Neuro + Head & Neck Flashcards by Tonia Forjoe

which order do the mucosal sinuses develop?

Maxillary & Ethmoid
Sphenoid
Frontal

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What condition is being described here?
Soft tissue extension across the nostril and narrowed/inward bow to maxillary spines (CT)
Associated with midline developmental anomalies (holoprosencephaly)

Pyriform aperture stenosis

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What are the red flag features for thyroid nodules?

Solid
Calcifications - microcalcifications

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What do the following findings suggest?
Microcalcifications in thyroid nodule
Metastases to lymph nodes (Microcalcifications)

Papillary thyroid cancer

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What do the following findings suggest?
Comet tail artifact
Thyroid US

Colloid nodule

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What do the following findings suggest?
Macrocalcification
Local invasion and lymphatic spread

Medullary thyroid cancer

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What do the following findings suggest in the thyroid?
Hypoechoic halo
Peripheral pattern of blood flow
Cystic/Spongiform nodule
Multiple nodules

Benign thyroid nodule

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What do the following findings suggest?
Solid colloid nodules
Can be hot on uptake scan

Thyroid adenoma

If hot on uptake = Toxic adenoma

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What do the following findings suggest?
Female 40-70s
Diffusely enlarged thyroid gland
US - Homogenous hypoechogenic
Decreased vascularity
Reduced uptake on uptake scan
MR - Dark on all sequences

Reidels thyroiditis (IgG4 related fibrous replacement of thyroid)

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What do the following findings suggest?
Hyperdense tissue at base of tongue

Lingual thyroid

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What do the following findings suggest?
Enlarged thyroid gland
Increased vascularity on doppler

Graves disease

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What do the following findings suggest?
Heterogenous giraffe skin appearance of thyroid
Uniform hyper echoic nodules

Hashimotos thyroiditis

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What do the following findings suggest?
Solid thyroid nodule
Metastases haematogenously

Follicular thyroid cancer

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Which is the most common thyroid cancer?
2nd?

Papillary
Follicular

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What do the following findings suggest?
Hypoechoic beans posterior to the thyroid
Early wash in and delayed washout

Parathyroid adenoma

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What are the causes of hyperparathyroidism?

Hyperfunctioning adenoma
Multi-gland hyperplasia
Cancer

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What nuclear medicine scan is used to image the parathyroid glands?

Sestamibi scan

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What do the following findings suggest?
CSF space
Anterior to foramen of monroe
Between frontal horns

Cavum Septum pellucidum

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What do the following findings suggest?
Posterior continuation of cavum septum pellucidum
Posterior to foramen of monroe
Between bodies of lateral ventricles

Cavum vergae

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What do the following findings suggest?
Extension of quadrigeminal plate cistern to foramen of monroe
Above the 3rd ventricle and below fornices

Cavum velum Interpositum

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What passes through the cavernous sinus?

CN III
CN IV
CN V1 + V2
CN 6
Carotid artery

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What is the orientation of CN 7 and 8 in the internal auditory canal?

CN 7 = Up
CN 8 = Down (Cochlear component)
Vestibular component splits into superior and inferior

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The following pass through which cranial foramen?
CN V3
Accessory meningeal artery

Foramen Ovale

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The following pass through which cranial foramen?
CN V2

Foramen Rotundum

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The following pass through which cranial foramen? CN 3, CN 4, CN V1, CN 6

Superior orbital fissure

The following pass through which cranial foramen? infra orbital nerve - branch of V2 Inferior ophthalmic vein Infra orbital artery

Inferior orbital fissure

The following pass through which cranial foramen? Middle meningeal artery

Foramen Spinosum

The following pass through which cranial foramen? CN 9 CN 10 + 11

Jugular foramen

The following pass through which cranial foramen? CN 12

Hypoglossal canal

The following pass through which cranial foramen? CN 2 Ophthalmic artery

Optic canal

The following pass through which cranial foramen? CN 3 + 4 + V1 + V2 + 6 Carotid artery

Cavernous sinus

The following pass through which cranial foramen? CN 7 + 8

Internal auditory canal

The following pass through which cranial foramen? Trigeminal ganglion

Meckels cave

The following pass through which cranial foramen? CN 6 Inferior petrosal sinus

Dorello's canal

The following are branches of which artery? Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superficial temporal

External carotid artery

What are the vessels that come off the vertebral artery?

