Neuro brain CORE - Sheet1 Flashcards
(168 cards)
1
Q
baby brain myelination: which changes first, T1 or T2
A
T1 changes precede the T2 changes (adult T1 pattern seen around age 1 , adult T2 pattern seen around age 2).
2
Q
last part of the brain to myelinate?
A
subcortical white matter (inf–>sup, central–>peripheral, sensory–>motor)
3
Q
which way does the corpus callosum form?
A
front to back (then rostrum last)
4
Q
MRI signal of skull bone marrow in babies
A
T1 hypointense in young kids, fatty in older kids (T1 bright)
5
Q
order of sinus formation
A
maxillary, ethmoid, sphenoid, frontal
6
Q
normal change in globus pallidus with age
A
brain iron increases, GP darkens up
7
Q
imprint of the high heeled shoe
A
oval part = foramen ovale, pointy heel = foramen spinosum
8
Q
foramen rotundum on the different views
A
axial = point heel of high-heeled shoe, sag = “level” (totally horizontal), coronal = coming straight at you
9
Q
what CN runs next to the carotid in the cavernous sinus?
A
CN6 (you get lateral rectus palsy earlier with cav sinus pathology)
10
Q
branches of the external carotid
A
superior thyroid, ascending pharyngeal, lingual, facial, occipital, post auricular, maxillary, superficial temporal (Some Admins Like Fucking Over Poor Medical Students)
11
Q
number of the carotids
A
C1 (cervical), C2 (petrous), C3 (lacerum), C4 (cavernous), C5 (clinoid), C6 (ophthalmic/supraclinoid), C7 (communication/terminal)
12
Q
persistent fetal connection between cavernous ICA (C4) and basilar artery?
A
persistent trigeminal artery (increases risk of aneurysm)
13
Q
what’s it called when the carotid artery courses through the tympanic cavity to join the horizontal carotid canal?
A
aberrant carotid artery - pulsatile! don’t biopsy
14
Q
3 deep cerebral veins
A
basal vein of rosenthal, vein of galen, inferior petrosal sinus
15
Q
superior and inferior anastomic veins ( collateral veins for alternate superficial middle cerebral vein) are also called
A
Trolard (top) and Labbe (lower)
16
Q
If I say “CN 3 palsy”, you say
A
PCOM aneursym
17
Q
If I say “CN 6 palsy”, you say
A
increased ICP
18
Q
classic findings in intracranial hypotension
A
- dural enhancement 2. distension of dural venous sinuses 3. prominence of intracranial vessels 4. engorgement of pituitary 5. subdural hematoma/hygromas
19
Q
classic findings in intracranial hypertension (pseudotumor)
A
- slit like vents 2. partially empty sella 3. compressed venous sinuses 4. tortuous optic nerves 5. flattening of posterior sclera
20
Q
most common congenital obstructive hydrocephalus
A
aqueductal stenosis (usually from a web or diaphragm)
21
Q
pathophys of communicating hydrocephalus
A
obstruction at the level of the villi/granulation, blocking reabsorption (all vents will be dilated)
22
Q
4 causes of communicating hydrocephalus
A
- NPH 2. SAH 3. Meningitis 4. Carcinomatous meningitis
23
Q
pathophys of non-obstructive hydrocephalus
A
something that produces CSF (choroid plexus papilloma)
24
Q
don’t be silly, if you see transependymal flow, is the hydrocephalus acute or chronic?
A
acute dummy
25
another name for subfalcine herniation
midline shift (ACA can get compressed)
26
what kind of vascular injury can you get with descending transtenorial herniation?
Duret Hemorrhages - compression of perforating basilar artery branches, seen at midline of pontomesencephalic junction
27
what CN injury can you get with descending transtenorial herniation?
CN3 gets compressed between the PCA and Superior Cerebellar Artery causing ipsilateral pupil dilation and ptosis
28
when do we see Ascending transtentorial herniation?
posterior fossa mass - causes severe obstructive hydro
29
fulminant form of ADEM with massive brain swelling and death
acute hemorrhagic leukoencephalitis (Hurst)
30
neuromyelitis optica aka
Devics (transverse myelitis + optic neuritis)
31
MS variant in kids that is horrible
Marburg Variant - fulminant, leads to rapid death, may have febrile prodrome
32
classic findings in Wernicke encephalopathy
1. enhancement of the mammillary bodies 2. T2/FLAIR in bilateral medial thalamus and periaqueductal gray
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defiency in Wernicke
thiamine
34
classic findings in CO poisoning
CT hypodensity/T2 bright globus pallidus (CO causes "globus warming"
35
Marchiafava-Bignami: findings
Swelling and T2 bright signal affecting the corpus callosum
36
classic findings in methanol toxicity
Optic nerve atrophy, hemorrhagic putamina! and subcortical white matter necrosis
37
On PET, what is always preserved in dementia?
