Neuro DDx

Question 1

Hypo intense T2 brain lesions

Answer 1

Metastasis containing mucin: GI adenocarcinomas.

Hypercellular tumours: lymphoma, medulloblastoma, germinoma, some glioblastomas may be hypointense.

Question 2

Hyper intense T1 tumours

Answer 2

Metastatic melanoma
Fat containing tumours: dermoid, teratoma.
Heamorrhagic mets: “MR CT BB”: Melanoma, RCC, Choriocarcinoma, Thyroid, Bronchogenic, Breast.

Question 3

Trans-callosal Mass

Answer 3

Glioblastoma
Lymphoma
Demyelinating Disease.

Question 4

Tumours / lesions with a cyst and an enhancing nodule:

Answer 4

Neurocysticercosis
Juvenile pilocytic astrocytoma
Haemangioblastoma
Pleomorphic xanthoastrocytoma (temporal lobe, dural thickening)
Desmoplastic infantile ganglioglioma
Ganglioglioma (temporal lobe, Ca++, calvarial remodelling).

Question 5

Intra ventricular tumours:

Answer 5

Central neurocytoma
Choroid Plexus papilloma / carcinoma (cauliflower like)
Intra ventricular meningioma
Subependymal giant cell astrocytoma (tuberous sclerosis)
Subependymoma

Question 6

Ring enhancing basal ganglia mass in immunocompromised:

Answer 6

Lymphoma

Toxoplasmosis

Question 7

Posterior Fossa mass in Child

Answer 7

Medulloblastoma (Hyperdense on Ct, diffusion restriction).
Juvenile Pilocytic astrocytoma (Cystic mass with enhancing nodule)
Ependymoma (Intra ventricular, pushes through foramina)
Haemangioblastoma (Cystic mass with enhancing nodule, flow voids, hx vHL)
ATRT (young, agressive appearances, renal mass)

Question 8

Posterior fossa mass in Adult:

Answer 8

Tumour like conditions:

• Metastasis (Hx of primary, enhancing mass with oedema, multiple)
• Haemangioblastoma (cystic mass with enhancing nodule, flow voids, Hx vHL).
• Astrocytoma (Minimal / little enhancement)
• Medulloblastoma (young adult, lateral location)
• Choroid Plexus Papilloma: (4th ventricle, enhancing papillary mass with hydrocephalus)

Infarction: e.g. PICA

Vascular malformation

Hypertensive haemorrhage.

Question 9

CPA Mass

Answer 9

"AMEN"
Acoustic Schwannoma (ice cream cone)

Meningoma

Ependymoma

Neuroepithelial cyst:

• Epidermoid Cyst (doesnt suppress on FLAIR and bright diffusion restriction.
• Arachnoid cyst (CSF intensity, does not diffusion restrict)

Aneursym (flow void)
Intra axial neoplasm with extension: exophytic glioma, medulloblastoma, ependymoma.

Question 10

Intrinsic Pituitary Mass:

Answer 10

Normal sizes:

• child upto 6mm,
• males / post menopausal women upto 8mm,
• menstruating females upto 12mm, pregnant / post partum / lactating upto 14mm.

Pituitary hyperplasia
Pituitary microadenoma
Pituitary macroadenoma
Lymphocytic hypophysitis
Granulomatous Hypophysitis (Sarcoidosis, Wegener granulomatosis, Tb, LCH)
Rathke’s cleft cyst, usually extrinsic to pituitary

Question 11

Suprasellar Mass:

Answer 11

“SATCHMO”
Sarcoidosis / Supra sellar extension adenoma
Aneursym
Teratoma / Tolosa Hunt
Craniopharyngioma / Cleft cyst (Rathke’s)
Hypothalamic Glioma (adults) / Hypothalamic Hamartoma (children)
Meningioma / Metastases (breast).
Optic Nerve glioma

Question 12

Supra sellar mass in Child:

Answer 12

Craniopharyngioma: Calcified, enhancing complex cystic mass, distinct from pituitary.
Optic pathway glioma: T2 hyperintense, enhancing mass, signs of NF1.
Germ cell tumour: avidly enhancing midline mass - germinoma. Contains fat - dermoid.
Hypothalamic hamartoma: non enhancing grey matter isointense mass. Gelastic seizures, precocious puberty.
LCH hypophysitis: enhancing enlarged pituitary stalk. Diabetes insipidus.

