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Flashcards in Neuro Buzz Deck (129):
1

Le Fort 1

The palate is separated from the maxilla
Lateral nasal aperture



Floating palate

2

Floating palate

? Which type of Le Fort?

Type 1

3

Le Fort type 2

The maxilla is separated from the face
Inferior orbital rim and orbital floor



Pyramidal

4

Pyramidal

What type of Le Fort fracture?

Type 2

5

Le Fort type 3

The face is separated from the cranium

The zygomatic arch and lateral orbital rim/wall

6

If .... is not fractured then you don't have a Le Fort fracture

Pterygoid process

7

Airless expanded sinuses

Mucocele

8

Most sensitive MRI sequence for SAH

FLAIR

9

The classic history for superficial siderosis

Sensorineural hearing loss and ataxia

10

Watershed infarct in a kid

Moyamoya

11

What is a pedicle aneurysm?

Artery feeding AVM

12

This type of aneurism is seen in patients with PAN, Ct disease and syphylis

Fusiform aneurysm

13

Pulsatile tinnitus is seen in ....

Sigmoid sinus thrombosis

14

Visual problem is caused by thrombosis in this venous structure

Cavernous sinus

15

Most common type of AVF's- gradual onset LE weakness

Spinal AVF

16

This venous anomaly looks like a large tree with multiple small branches/ caput medusa.
It is also associated with cavernous malformation

DVA

17

Slow flow lesion with dilated capillary bed without intervening normal brain tissue

Popcorn like with peripheral rim of haemosiderin

Cavernous malformation

18

Slow flow lesion with normal intervening brain tissue. They have brush like or stippled appearance of enhancement

Capillary telangectasia

19

This malformation can be seen as a complete location of radiation therapy

Capillary telangectasia

20

Define colpocephaly

This is asymmetric dilation of the occipital horns

21

Name two causes of colpocephaly

CC a genesis and pericallosal lipoma

22

Which type of CNS lipoma usually calcify?

The tubulonodular type

23

Define anencephaly

Neural tube failing to close on the cranial end leading to reduced or absent cerebrum and cerebellum. The hindbrain will be present

24

In this condition the AFP will be elevated and there will be polyhydramnios

Frog eye appearance

Anencephaly

25

What is iniencephaly

This is when the occipital bone is missing and there will be an enlarged foramen magnum

Star gazing fetus

26

What is rhombencephalosynapsis

Congenital anomaly of the cerebellum where the vermis does not develop and the cerebellum is fused

27

What is Joubert syndrome associated with?

Retinal dysplasia
Multicystic dusplastic kidney

28

Molar tooth appearance- small or aplastic vermis and absence of pyramidal decussation

Joubert syndrome

29

Joubert syndrome and liver fibrosis

Coach syndrome

30

Absent vermis

Torcular lambdoid inversion

Dandy Walker

31

Holoprosencephaly- HP

This is a midline cleaving problem with brain failing to cleave into two separate hemisphere

32

The olfactory bulb is affected in this type of HPE

Semi lobar

33

HPE association (3)

- single midline monster eye

- solitary median maxillary incisor- MEGA INCISOR

- Nasal process overgrowth leading to pyriform aperture stenosis

34

What is meckel gruber syndrome

Classic triad of

HPE

Multiple renal cysts

Polydactyly

35

Hemimegalencephaly

Big brain with big ventricles

36

Types of lissencephaly pachygyria

Type 1- classic form - smooth brain due to arrest of migration

Type 2- cobblestone brain due to over migration. The cortex is thinner than type 1. No band heterotopia.

37

This type of lissencephaly is associated with band heterotopia. It's a figure 8, hour glass configuration with shallow sylvian fissure

Type 1/ classic lissencephaly

38

What conditions are associated with schizencephaly

Optic nerve hypoplasia 30%
Absent septum pellucidum 70%
Epilepsy 50-80%

39

What is hydranencephaly?

Destruction of cerebral hemispheres. Bag of CSF. Secondary to vascular insult e.g. Double mca infarct.

Can also be caused by TORCH- HSV

Normal falx but the cortical mantle is gone.

40

Define type 1 chiari

One cerebellar tonsil more than 5 mm below the foramen magnum. Look for syringohydromyelia

41

What is chiari 1 associated with?

Klipple feil syndrome

42

name some of the findings of chiari 2

Hydrocephalus
Myelomeningocele
Towering cerebellum
Tectal plate beaking
Long skinny 4th ventricle- normal 4th ventricle ? Shunt malfunction
Interdigitated cerebral gyri

43

Scaphocephaly

Which suture?

Also known as ?

This is premature fusion of Sagittal suture

Also known as dolichocephaly

44

Brachycephaly

Premature fusion of Coronal and / or lambdoid and is often associated with syndromes

45

Brachycephaly and fused fingers

Aperts

46

Brachycephaly and first arch ( maxilla and mandible hypoplasia

Crouzons

47

Brachycephaly and Wormian bone and absent clavicle

Cleidocranial dysostosis

48

BESSI vs Subdural collection (1)

BESSI - cortical veins are adjacent to inner table

Subdural- cortical veins are displaced away from the inner table

49

Diagnosis?