Anterior spinal artery

What vessels come off the basilar artery (Distal to proximal)?

PICA AICA Superior cerebellar artery

What do the following findings suggest? Acute CN3 palsy

PCOM aneurysm

What do the following findings suggest? Venous connection between the superficial middle cerebral vein and superior sagittal sinus Higher

Anastomotic vein of Trolard

What do the following findings suggest? Connects superficial middle cerebral vein and transverse sinus Lower

Vein of Labbe

The following veins are found where in the brain? Superior cerebral veins Vein of Trolard Vein of Labbe Superficial middle cerebral veins

Superficial

The following veins are found where in the brain? Basal vein of Rosenthal Vein of Galen Inferior petrosal sinus

Deep veins

What do the following findings suggest? Deep vein that passes lateral to the midbrain through the ambient cistern and drains into the vein of Galen

Basal vein of Rosenthal

What do the following findings suggest? Big vein formed by union of 2 internal cerebral veins

Vein of Galen

What do the following findings suggest? Middle nasal conchae is pneumatised

Concha Bullosa

Which sequence is best for assessing myelination in a 1yr old? Which sequence is best for assessing myelination in a 2 yr old?

1yr = T1 2yrs = T2

Which area of the brain is the last to myelinate?

Subcortical white matter

Which areas of the brain are myelinated at birth?

Brainstem Posterior limb of internal capsule

The following signifies what age of the patient: Anterior pituitary T1 high signal Posterior pituitary T1 high signal

Birth until 2 months

The following signifies what age of the patient: Anterior pituitary = T1 & T2 Iso Posterior pituitary = T1 high and T2 low signal

Adult

What do the following findings suggest? T1 high signal in calvarium

Normal

What is the order of paranasal sinus development?

Maxillary Ethmoid Sphenoid Frontal

What do the following findings suggest? Colpocephaly (Asymmetric dilatation of the occipital horns)

Corpus callosum agenesis

What do the following findings suggest? Absence of the splenium of the corpus callosum, genu in tact

Hypoplasia of the corpus callosum

What do the following findings suggest? Steer horn appearance of lateral ventricles on coronal Widely spaced ventricles on axial

Agenesis of the corpus callosum

What do the following findings suggest? Intracranial lipoma (T1 & T2 high signal) Interhemispheric recess

Associated with Corpus Callosum Agenesis

What do the following findings suggest? T1 & T2 high signal mass Interhemispheric fissure location (Pericallosal)

Intracranial lipoma

What do the following findings suggest? Absent top of head Reduced/Absent cerebrum/cerebellum Hindbrain present Not compatible with life Elevated AFP

Anencephaly

What do the following findings suggest? Defect in occipital bone & cervical region Retroflexion of the head Enlarged foramen magnum Not compatible with life AFP elevated

Iniencephaly

What do the following findings suggest? Neural tube defect Brain + Meninges herniate through defect in cranium Midline in occipital region

Meningoencephalocele

What do the following findings suggest? Cerebellar vermis absent Transversely oriented single lobed cerebellum Small 4th ventricle Rounded fastigial point Absent primary fissure

Rhombencephalosynapsis

What do the following findings suggest? Vermis is absent Molar tooth appearance - Superior cerebellar peduncles look elongated Small cerebellum Large 4th ventricle Absent fastigial point Absent primary fissure

Joubert syndrome

The following describe what? - Normal angular contour (not round) along the ventral surface of the cerebellum. - Deep trapezoid shaped cleft along the posterior cerebellum.

"fastigial point”is normal angular contour (not round) along the ventral surface of the cerebellum. Primary cerebellarfissure is a deep trapezoid shaped cleft along the posterior cerebellum.