Question 13

Supra sellar Mass adult:

Answer 13

Pituitary macroadenoma extension: pituitary mass extending superiorly. Expansion of sella.
Meningioma: intense enhancement with normal sella. Enhancing tail. Adjacent hyperostosis. Narrows adjacent vasculature.
Craniopharyngioma: calcified, enhancing complex cystic mass. Distinct from pituitary.
Rathkes cleft cyst: non enhancing cystic mass without Ca++, claw sign.
Aneursym: enhancement equal to blood pool, calcified rim.
Lymphocytic or granulomatous hypophysitis: enhancing enlarged pituitary stalk. Diabetes insipidus.

Question 14

Intrinsic Pineal Mass:

Answer 14

“elevate internal cerebral veins”

Germinoma: avid enhancement, hypderdense, isointense, dark ADC, engulfs with central Ca++. Neuro axis seeding

Teratoma: Heterogenous, intra lesional fat, central course Ca++.

Pineal Cyst:

Pineocytoma: internal enhancement, cystic components. adults 20s-30s. Neuro axis seeding

Pineoblastoma: young children, tri lateral retinoblastoma, obstructive hydrocephalus, invasion restricted diffusion, exploded / blasts Ca++. Leptomeningeal spread.

Metastases

Question 15

Extra Pineal Mass:

Answer 15

Gliomas (tectum, midbrain, splenium)
Vein of Galen aneurysm.
Meningioma: depress internal cerebral veins
Quadrigeminal / tectal plate lipoma: agenesis corpus callosum

Question 16

Cortically Based Tumour:

Answer 16

"PDOG"
Pleomorphic Xanthoastrocytoma
DNET
Oligodendroglioma
Ganglioglioma

Question 17

Intraparnechymal Haemorrhage:

Answer 17

HTN: Basal ganglia, thalamus, cerebellum. Microbleeds T2*, prior lacunar infarcts.

Amyloid angiopathy: normotensive elderly, lobar / cortical location. Microbleeds T2*

Aneurysmal haemorrhage: extensive SAH, aneurysm adjacent to haematoma.

Arteriovenous malformation: young patients. Enlarged feeding vessel, adjacent encephalomalacia.

Dural AV fistula: Haemorrhage adjacent to cavernous sinus or posterior fossa, enlarged meningeal artery or cortical vein.

Venous thrombosis: para sagittal or bilateral thalamic haemorrhage, young patient. Increased density cortical vein / dural sinus.

Haemorrhagic neoplasm: Gliobastoma, Mets (Choriocarcinoma, Thyroid, Melanoma, RCC, Breast, bronchogenic). More oedema than expected, more heterogenous signal, multiple enhancing lesions.

Cavernous malformation: angiographically occult. Adjacent DVA, multiple dark spots on T2*.

Haemorrhagic transformation of infarct:

Vasculitis: beaded vessels. Multifocal T2 bright deep white matter.

Moyamoya: progressive stenosis intracranial ICA causing fragile lenticulostriate vessels. Puff of smoke angiography. Multiple collateral vessels.

