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Flashcards in Neuro Deck (169)
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1

Ddx intraaxial hemorrhage

HTN, tumor (primary or mets), vascular malformation (cavernoma, AVM), trauma, amyloid, venous infarct, transformation of ischemic stroke

2

gelatinous pseudocysts - who? describe? caused by?

HIV pts
perivascular spread of infection from
cryptococcus, toxo, TB, fungal, angiocentric lymphoma

3

Intraventricular mass in adult

glioma (astrocytoma, subependymoma, giant cell astrocytoma), meningioma, ependymoma, choroid plexus papilloma, metastasis, cystercosis, central neurocytoma (young adult)

4

intraventricular mass in child

choroid plexus papilloma, ependymoma, primitive neuroectodermal tumor (PNET), teratoma, and astrocytoma

5

Posterior dysmyelinating disease

Adrenoleukodystrophy (unless it's a girl - very unlikely in this X-linked disease) - has a leading edge of enhancement
PRES (ask about HTN)

6

Anterior dysmyelinating disease

Alexander
Childhood onset Alexander disease is sporadic and typically presents with macrocephaly, rapid neuorological deterioration, seizures and spasticity, and retarded psychomotor development

7

Describe pattern of metachromatic leukodystrophy

Diffuse, sparing of subcortical U fibers, "tiger striping"

8

How do you grade an AVM?

Spetzler-Martin
Size of nidus (6cm)
location (eloquent?)
draining vein deep or superficial

9

What is a ganglioglioma

low grade, typically temporal lobe.
Solid or partially cystic mass.

10

Ddx temporal lobe mass with cystic component

Ganglioglioma
PXA: pleomorphic xanthoastrocytoma
hemangioblastoma (can have cystic component)
pilocytic astrocytoma
met (lung, breast, etc.)
oligodendroglioma (look for calcs on CT)
DNET (bubbly on T2)
all cystic - neurocysticercosis

11

Name the CNS vascular malformations

capillary telangiectasia, AVM, cavernous hemangioma, developmental venous anomaly

12

periventricular cystic spaces in a child

periventricular leukomalacia
from HIE (hypoxic ischemic encephalopathy) in former premie

13

hypothalamic/suprasellar masses - adult

craniopharyhgioma, pituitary adenoma (maybe with hemorrhage), teratoma, aneurysm, rathke cleft cyst, chordoma,
mets

14

Wernickes Encephalopathy - what is it? findings?

Thymine (B1) deficiency
symmetrical increased T2 signal in the thalami, mamillary bodies, tectal plate, and periaqueductal area

15

Ddx leptomeningeal enhancement

meningitis (bacterial, fungal, TB)
leptomeningeal carcinomatosis (CNS)
lymphoma/leukemia
sarcoidosis
(moya moya)

16

intracranial hypotension - what? findings?

CSF leak (usually in spine)
cerebellar tonsillar herniation
dural venous sinus distention
dural (pachymeningeal) enhancement

17

Ddx dural/pachymeningeal enhancement

infection: bacterial, fungal, TB
intracranial hypotension
post-op
dural mets (breast and prostate)
sarcoid
lymphoma

18

What's the difference between leptomeninges and dura/pachymeninges?

Lepto = pia and arachnoid (gyriform)
Pachymeninges = dura (follows dural reflections)

19

Enlarged lateral and third ventricles, small 4th ventricle

aqueductal stenosis

20

Multiple hemosiderin deposits in brain ("black dot" differential)

DAI, mets, amyloid, cavernomas, neurocystercercosis (calcification internally)

21

ring-enhancing lesions in the CNS

GBM (thick rim)
abscess (restricted diffusion)
CNS lymphoma with immunocompromised host
tumefactive MS (incomplete ring)
sequestered subacute infarct
resolving hematoma
radiation necrosis
Toxoplasmosis
(neurocystercercosis - some enhance, some not)

22

lesion in 3rd ventricle

colloid cyst, aneurysm, neurocystercercosis, subependymoma

23

NF2 lesions

meningioma, schwannoma (esp 8th nerve), ependymoma

24

what is a phakomatosis? name some

neurocutaneous disorder characterised by involvement of structures that arise from the embryonic ectoderm (thus central nervous system, skin and eyes)
neurofibromatosis type 1 (NF1)
neurofribromatosis type 2 (NF2)
tuberous sclerosis
encephalotrigeminal angiomatosis: or Sturge-Weber syndrome
von Hippel-Lindau disease
ataxia telangiectasia (etc...)

25

lesions in Tuberous Sclerosis

cortical tubers
subependymal nodules
subependymal giant cell astrocytomas (SGCA)
renal angiomyolipomas (AML)
renal cysts
cardiac rhabdomyoma(s)
LAM (lungs)

26

lesions in NF1

neurofibromas,
pheochromocytoma
malignant peripheral nerve sheath tumour (MPNST)
previously known as neurofibrosarcoma
overal risk of developing a MPNST is ~10%
*optic nerve glioma*
Wilms tumour
rhabdomyosarcoma
renal angiomyolipoma
glioma
juvenile pilocytic astrocytoma
diffuse brainstem glioma
spinal astrocytoma and spinal pilocytic astrocytoma
carcinoid tumour(s)
ganglioglioma
leukemia

27

Sturge-Weber syndrome in the brain: features?

leptomeningeal hemangioma results in a vascular steal affecting the subjacent cortex and white matter producing localised ischemia. The majority of cases (~ 80%) have unihemispherical involvement
Look for port wine stain on face
later get calcification starting subcortically

28

Hemangioblastoma - where? who gets them?

posterior fossa, spine. ~young adults. Consider vHL (25% are vHL, so always raise this possibility).

29

posterior fossa mass in child

medulloblastoma, JPA, ependymoma

30

posterior fossa mass in adult

mets, hemangioblastoma, meningioma, astrocytoma, epidermoid