Failure to get ass an NGT in a child or respiratory distress while feeding

Choanal atresia

50

Name 5 syndromes associated with choanal atresia

1. CHARGE
2. Crouzons
3. DiGeorge
4. Treacher Colins
5. Fetal alcohol syndrome

51

The piriform aperture stenosis is highly associated with ...

Hypothalamic pituitary adrenal axis dysfunction

52

Diagnosis?
Mitochondrial disorder with lactic acidosis and stroke like episodes

MELAS

53

What are the spect findings in MELAS

Increased lactate and decreased NAA

54

Name the leukodystrophies:

Shown with SPECT WITH ELEVATED NAA

Canavans

55

Name the leukodystrophies:

big head with frontal lobe white matter involvement

Alexanders

Big head like Alexander the Great

56

Name the leukodystrophies:

Tigroid- dark spots or stripes within the T2 bright demyelinated periventricular wm

Deficiency of enzyme arylsulfatase A

Metachromatic

57

Name the leukodystrophies:

Normal head with symmetric occipital and splenium of cc white matter involvement

It is sex linked and only occurs in boys

Adreno leukodystrophy

58

Name the leukodystrophies:

Normal head
Focal areas of subcortical wm. BG and the periaquaductal GM have involvement

Leigh disease

Also called subacute necrotising encephalomyelopathy

Mitochondrial enzyme defect

59

The NAA and s super high in this disease

Canavans

60

Name three reasons for raised choline

Increased choline in increased cell turn over:

Malignancy

Infarct

Inflammation

61

There is usually no peak for lactate. If there is then it means ...... and ....

Necrotic tumour
And
Infection - abscess

62

What is raised in hepatic encephalopathy

Glutamine

63

What is raised in meningioma

Alanin

NAA is not raised

64

Myoinositol is raised in which 2 conditions?

Alzheimer's and low grade glioma

65

MRS pattern in

High grade tumour

Choline raised
Lactate and lipid raised

NAA reduced

66

MRS pattern in

Low grade tumour

Choline and NAA reduced

Inositol raised

67

MRS pattern in

Radiation necrosis

Choline and NAA reduced

Lactate increased

68

This lesion is the primary petrous apex lesion. It's T1 and T2 bright with T2 dark hemosiderin rim

Cholesterol granuloma

69

Lesion in petrous apex
T1 dark
T2 bright
With restricted diffusion

Cholesteatoma

70

Difference between cholesteatoma and cholesterol granuloma

Granuloma: T1 and T2 bright. Does not restrict. Smooth expansile bone changes.

Cholesteatoma: T1 dark, T2 bright with restricted diffusion. Smooth expansile bone changes.

71

Classic triad for grandenigo syndrome

Otomastoiditis

Face pain- trigeminal neuropathy

Lateral rectus palsy

72

Endolymphatic sac tumour is associated with

VHL

73

Appearances of endolymphatic sac tumour

They grow into CPA
Internal amorphous ca++ on CT
T2 bright with intense enhancement
Very vascular with flow void and tumour blush on angio

74

Patient presents with hoarseness

MRI: hypervascula lesion, salt and pepper on post contrast MRI with flow void

FDG avid

Paraganglioma

75

Imaging findings in labyrinthitis

The cochlea and semicircular canals will be enhancing on T1 post contrast images.

76

Conductive hearing loss in adult female

Otosclerosis

77

Types of otosclerosis (2)

Fenestral

Retro fenestral

78

Cholesteatoma order of destruction predictable

Scutum is eroded early
The ossicles- long process of incus
The lateral segment of the semi circular canal

Fistula to the semi circular canal most commonly involves the lateral segment

79

In labyrinthine fistula, which part is most commonly affected?

The lateral semicircular canal is most often involved

80

Noise induced vertigo

Superior semicircular canal dehiscence

81

Necrotising external otitis

Predisposing disease
Causative agent

95% have diabetes and the causative agent is 98% pseudomonas

82

Which part of the facial nerve does not enhance?

The cisternal , canalicular and labyrinthine segments should not enhance


The normal enhancement is due to perineural venous plexus

83

What causes abnormal enhancement of the facial nerve? (4)

Bell's palsy
Lymes
Ramsay Hunt
Cancer

84

Ground glass lesion in a young patient

Fibrous dysplasia

It usually spares the optic capsule

85

Multi focal fibrous dysplasia, cafe au lair spots and precocious puberty

Mc Cune Albright syndrome

86

Mouth mass lesion in the midline. It's fluid sack with globules of fat- sack of marbles.

Floor of mouth dermoid/ epidermoid

87

What is a ranula?