Question 18

Intra medullary spinal cord lesion

Answer 18

" I'D HEAL"
Infarction
Demyelination
Haemangioblastoma
Ependymoma
Astrocytoma
Lipoma

Question 19

T2 Hyper intense Basal Ganglia

Answer 19

“LINT”

Lymphoma
Ischaemia
Neurodegenerative conditions:
 - autoimmune encephalitis
 - CJD
 - Extra pontine myelinosis
 - Huntington disease
 - Mitochondrial diseases: Leigh disease
 - Wilson disease
Toxins:
 - Carbon monoxide
 - Cyanide
 - Organophosphates
 - Hypoglycaemia
 - Methanol

Question 20

Calcified glial tumours frequency

Answer 20

"Old Elephants Age Gracefully"
Oligodendroglioma
Ependymoma
Astrocytoma
Gliobastoma

Question 21

NF 1 Features

Answer 21

"CAFE SPOT"
Cafe au lait spots
Axillary or inguinal freckling
Fibromas
Eye harmatomas - Lisch nodules
Skeletal abnormalities: posterior vertebral scalloping, sphenoid wing dysplasia, leg bowing.
Postive FHx
Optic Tumour - Optic nerve glioma

Question 22

NF 2 Features

Answer 22

“MISME”
Multiple inherited Schwannomas
Meningiomas
Ependymomas

Question 23

Ring enhancing Lesion

Answer 23

"MAGIC DR"
Metastasis
Abscess
Glioblastoma
Infarct / Inflammatory - neurocysticossis / tuberculoma / toxoplasmosis
Contusion
Demyleinating
Radiation necrosis

Question 24

Posterior vertebral scalloping:

Answer 24

"SALMON"
Spinal cord tumour: ependymoma, astrocytoma, schwannoma.
Achrondroplasia, acromegaly.
Loeys Dietz syndrome
Marfans / mucopolysacchirdoses
Osteogenesis
NF 1

Question 25

Intra dural extra medullary mass

Answer 25

``` "No More Spinal Masses" Neurofibroma Meningioma Schwannoma Metastases. ```

Question 26

Multiple Endocrine Neoplasia types:

Answer 26

MEN 1: "PPP" - Pituitary adenoma - Pancreatic islet cell tumour: gastrinoma. - Parathryoid hyperplasia / adenoma MEN 2A: "PMP" - Phaeochromocytoma - Medullary thryoid cancer - Parathyroid hyperplasia MEN 2B: "MPM" - Medullary thyroid cancer - Phaeochromocytoma - Mucosal neuromas

Question 27

von Hippel Lindau disease features:

Answer 27

"HIPPEL" Haemangioblastoma Increased risk of RCC Pheochromocytoma Pancreatic lesions (cyst, cystadenoma, cystadenocarcinoma) Eye dysfunction: retinal haemangioblastoma, endolymphatic sac tumour. Liver / renal / pancreatic cysts.

Question 28

Confluent White matter lesions:

Answer 28

Demyelinating disease: - MS: Periventricular Dawson fingers, usually no mass effect, incomplete ring of enhancement. - ADEM - Lyme disease Neoplasm: - Gliomatosis cerebri - anaplastic astrocytoma - Lymphoma Progressive multifocal leukoencephalopathy: (PML) - periventricular subcortical WM T2 hyperintensity - without mass effect - Involves U-fibres (lots of "U" in PML) - No enhancement, or faintly peripheral. - No atrophy. HIV encephalitis: - diffuse bilateral, sparing sub cortical WM ( no "U" in HIV encphalitis), - cerebral atrophy. ``` Vascular: Ageing normal brain Arteriosclerosis Chronic hypertensive encephalopathy: - BG lacunae, periventricular T2 bright, - microhaemorrhages. Multi infarct dementia Cerebral amyloid: CADASIL: - Symmetric sub cortical WM, anterior temporal lobe or para median frontal lobe, external capsule ``` Radiation Inherited metabolic disorders: - Alexander disease (frontal) - Metachromatic leukodystrophy ("Middle" central) - X Linked adrenoleukodystrophy (posterior) - Canavan disease: peripheral lateral

Question 29

Multiple parenchymal Calcifications:

Answer 29

