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Flashcards in Neuro Deck (19)
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1

What imaging modality should be performed first in the setting of head trauma?

CT w/o contrast (+ normal trauma series)

2

Epidural Hematoma

biconvex or lenticular in shape
overlays fracture site
doesn't cross suture lines
typically arterial
lucid intervals with risk for deterioration and herniation

3

Subdural Hematoma

crescent shaped
tearing for bridging veins
cross suture lines
reflects with arachnoid mater at falx but doesn't cross

4

Subarachnoid Hemorrhage

between arachnoid and pia mater
trauma or rupture of an aneurysm
hyperdense areas on the CT within the sulci and the cisterns
best if detected w/n 12hrs on CT
Feared complication- vasospasm!

5

Intraventricular Hemorrhage

tearing of subependymal veins
collection in lateral ventricles
typically results from corpus collosum injury

6

Intraparenchymal Hemorrhage

trauma, hemorrhagic stroke, a ruptured AVM, or a hemorrhagic neoplasm.

7

The NEXUS Criteria for C-spine imaging

All trauma imaged unless all criteria met:
-No posterior midline c-spine tenderness
-No intoxication
-Normal level of alertness
-No focal neurological deficit
-No clinically apparent painful injuries that might distract from pain of a cervical spine injury

8

Canadian C-Spine Rules for C-spine imaging

Image if high-risk factors:
-Age >65 years
-"Dangerous mechanism"- MVA
-Paresthesias in extremities
Don't image if:
-Simple rear-end MVA
-Sitting position in ED
-Ambulatory at any time
-Delayed onset of neck pain
-Absence of midline cervical tenderness
-Able to actively rotate neck 45° left and right

9

What is the best modality to look for spinal cord injury or compression?

MRI

10

What is the best modality to look for spinal fractures?

CT

11

Uncal herniation

-medial temporal lobe herniates through the tentorial hiatus
-effacement of the suprasellar
-cranial nerve III palsies

12

Cerebellar tonsillar herniation

-cerebellar tonsils are pushed inferiorly through the foramen magnum
-often seen with posterior fossa masses

13

Best imaging for Diffuse axonal injury ?

MRI GRE or FLAIR are more sensitive and should follow CT for confirmation.

14

Rank from most likely to least likely the locations where berry aneurysms are known to occur.

ACA
PCA
MCA

15

What is the most sensitive examination for detection of acute ischemia?

MRI DWI
(CT doesn't show imaging features of infarct until at least 6 hours)

16

Differential for seizure in immunocompromised patient with history of cerebral aneurysm?

-Toxoplasmosis
-CNS lymphoma
-Neurocysticercosis
-Cerebral metastasis
-Pyogenic abscess
-Aneurysm recurrence

17

MRI findings which favor toxoplasmosis include:

- Multiple lesions
- Abundant edema
- Target Enhancement
- Deep gray matter (caudate nucleus, basal ganglia) involvement
(Typically due to reactivation of latent disease)

18

MRI findings suggestive of PCNSL include:

- Solitary lesion
- Subependymal enhancement
- Encasement of the ventricles
- Hypointensity of the core on T2-weighted imaging

19

MR Spect Distinguishing cerebral lymphoma from toxoplasmosis

Malignancy=
1) HIGHT Choline/Creatine rati
2) Low N-Acetyl-Aspartate/Creatine ratio