What do the following findings suggest? Hypoplasia of the vermis Hypoplastic vermis is elevated and rotated Dilated cystic 4th ventricle

Dandy walker malformation

What do the following findings suggest? Torcula above the level of the lambdoid suture, due to elevation of the tentorium

Dandy walker classic version

What do the following findings suggest? Focal enlargement of the retrocerebellar CSF space Normal vermis, 4th ventricle, cerebellar hemispheres, posterior fossa, torcula No hydrocephalus

Mega cisterna magna

What do the following findings suggest? Cystic protrusion through the foramen of Magendie into the retrocerebellar region Vermis is normal but displaced up Dilated 4th ventricle Normal cerebellar hemispheres, posterior fossa, torcula Hydrocephalus

Blake Pouch

What do the following findings suggest? Hypoplastic vermis with dilatation of 4th ventricle Hypoplastic cerebellar hemisphere Normal posterior fossa + Torcula May have hydrocephalus

Variant DWM

What do the following findings suggest? Hypoplastic, elevated rotated vermis Cystic dilatation of 4th ventricle Normal cerebellar hemispheres displaced anterolaterally Expanded posterior fossa High insertion of torcula Hydrocephalus

Classic Dandy Walker Malformation

What do the following findings suggest? Focal areas of incomplete fusion anteriorly Mild fusion of frontal horns Normal thalamus Absent septum pellucidum + corpus callosum

Lobar Holoprosencephaly

What do the following findings suggest? Fused frontal lobes Body of lateral ventricles are 1 chamber, occipital and temporal horns are partially developed Fused thalamus Absent (Septum pellucidum + CC + Anterior inter hemispheric fissure + Anterior falx)

Semi-lobar Holoprosencephaly

What do the following findings suggest? Cerebral hemispheres fused with single midline ventricle Fused thalamus Absent (Septum pellucidum + CC + Interhemispheric fissure + Falx)

Alobar Holoprosencephaly

What do the following findings suggest? Cyclops eyes Cleft lip/palate Piriform aperture stenosis Mega incisor (Solitary median maxillary incisor)

Holoprosencephaly

What do the following findings suggest? Midline olfactory bulbs absent Absence of smell

Arhinencephaly

What do the following findings suggest? Occipital enceohalocele Multiple renal cysts Polydactylyl

Meckel Gruber syndrome - associated with Holoprosencephaly

What do the following findings suggest? Absent septum pellucidum Absent Optic chiasm and Optic nerves Associated with Schizencephaly

Septo-Optic dysplasia

What do the following findings suggest? Enlargement (Hamartomatous) of all parts of one cerebral hemisphere

Hemiemegalencephaly

What do the following findings suggest? Big cerebral hemisphere with big ventricle Hamartomatous overgrowth of all/part of cerebral hemisphere

Hemimegalencephaly

What do the following findings suggest? - Children - Small side cerebral hemisphere = atrophy + Ventricular dilatation - GWM blurring + Sulcal effacement - Big ventricle - Viral illness

Rasmussens Encephalitis

What do the following findings suggest? Unilateral skull thickening Expanded sinuses Superior sagittal sinus & fissure moved across the midline Due in utero or childhood stroke

Dyke-Davidoff Masson (Cerebral Hemi-atrophy)

What do the following findings suggest? Smooth cerebral surface Thick cortex Prominence of occipital horns Undermigration + cortical folding doesn't happen

Lissencephaly Classic type

What do the following findings suggest? Undermigration - 2nd layer of cortical neurons deep to superficial cortex Associated with seizures Gyral pattern is normal Subcortical band of heterotopic grey matter

Double cortex band heterotopia

What do the following findings suggest? Overmigration Additional layer of cortex (Gray matter) Cobblestone cortex Associated with congenital muscular dystrophy + retinal detachment

Lissencephaly Type II

What do the following findings suggest? Failed migration Neurons in periventricular region dont migrate - subependymal gray matter Associated with seizures Follow grey matter on all sequences and dont enhance