``` Basal Ganglia: - Thyroid / parathryoid - Inflammatory / infectious Cortex: - Neurocysticercosis - Tb - Sturge Weber Grey White junction: - Fahr disease - Tuberous sclerosis complex - Mets: treated - Radiation. Periventricular: - Fahr disease - TORCH infection - Tuberous sclerosis complex NF 2. ``` Neurocysticercosis: multiple, small Ca++ lesions. Cavernous malformation: variable size TB: Healed granuloma, target sign. Tuberous Sclerosis: Ca++ subependymal nodules. Sturge Weber Syndrome: gyral, tram track Ca++, atrophy Mets: TORCH: CMV periventricular Ca++. Fahr disease: extensive BG Ca++ MELAS: cortical & BG lacunae, BG Ca++

Question 30

Basal Ganglia Ca++:

Answer 30

Infection: - Neurocysticercosis - TB - Toxoplasmosis - Congenital infections: CMV, HIV Metabolic: - Fahr Disease - Mitchondrial Disorders; Leigh Syndrome Endocrine: - hypo PTH, / hyper PTH - hypothyroidism Hypoxic Ischaemic Injury Radiation.

Question 31

T1 Hyperintense Basal Ganglia:

Answer 31

``` NF1 Hepatic encephalopathy Hyperalimentation Hypoxic ischaemic injury Hypotensive cerebral infarction Carbon monoxide poisoning Kernicterus Wilson disease ```

Question 32

Cerebellar Hemisphere Mass:

Answer 32

``` Cerebellar ischaemia / infarction Hypertensive bleed Medulloblastoma Pilocytic astrocytoma haemangioblastoma Mets ``` ``` Tumefactive demyelinating: MS, ADEM. Abscess Cavernous malformation Arteriovenous malformation Atypical teratoid rhabdoid tumour. ```

Question 33

Brain tumour child > 1 year by location

Answer 33

Posterior Fossa: - Pilocytic astrocytoma - Medulloblastoma - Ependymoma - Brainstem glioma Supra tentorial: - Diffuse astrocytoma low grade - Craniopharyngioma - SEGA (TS) Midline pineal / supra sellar: - Germinoma - Teratoma - Phineoblastoma Intra axial: peripheral and cortical: - DNET - Pleomorphic xanthoastrocytoma - Ganglioglioma - Oligodendroglioma Intra axial Deep and hemispheric: - Anaplastic astrocytoma - CNS embryonal tumour - Glioblastoma Extra axial: - Chorid plexus tumour NF2

Question 34

Thickened Dura

Answer 34

``` Post operative Dural Mets Chronic sub dural haematoma Intra cranial hypotension Meningitis Neurosarcoid Tb Syphillis Metastatic intracranial lymphoma Meningioma IgG 4 related hypertrophic pachymeningitis. ```

Question 35

Sacral Mass:

Answer 35

``` Chordoma Chondrosarcoma Neurofibroma Giant Cell tumour Osteoblastoma. Plasmacytoma ```

Question 36

Unilateral thalamic Lesion

Answer 36

``` Lacunar infarction Hypertensive intracranial haemorrhage NF1 Low grade astrocytoma Glioblastoma Anaplastic astrocytoma ADEM (usually bilateral) Cavernous malformation AV malformation ```

Question 37

Bithalamic lesion

Answer 37

Reduced diffusion: - artery of Percheron infarct - Bilateral PCA infarcts - Encephalitis (Japanese encephalitis) - Hypoxic ischaemic encephalopathy - Mitochondrial disorder Haemorrhagic: - Deep venous thrombosis - Vasculitis - Encephalitis Symmetrical: - Wernicke encephalopathy - Osmotic myelinolysis - Hypoxic ischaemic encephalopathy. - CJD - Inborn errors metabolism. - Viral encephalitis (japanese) doesnt have to be DWI bright)

Question 38

MRS Disease summary

Answer 38

Gliomas: as grade increases, NAA and creatine decrease, and choline, lipids and lactate increase. Radiation: Recurrent tumour choline will be elevated. Radiation change NAA, choline, and creatine will all be low. Ischaemia / infarction: lactate increases. With infarction lipid peak appears. Infection: NAA is absent. Bacterial abscess shows lactate, alanine, systolic acid and acetate elevation. Choline low / absent in toxoplasmosis, while it is elevated in lymphoma. PML: elevated myoinositol. Canavan disease: elevated NAA. Leigh syndrome: elevated choline, reduced NAA, may have elevated lactate.

Question 39

Herpes encephalitis DDx:

Answer 39

Acute cerebral ischaemia Status epilepticus Limbic encephalitis Infiltrating neoplasm / gliomatosis cerebri.

Question 40

Infra tentorial Midline Cyst:

Answer 40