the motor strip
38
Binswanger disease is a form of what kind of dementia
small vessel vascular dementia - seen in older ppl with HTN, spares the subcortical U fibers
39
dementia classic findings on PET: alzheimer
low posterior temporoparietal cortical activity
40
dementia classic findings on PET: multi-infarct
scattered areas of decreased activity
41
dementia classic findings on PET: Lewy bodies
low in lateral occipital cortex (sparing cingular gyrus)
42
dementia classic findings on PET: Picks/frontotemporal
low frontal lobe (depression is a mimic)
43
dementia classic findings on PET: huntington
low activity in caudate and putamen
44
TORCH findings: CMV
Most Common, Periventricular Calcifications, Polymicrogyria
45
TORCH findings: toxo
Hydrocephalus, Basal Ganglia Calcifications
46
TORCH findings: rubella
Vasculopathy/ischemia. High T2 signal- Less Calcifications
47
TORCH findings: HSV
Hemorrhagic Infarct, and lead to bad encephalomalcia (hydranencephaly)
48
TORCH findings: HIV
Brain Atrophy in frontal lobes
49
HIV infections: AIDS encephalitis
symmetric T2 bright, spares U fibers
50
HIV infections: PML
asymmetric T2 bright (out of proportion to mass effect), involved U fibers
51
HIV infections: CMV
periventricular T2 bright, ependymal enhancement, brain atrophy
52
HIV infections: toxo
ring enhancement with LOTS of edema
53
HIV infections: cryptococcus
dilated perivascular spaces filled with mucoid gelatinous crap, basilar meningitis
54
HSV 1 or 2 in adults vs. babies
HSV 1 in adults, HSV 2 in babies
55
what sequence is most sensitive in HSV encephalitis?
diffusion is more sensitive than T2
56
looks like HSV encephalitis, but HSV titer negative
limbic encephalitis - paraneoplastic from small cell lung ca - ask for lung cancer screening
57
infection that involves the basal ganglia?
West Nile - T2 bright basal ganglia and thalamus, with restricted diffusion.
58
3 ways to show CJD
1. cortical gyriform restricted diffusion 2. restricted diffusion in medial thalamus (hockey stick sign) 3. series of MR/CTs showing rapidly progressive atrophy
59
4 stages of neurocysticercosis
1. Vesicular- thin walled cyst (iso-iso TI/T2 + no edema) 2. Colloidal - hyperdense cyst (bright-bright T I /T2 + edema) 3. Granular - cyst shrinks, wall thickens (less edema) 4. Nodular -small calcified lesion (no edema)
60
5 supratentorial peds tumors
1. astrocytoma 2. PXA 3. PNET 4. DNET 5. ganglioglioma
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4 infratentorial peds tumors
1. JPA 2. medulloblastoma 3. ependymoma 4. brainstem astrocytoma
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3 supratentorial adult tumors
1. mets ++ 2. astrocytoma 3. oligodendroglioma
63
2 infratentotial adult tumors
1. JPA 2. hemangioblastoma
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4 CP angle tumors
1. schwannoma 2. meningioma 3. epidermoid 4. arachnoic cyst
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3 cortically based tumors
DOG - 1. DNET 2. oligodendroglioma 3. ganglioglioma
66
3 tumors that like to be multifocal
1. lymphoma 2. multicentric GBM 3. gliomatosis cerebri
67
4 tumors that are multifocal from seeding
1. medulloblastoma 2. ependymoma 3. GBM 4. oligodendroglioma
68
"tumors" that restrict diffusion
1. abscess 2. lymphoma 3. maybe GBM 4. epidermoid at CP angle 4. herpes in temporal horns 5. xanthrogranuloma in choroid plexus
69
tumors that calcify
1. oligodendroglioma (90% have Ca) 2. astrocytoma (only 20% have Ca, but \>\>\> more common than oligo)
70
hemorrhagic mets (MR/CT)
melanoma, renal, carcinoid/choriocarcinoma, thyroid
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T1 bright tumors
Fat: Dermoid, Lipoma Melanin: Melanoma Blood: Bleeding Met or Tumor Cholesterol: Colloid Cyst
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syndrome with GI polyps + GBMs
Turcot
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chromosome deletion with better outcome in oligodendroglioma
1p/19q
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most common brain mets
lung or breast
75
foramen of Monro/4th ventricle tumor in adults
subependymoma
76
most common IV mass 20-40yo
central neurocytoma (swiss cheese, calcify)
77
intraventricular mass that restricts diffusion
xanthogranuloma - benign choroid plexus mass
78
round well circumscribed mass in the anterior 3rd ventricle
colloid cyst - can cause sudden death via acute hydro
79
most common intraventricular location for meningioma
trigone of the lateral ventricles
80
most common functional pituitary adenoma
prolactinoma
81
craniopharyngioma subtypes in kids vs. adults
1. Papillary - adults 2. Adamantinomatous - kids
82
very bright T2 suprasellar lesion
rathke cleft cyst
83
3 adult meningeal tumors
1. meningioma 2. hemangiopericytoma (soft tissue sarcoma that mimics aggressive meningioma) 3. mets
84
4 tumors in the first year of life
1. atypical teratoma/rhabdoid 2. Desmoplastic infantile Ganglioglioma/Astrocytoma 3. choroid plexus papilloma/carcinoma 3. mets (neuroblastoma)
85
when I say "rapidly increasing head circumferance + baby + tumor"
Desmoplastic infantile Ganglioglioma/Astrocytoma
86
13 year old with seizures, and a temporal lobe mass that is cystic and solid with focal calcifications
ganglioglioma
87
Kid with drug resistant seizures.