Periventricular nodular heterotopia

What do the following findings suggest? Fine undulating/bumpy cortex Most common adjacent to Sylvia fissures Excessive number of small folds

Polymicrogyria

What do the following findings suggest? Cleft lined with gray matter connecting CSF spaces with ventricular system

Schizencephaly

What do the following findings suggest? Cleft lined with grey matter connecting CSF spaces with ventricular system Less common No CSF filled cleft Grey matter running across corona radiata

Closed lip Schizencephaly

What do the following findings suggest? Cleft lined with grey matter connecting CSF spaces with ventricular system More common CSF filled cleft extending from ventricle to pial surface

Open lip Schizencephaly

What do the following findings suggest? Focal necrosis of both gray and white matter leading to cystic degeneration

Encephalomalacia

What do the following findings suggest? Brain cleft/hole from prior ischaemic event Encephalomalacia, lined by white matter Cyst/cleft can communicate with subarachnoid space or only ventricular system Cleft NOT lined with CSF

Porencephalic cyst/Porenchephaly

What do the following findings suggest? Absent cortical mantle Due to bilateral ICA occlusion Destruction of both cerebral hemispheres Cerebellum, midbrain and falx present

Hydranencephaly

What causes Hydranencephaly?

Herpes or CMV/Toxo

What do the following findings suggest? Cortical mantle present Falx present

Severe hydrocephalus

What do the following findings suggest? Cortical mantle present Falx absent

Holoprosencephaly - Alobar

What do the following findings suggest? Cortical mantle absent

Hydranencephaly

What do the following findings suggest? Herniation of CSF + Meninges No brain

Meningocele

What do the following findings suggest? Herniation of CSF + Brain + Meninges

Meningoencephalocele

What do the following findings suggest? Herniation of the cerebellar tonsils >5 mm Associated with cervical cord syrinx

Chiari I malformation

What do the following findings suggest? Herniation of cerebellar tonsils >5mm Cerebellar vermian displacement Low lying torcula Tectal beaking Hydrocephalus Clival hypoplasia + Lumbar myelomeningocele

Chiari II malformation

Chiari III malformation

What do the following findings suggest? Hippocampal volume loss Gliosis/Scar - High T2 Signal Loss of normal hippocampal morphology (Interdigitations) Contralateral amygdala enlargement Seizures

Mesial temporal sclerosis

Where is the hippocampus located?

Medial temporal lobe

What do the following findings suggest? Pachymeningeal engorement - enhancement Distension of dural venous sinuses Prominent intracranial vessels Pituitary engorgement Subdural hygroma/Haematoma Brainstem sagging + Acquired tonsillar ectopia

Intracranial hypotension

What do the following findings suggest? Slit like ventricles Partially empty sella Compression of venous sinuses Vertical tortuosity of optic nerves Flattening of posterior sclera

Idiopathic intracranial hypertension

What do the following findings suggest? All ventricles enlarged Level of obstruction between basal cisterns and arachnoid granulations CSF can exit all ventricles

Communicating hydrocephalus

What do the following findings suggest? Upstream ventricles are enlarged Level of obstruction is within the ventricular system CSF cannot exit all the ventricles

Non-Communicating hydrocephalus

What do the following findings suggest? Urinary incontinence, confusion, ataxia >60yrs Ventricular size out of proportion with atrophy Upward bowing of corpus callosum Transependymal flow

Normal pressure hydrocephalus

What do the following findings suggest? Communicating hydrocephalus Middle aged Headache

Syndrome of Hydrocephalus in the young and middle aged adult

What do the following findings suggest? Web or diaphragm at aqueduct of sylvius Enlarged lateral & 3rd ventricles Normal 4th ventricle Thinning of cortical mantle

Aqueductal stenosis

What do the following findings suggest? Cystic structure in the subarachnoid space No solid components No restricted diffusion Can cause obstructive hydrocephalus

Arachnoid cysts

What do the following findings suggest? Debris within the ventricles DWI - Debris restricts diffusion Ventricular ependymal contrast enhancement

Ventriculitis

What do the following findings suggest? Loss of grey white matter differentiation Failed Na/K pump, BBB intact

Cytotoxic oedema

What do the following findings suggest? Oedema tracking through white matter, normal G/W matter differentiation Increased capillary permeability, BBB not intact Spares grey matter

Vasogenic oedema

What do the following findings suggest? Midline shift - deviation of ipsilateral ventricle and bowing of the falx

Subfalcine herniation

What is the complication of subfalcine herniation?