``` Mega Cisterna Magna Arachnoid cyst Neurocysticercosis Dandy Walker Malformation Obstructive hydrocephalus with trapped 4th ventricle Pilocytic astrocytoma Haemangioblastoma Epidermoid cyst Dermoid cyst ```

Question 41

Cystic appearing posterior fossa lesion:

Answer 41

``` Mega cisterna magna Arachnoid cyst Dandy Walker malformation Blake Pouch Cyst Joubert syndrome ``` ``` Pilocytic astrocytoma Encephalocele Obstructive hydrocephalus Abscess Epidermoid Dermoid Haemangioblastoma ```

Question 42

Thick Cortex:

Answer 42

``` Viral encephalitis Autoimmune encephalitis Tuberous Sclerosis Focal cortical dysplasia PAchygyria poly microgyria Hemigalencephaly ```

Question 43

Thin cortex:

Answer 43

``` aging brain Obstructive hydrocephalus Chronic ifarction General encephalomalacia Multiple Sclerosis Alzheimer dementia Vascular dementia Parkinson disease ```

Question 44

Focal Cortical Mass:

Answer 44

``` Acute cortical ischaemia / infarction Mets Pleomorphic Xanthoastrocytoma Oligodendroglioma DNET Ganglioglioma Diffuse astrocytoma Cerebritis Venous infarction Viral encephalitis ```

Question 45

Abnormal shape Corpus callosum:

Answer 45

``` Normal vairant Callosal dysgenesis Neoplasm: lipoma, glioblastoma, lymphoma. Decreased white matter volume Obstructive hydrocephalus Marchiafava Bignami ```

Question 46

Fat like Lesions:

Answer 46

``` Choroid plexus xanthogranloma Lipoma Craniopharyngioma Teratoma Dermoid cyst Petrous apex cholesterol granuloma White epidermoid ```

Question 47

Enlarged Cortical Veins:

Answer 47

``` Developmental Anamoly AV malformation Dural arteriovenous fistula Dural sinus thrombosis Cortical venous thrombosis Vein of Galen malformation ```

Question 48

Enlarged deep veins:

Answer 48

``` Developmental venous anomaly AV malformation Sturge Weber Syndrome THrombosis deep vein Thrombosis dural sinus. Glioblastoma Intracranial hypotension ```

Question 49

Solitary parenchymal Ca++

Answer 49

``` Neurocysticercosis TB Cavernous malformation Oligodendroglioma Ganglioglioma Low grade astrocytoma Pilocytic astrocytoma ```

Question 50

Multiple parenchymal Ca++

Answer 50

``` Neurocysticercosis Multiple cavernous malformations TB Tuberous sclerosis complex Sturge Weber SYndrome Mets Oppurtunistic infection in AIDS TORCH infection Metabolic diseases: Fahr disease, MELAS. ```

Question 51

Multiple Hypointense Foci GRE/SWI:

Answer 51

``` Chronic HTN Cerebral amyloid angiopathy Traumatic axonal injury Mets Pneumocephalus Multiple cavernous malformations Neurocysticercosis TB Fat embolisation syndrome Radiation induced telangiectasia. ```

Question 52

Cortical Hyperintensity T2 / FLAIR

Answer 52