This is a mucous retention cyst- typically lateral

88

Where would ranula arise from?

Arise from sublingual gland/ space
Once it's under the mylohyoid muscle it's plunging

89

Diagnosis?

Grandmothers dentures won't stay in

Torus palatinus- bony exostosis that comes off the hard palate in the midline

90

Re sialolithiasis , which gland is most commonly affected?

Submandibular gland duct- whartons

91

Diagnosis?

Young patient with new level II neck mass

HPV related SCC

92

Aetiology of osteonecrosis of the mandible (2)

Prior radiation

Bisphosphonate treatment

93

Microcalcification is seen in thyroid mass. Diagnosis?

Papillary thyroid cancer

94

Come tail in thyroid nodule means.... nodule.

Colloid nodules

95

This condition increased your risk of primary thyroid lymphoma

Hashimotos

96

Hashimotos is associated with which auto antibodies

Thyroid peroxidase TPO and anti thyroidglobulin

97

Name two findings associated with hashimotos on uss

White knight- uniform hyperechoic nodules

Giraffe skin- heterogenous appearances

98

A sick looking level 6 node or delphian node is a sign of ....

Laryngeal cancer met

99

What are the causes of hyper PTH? (3)

1. Hyper functioning adenoma
2. Multi gland hyperplasia
3. Cancer

100

What factors does sestamibi parathyroid imaging depend on?

Mitochondrial density and blood flow

101

This type of thyroid cancer is asso with MEN 2 They produce calcitonin

Medullary type

102

This type of thyroid cancer is seen in elderly patients with prior radiation treatment

Anaplastic type

103

What is the best way to monitor the Hurthle cell follicular cancer?

FDG PET

104

What's contained in the parotid space (3)

1. parotid gland
2. Facial nerve
3. Retro- mandibular vein

105

This is the only salivary gland containing lymph nodes

Parotid gland
can get lymphoma therefore.

106

Diagnosis?
male smoker presenting with bilateral cystic mass in parotid gland

Warthins

107

How do you diagnose warthins?

it takes up pertechnetate
the only super rare tumour to take this up is parotid oncocytoma

108

this salivary gland tumour likes perineurial spreads

adenoid cystic carcinoma

109

This group of patients have high risk of getting bilateral lymphoma in parotid gland

Sjogren

110

Diagnosis?
HIV patient with painless bilateral mixed solid and cystic lesions with enlarged parotid glands

Benign lymphoepithelial disease.

111

Diagnosis?
female in their 60's present with dry eyes and mouth. The parotid gland has honeycomb appearance

Sjogrens

112

Which type of lymphoma would patients with Sjogren's get?

non hodgkins MALT type lymphoma.

113

What is contained in the carotid space? (4)

1. Carotid artery
2. Jugular vein
3. Cranial nerves 9, 10 and 11
4. internal jugular chain lymph nodes

114

Name the different types of tumours arising from the carotid space (3)

1. Schwannoma
2. Paraganglioma
3. Neurofibroma

115

compare the schwannomas and paraganglioma (4)

Paraganglioma:
Flow void
Hypervascular
In 111 octreotide avid
Salt and pepper look on MRI

Schwannomas
Not all are hyper vascular
No flow void - target sign
NOT IN111 Octreotide avid
No salt or pepper



116

What is Lemierre disease?

Thrombophlebitis (thrombosis) of the jugular vein with distant metastatic sepsis- usu septic emboli in lung. It is usually found in the setting of oropharyngeal infection or recent ENT surgery
BUZZ: Fusobacterium Necrophorum

117

When i say perineurial spread, you should think: (2)

1. adenoid cystic salivary tumour
2. melanoma

118

This tumour causes neural foramina expansion

Schwannoma

119

What is Grisel's syndrome?

Torticollis with atlantoaxial joint inflammation seen in H&N surgery or retropharyngeal abscess

120

what is contained within the parapharyngeal space?

trigeminal nerves and the pterygoid veins

121

Bilateral optic nerve glioma is seen in this condition:

NF1

122

Diagnosis?
doughnut appearance with circumferential enhancement around optic nerve. Tram track calcification.

Optic nerve sheath meningioma

123

Most common location for orbital dermoid

superior and lateral. From frontozygomatic suture

124

DDx for raccoon's eyes: (2)

Met neuroblastoma and skull fracture

125

Orbital lymphoma is associated with these 2 conditions

chlamydia Psittaci and MALT lymphoma

126

Diagnosis?
Ca in globe of a child <3 years

Retinoblastoma

127

Diagnosis?
Bilateral coloboma is associated with .....

CHARGE syndrome
Coloboma
Heart defect
Atresia choanal
Retardation
Genital hypoplasia
Ear abnormality- Deaf

128

Small size eyes ddx (3)

PHPV
Coats
Retinopathy of prematurity

129

What is type 2 lissencephaly is associated with?

Cerebellar and ocular malformation and muscular dystrophy - walker warburg syndrome