DNET (temporal lobe, high T2 "bubbly lesion")
88
cyst with a nodule in the temporal lobe
PXA
89
histologically the same as medulloblastoma, but supratentorial
PNET (deep white matter)
90
when I say "gelastic seizures", you say
hypothalamic hamartoma (of the tuber cinereum), also can have precocious puberty
91
3 main pineal region tumors
1. germinoma (fat + "engulfed" Ca) 2. pineocytoma (not in kids, non-invasive) 3. pineoblastoma (kids, retinoblastoma, highly invasive)
92
most common location of chordoid glioma
anterior wall of 3rd ventricle
93
Parinaud syndrome location
lesion of the pineal gland (upward-gaze deficiency, pupillary light-near dissociation, convergence-retraction nystagmus)
94
cell of origin: meningioma
arachnoid cap cell
95
most common 4th ventricle mass in an adult
subependymoma
96
the basal ganglia in chronic liver disease can exhibit what MR abnormality
increased T1 signal intensity (manganese accumulation - can also been seen in TPN patients)
97
epidermoids or dermoids can rarely transform into
squamous cell cancer
98
most common location of central neurocytoma
lateral ventricle attached to septum pellucidum
99
what subtype of medulloblastoma occurs in adults?
desmoplastic/nodular (more peripheral than classic)
100
iatrogenic fake out for SAH on FLAIR?
supplemental O2
101
"blood anterior to brainstem"
Benign Non-Aneurysm Perimesencephalic hemorrhage:
102
classic clinical history in superficial siderosis (following repeated SAH)
sensorineural hearing loss and ataxia.
103
"numerous small foci of restricted diffusion"
septic emboli
104
watershed infarcts in a kid
moya moya
105
the big list of things that restrict diffusion besides strokes
Bacterial Abscess, CJD (cortical), Herpes, Epidermoids, Hypercellular Brain Tumors (Classic is lymphoma), Acute MS lesions, Oxyhemoglobin, and Post Ictal States. + artifacts
106
how long before strokes are bright on FLAIR?
about 6 hours
107
what % of infarcts demonstrate hemorrhagic conversion
50% (6hrs-4 days), 90% petechial, 10% full on hematoma
108
mnemonic for MRI signal of bleeds
I Bleed, I Die, Bleed Die, Bleed Bleed, Die Die. (I-iso, B-hyper, D-Hypo) I Bleed (hyperacute), I Die (acute), Bleed Die (early subacute), Bleed Bleed (late subacute), Die Die (chronic)
109
why do babies get venous infarcts?
dehydration
110
why do big kids get venous infarcts?
mastoiditis
111
why do adults get venous infarcts?
coagulopathies or birth control
112
Stigmata of chronic venous thrombosis
development of a a dura l AVF, or increased CSF pressure from impaired drainage.
113
3 things associated with Fusiform aneurysms
PAN, Connective Tissue Disorders, or Syphilis (most common in the posterior circulation)
114
2 things associated with pseudoaneurysms
trauma, mycotic (often distal MCA)
115
Pedicle Aneurysm
Artery feeding the AVM
116
4 things that increase risk of bleeding in AVMs
1. small size 2. single draining vein 3. intranidal aneursym 4. BG/thalamic/periventricular location
117
classic symptom of dural AVF
pulsatile tinnitus (when it involves the sigmoid sinus) or vision problems (cavernous sinus)
118
increased risk of bleeding in dural AVF
direct cortical venous drainage
119
when I say "caput medusa", you say
DVA
120
"popcorn-like" with "peripheral rim of hemosiderin"
Cavernous Malfonnation aka "cavernomas" aka "cavernous angiomas"
121
which vascular malformation can develop as a complication of radiation therapy
Capillary Telangiectasia (don't bleed, totally incidental)
122
classic timing for vasospasm
4-14 days after SAH (NOT immediately).