``` Acute cerebral ischaemia / infarction Cerebral contusion Hypotensive cerebral infarction status epilepticus Herpes Encephalitis ``` Low grade diffuse astrocytoma - T2 FLAIR mismatch can suggest IDH status. PRES (acute hypertensive encephalopathy)

Question 53

Cortical Enhancement:

Answer 53

``` Subacute cerebral infarction herpes encephalitis Hypotensive cerebral infarction status epilepticus Acute hypertensive encephalopathy / PRES Cerebritis Malignant glioma ```

Question 54

T2 Hyperintense Basal Ganglia:

Answer 54

``` Enlarged perivascular spaces Hypoxic injury NF1 ADEM Vasculitis Toxic insults: CO, cyanide, methanol. Metabolic: leigh syndrome, Wilson disease, MELAS. ```

Question 55

Bilateral Basal Ganglia Lesions:

Answer 55

``` Enlarged perivascular spaces Mineralisation Metallic ion deposition Lacunar infarction Hypoxic ischaemic injury Glioma / lymphoma. Infection: cryptococcus, toxoplasmosis, viral encephalitis. ```

Question 56

Bithalamic lesions:

Answer 56

``` Arterial ischaemia Venous ischaemia Acute disseminated encephalomyelitis VIral encephalitis astrocytoma PRES MS Lymphoma Wenicke encephalopathy. ```

Question 57

Restricted Diffusion:

Answer 57

``` Cerebral ischamie / infarction. abscess Empyema Epidermoid cyst Intracerebral haematoma Choroid plexus cyst Ventriculitis Diffuse axonal injury Meningioma Lymphoma Status epilepticus Osmotic demyelination ```

Question 58

Hyperdense dural sinus:

Answer 58

Physiologic hyperdensity Dural sinus thrombosis Polcythema

Question 59

Multiple Parenchymal Ca++

Answer 59

``` Neurocysticercosis Multiple cavernous malformations TB Tuberous sclerosis COmplex Sturge Weber SYndrome Parenchymal Mets Remote Brain injury. TORCH infection Fahr Disease MELAS ```

Question 60

Solitary Ring Enhancing Lesion

Answer 60

``` Parenchymal Met GBM Abscess Sub acute intra cerebral haematoma Subacute cerebral infarction Radiation necrosis Tumefactive demyelination Neurocysticercosis Lymphoma Toxoplasmosis Tuberculoma Ganglioglioma Pilocytic astrocytoma ```

Question 61

Multiple ring enhancing lesions:

Answer 61

``` Parenchymal Mets Abscess MS ADEM Neurocysticercosis TB Oppurtunistic infection Lymphoma Multifocal GBM ```

Question 62

Cyst with Nodule

Answer 62

``` Neurocysticercosis Pilocytic astrocytoma Ganglioglioma Haemangioblastoma PXA Demosplastic infantile ganglioglioma Intraparenchymal schwannoma. ``` ``` Mets Glioblastoma Abscess Toxoplasmosis DNET Supratentorial ependymoma ```

Question 63

Sulcal / Cisternal Enhancement

Answer 63

``` Meningitis Meningeal carcinomatosis Lymphomatous Meningitis Neurocysticercosis TB meningitis Neurosarcoid Sturge Weber Fungal disease Aneurysmal SAH ```

Question 64

Ependymal Enhancement:

Answer 64

``` Developmental Venous anomaly MS Ventriculitis Oppurtunistic infction in AIDS Neoplasm with CSF seedig Lymphoma Neurosarcoid TB ```

Question 65

Large Ventricles:

Answer 65

Aging brain Intraventricular obstructive hydrocephalus Extraventricular obstructive hydrocephalus Obstructive hydro cephalus: shunt failure Encephalomalacia Normal pressure hydrocephalus Enlarged subarachnoid spaces

Question 66

Small ventricles:

Answer 66

