrophy.
124
Most common association with Chiari 1 malformation?
Syrinx

FRCR 2a Flashcards (11 decks)

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