123
Are there Non-SAH causes of vasospasm?
Yep. Meningitis, PRES, and Migraine Headache.
124
most common systemic vasculitis to involve the CNS
PAN
125
most common collagen vascular disease causing CNS vasculitis
SLE
126
"puff of smoke"
moya moya
127
4 association of moya moya
1. sickle cell 2. NF 3. prior radiation 4. down syndrome
128
40yo presenting with migraine headaches and then dementia
CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical inarcts and Leukoencephalopathy).
129
typical findings in CADASIL
Diffuse White Matter Disease, Hitting the Temporals, Sparing Occipitals
130
NASCET criteria formula
[1- A/B] x 100% (A=at lesion and B=normal distal segment)
131
definition: colpocephaly
disproportionate prominence of the occipital horns (seen in agenesis of the CC)
132
"neoplasm" associated with agenesis of the CC
intracranial lipoma (most commonly in the interhemispheric fissure)
133
definition: iniencephaly
deficit of occipital bones -\> enlarged foramen magnum; "star gazing fetus"
134
definition: arhinencephaly
no olfactory bulb or tracts (seen with Kallman syndrome - hypogonadism + MR)
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definition: rhomboencephalosynapsis
no vermis/fused cerebellum (aunt minnie)
136
"molar tooth" appearance of the superior cerebellar peduncles
Joubert syndome - strong association with retinal dysplasia
137
Dandy Walker =
absent vermis
138
"torcular-lamboid inversion"
Dandy Walker
139
midline defects associated with holoprosencephaly
1. single midline monster eye 2. solitary/mega-incisor 3. pyriform aperture stenosis
140
classic triad of Meckel-Gruber
1. holoprosencephaly 2. multiple renal cysts 3. polydactyly
141
major finding in semi-lobar HPE
fused at thalami, posterior brain normal, olfactory tracts gone
142
major finding in alobar HPE
single large ventricle, fusion of thalami + BG, no falx or CC
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when I say "big side + big ventricle", you say
hemimegalencephaly
144
3 associations of schizencephaly
1. optic nerve hypoplasia (30%) 2. absent septum pellucidum (70%) 3. epilepsy (50-80%)
145
"in utero double MCA infarct"
hydrancephaly - destruction of cerebral hemispheres, can also be caused by TORCH
146
Chiari 1
one cerebellar tonsil \> 5mm below foramen magnum + syringohydromelia (50%)
147
Chiari 2 associations (5)
1. Myelomeingocele (L-spine) 2. towering cerebellum 3. tectal beaking 4. long skinny 4th vent 5. interdigitated cerebral gyri (on axial CT)
148
Chiari 3
Chiari 2 + encephalocele (high cervical or low occipital)
149
most common craniosynostosis
Scaphocephaly (Sagittal suture), aka dolichocephaly
150
fused sutures: brachycephaly
bicoronal +/- bilambdoid (long side-side)
151
fused sutures: scaphocephaly
sagittal (long front-back)
152
fused sutures: plagiocephaly
unilateral coronal
153
fused sutures: trigonocephaly
metropic (forehead suture)
154
"harlequin eye"
unilateral coronal suture craniosynostosis
155
"failure to pass NG tube"
choanal atresia
156
"respiratory distress while feeding"
choanal atresia
157
piriform aperature stenosis is associated with dysfunction of
hypothalamic-pituitary-adrenal axis
158
SPECT abnormality with MELAS
increased lactate, decreased NAA (mitochondrial disorder with lactic acidosis and stroke-like episodes)
159
highest normal SPECT peak
NAA
160
NAA peak will be super high with
Canavans (one of the leukodystophies)
161
SPECT abnormality with high cell turnover
Choline elevation (tumor, infarct, inflammation)
162
lactate can be normally elevated when?
first hours of life (who is getting a SPECT that early??)
163
Myoinositol is elevated in these 2
Alzheimer and low grade glioma
164
SPECT abnormality specific for meningiomas
Alanine elevation
165
SPECT abnormality with hepatic encephalopathy
glutamine elevation
166
SPECT peaks are in what order?
alphabetical (choline, creatine, and NAA), but lactate comes last if it's present
167
Cranial fossas and their contents?
168