``` CSF shunts and complications Cerebral oedema Herniation syndromes Hypoxic ischaemic injury Cerebral infection Intracranial HTN and Hypotension ```

Question 67

Asymmetric lateral ventricles:

Answer 67

``` Normal variant Extrinsic mass effect Encephalomalacia Intraventricular haemorrhage Herniatin syndromes Surgical defects Obstructive hydrocephalus Choroid plexus cyst Ventriculitis ```

Question 68

Irregular lateral ventricles:

Answer 68

``` CSF shunt / complication Surgical defect Periventricular leukomalacia Chronic cerebral infarction Porenchepahlic Cyst Chiari 2 Heterotopic Grey matter Tuberous sclerosis complex Mets ```

Question 69

Large Brainstem:

Answer 69

``` Brainstem glioma HTN intracranial Haemorrhage Intracranial hypotension Osmotic demyelination syndrome Acute cerebral ischaemia / infarction Demyelination Cavenrous malformation ```

Question 70

Pontine lesion:

Answer 70

``` Ischaemic rarefaction / arteriosclerosis Acute cerebral ischamia / infarction HTN haemorrhage Vascular malformation: capillary telangiectasia, cavernous malformation. Demyelination Diffuse infiltrative pontine glioma Malignant glioma Pilocytic astrocytoma Wallerian degeneration PRES Osmotic demyelination syndrome ```

Question 71

Medulla Lesion:

Answer 71

``` Lateral medullary infarct Medial medullary infarct Wallerian degeneratino Demyelination Cavernous malformation Paeds: diffuse fibrillary astrocytoma Adults: glioma, haemangioblastoma. ```

Question 72

Brain tumour child < 1year:

Answer 72

Posterior Fossa: - Pilocytic astrocytoma - Medulloblastoma - Ependymoma - Brainstem glioma Supratentorial: - Diffuse low grade astrocytoma - Crainopharyngioma - SEGA Midline Pineal / Supra sella: - Germinoma - Teratoma - Pineoblastoma Intra axial peripheral and cortical: - DNET - PXA - Ganglioglioma - Oligodendroglioma Intra axial deep white matter and hemispheric: - Anaplastic astrocytoma - CNS embryonal tumour - Glioblastoma.

Question 73

Bubbly intra ventricular mass:

Answer 73

``` Choroid plexus cyst Neurocysticercosis Choroid plexus papilloma / carcinoma Central neurocytoma Ependymoma Subependymoma Ependymal cyst Epidermoid cyst ```

Question 74

Ependymal / subependymal Lesions:

Answer 74

``` Tuberou Sclerosis complex SEGA Focal cortical dysplasia Heterotopic Grey Matter Developmental venous anomaly MS GBM Lymphoma Ependymoma Ventriculitis Subependymoma Neurosarcoid ```

Question 75

Ependymal Enhancement:

Answer 75

``` Developmental venous anomaly MS Ventriculitis Oppurtunistic infection AIDS CSF tumour seeding CNS lymphoma Neurosarcoid Neuromyeltis optica TB LCH ```

Question 76

Periventricular Enhancing Lesions:

Answer 76

``` MS / tumefactive demyelination ADEM GBM Lymphoma Mets Abscess Septic emboli Toxoplasmosis Neurocysticercosis Neurosarcoid ```

Question 77

Thick Infundibular Stalk:

Answer 77

``` Neurosarcoid (adult) Germinoma (young) Basilar Meningitis LCH (young) Lymphocytic Hypophysitis (adult) Lymphoma (adult) ```

Question 78

Solitary Dural Based Mass:

Answer 78

``` Epidural Haematoma Meningioma Meningeal Mets Neurosarcoid Metastatic lymphoma Empyema Benign mesenchymal tumours Leukaemia ```

Question 79

Multiple Dural Based Mass:

Answer 79

``` Meningioma Meningeal Mets Chronic Subdural Haematomas Neurosarcoid NF2 Lymphoma Erdheim-Chester Disease. ```

Question 80

Cystic CPA Mass:

Answer 80

``` Epidermoid Arachnoid Cyst Vesticular Schwannoma with intramural Cyst Haemangioblastoma Large endolymphatic sac anomaly Neurocysticercosis Neuroenteric cyst ```

Question 81

CSF like Parenchymal Lesions:

Answer 81

``` Enlarged perivascular space Encephalomalacia Lacunar infarction Neurocysticerosis Porencephalic Cyst MS Hippocampal sulcus remnants Cryptococcus ```

Question 82

CSF Like Extra Axial Fluid Collection:

Answer 82

``` Enlarged subarachnoid spaces Mega Cisterna Magna Chronic Subdural Haematoma Subdural hygroma Subdural effusion Arachnoid cyst ```

Question 83

Hypodense Extra Axial Mass:

Answer 83

``` Arachnoid cyst Chronic Subdural Haematoma Post op epidural fluid Pneumocephalus Neurocysticercosis Lipoma ```

Question 84

Choroid Plexus Lesion:

Answer 84

``` Choroid plexus cyst Enlarged choroid plexus Choroid plexus papilloma Meningioma Intra ventricular Mets Ventriculitis ```

Question 85

Enlarged perivascular Spaces:

Answer 85

``` Normal Variant Aging brain Tumefactive perivascular spaces Cryptococcosis Mucopolysaccharidoses CADASIL ```

Question 86

Multi focal WM abnormalities in child:

Answer 86

``` MS (teens) ADEM Neuromyelitis optica PRES Tuberous sclerosis complex NF1 Viral encephalitis Metabolic brain disease: usually symmetrical. Lyme disease: CrN enhancement CADASIL (usually adults). ```

Question 87

White matter disease with sparing subcortical U-fibres:

Answer 87

``` Chronic small vessel ischaemic changes. CADASIL HIV encephalopathy Toxic leukoencephalopathies: - Chasing the dragon - Radiation / chemo. Leukodystrophies: - X-linked adrenoleukodystrophy - Metachromatic leukodystrophy - Krabbe disease. Inborn errors metabolism: - Phenylketonuria - Maple syrup urine disease ```

Question 88

White matter disease involving subcortical U-fibres early:

Answer 88

MS Progressive multifocal leukoencephalopathy (PML) Acute disseminated encephalomyelitis (ADEM) Canavan disease Alexander disease

Question 89

Imaging features Intracranial Hypotension:

Answer 89

``` Pachymeningeal enhancement Venous distension - dural sinuses Enlarged pituitary gland Eventual subdural effusions and haematomas Reduced CSF volume: - tonsillar ectopia, - drooping splenium, Reduced maillopontine distance. ```

Question 90

Imaging features of intracranial hypertension:

Answer 90

``` MOVES M: Meckel's cave enlargement O: optic disc protrusion V: venous sinus stenosis E: empty sella S: slit like ventricles ``` Can have tonsillar ectopia Common fat neck soft tissues.

Question 91

Increased T2 signal basal ganglia / thalami in a child:

Answer 91

``` Ischaemia Carbon monoxide poisoning Wilson disease Mitochondrial disorder Kernicterus osmotic demyelination ```

Question 92

Cerebellar Atrophy:

Answer 92

``` Alcohol abuse anticonvulsant therapy Paraneoplastic syndrome Sporadic olivo-ponto-cerebllar atrophy Cerebello-pontine degeneration Friedreich ataxia. ```

Question 93

Prominent periventricular / basal ganglia cystic lesions:

Answer 93

``` Virchow robin spaces Lacunar infarct Infection: - Neurocysticercosis - Cryptococcus Cystic neoplasm Neuroglial cyst ```