ACA compression + infarct

What do the following findings suggest? Uncus and hippocampus herniate through tensorial incisura Effacement of ipsilateral suprasellar cistern

Descending tentorial (Uncal) herniation

What are the complications of uncal herniation?

Duret haemorrhages - perforating basilar artery compression) CN 3 compression

What do the following findings suggest? Vermis herniates upwards through tentorial incisura Severe hydrocephalus Flattened quadrigeminal cistern smile

Ascending transtentorial herniation

What do the following findings suggest? Herniation of the cerebellar tonsils down >5 mm

Cerebellar tonsil herniation

What do the following findings suggest? T2 bright central pons (Spares periphery) Restricted diffusion in lower pons

Osmotic demyelination

What do the following findings suggest? High T2/FLAIR in medial thalamus High T2/FLAIR in periaqueductal gray, mamillary bodies and tectal plate Enhancement in mamillary bodies

Wernicke Encephalopathy (Thiamine deficiency)

What do the following findings suggest? High T2/FLAIR in corpus callosum Seizures + Muscle rigidity Begins in CC body - genu - splenium Chronic: Thinned CC + Cystic cavities favouring genu + splenium

Machiafava Bignami

What do the following findings suggest? Brain atrophy - cerebellum and cerebellar vermis

Direct alcoholic injury

What do the following findings suggest? T1 bright basal ganglia

Copper & Manganese deposition

What do the following findings suggest? Optic nerve atrophy Haemorrhagic putamen Subcortical white matter necrosis T2 bright putamin CT Hyperdense putamin

Methanol toxicity

What do the following findings suggest? CT Hypodensity in globus pallidus T2 bright globus pallidus

Carbon monoxide

What do the following findings suggest? Asymmetric cortical and subcortical white matter oedema - parietal/occipital No restricted diffusion

PRES (Posterior reversible encephalopathy syndrome)

What do the following findings suggest? Asymmetric cortical and subcortical white matter oedema - sparing the occipital lobes, favours basal ganglia, brainstem and cerebellum OR Periventricular white matter - bilateral T2/FLAIR high signal

Methotrexate changes

What do the following findings suggest? Ovoid/fusiform High T2/FLAIR lesions Central vein sign (Central linear low signal on SWI) Juxtacortical and periventricular Involves callososeptal interface May enhance (If active) T1 black holes (Severe) 20-40yrs

Multiple sclerosis

What are the McDonald criteria for MS?

- Disseminated in space - periventricular, juxtacortical, infratentoral, spinal cord - >1 in at least 2 locations - Dissemination in time - T2 high signal active lesions (Enhance) and inactive lesions (No enhancement)

What do the following findings suggest? C spine Short segment Lateral and dorsal columns Peripherally located high T2/FLAIR lesions

Spinal MS

What determines if an MS plaque is active?

Enhancement (May be incomplete ring) restricted diffusion

What do the following findings suggest? Young child Post viral illness/vaccination Multiple large T2 bright lesions enhancing in open ring pattern Patchy, large asymmetric white matter lesions Does not involve callososeptal interface Peripheral/incomplete ring enhancement

ADEM (Acute disseminated encephalomyelitis)

What do the following findings suggest? Transverse myelitis - long segment spinal cord enhancement >3 segments Optic neuritis - enhancing optic nerve Periependymal lesions, confluent. Dorsal medulla (Area postrema) High T2/FLAIR lesions in cord and optic nerve

Devics (Neuromyelitis optica)

What do the following findings suggest? High T2/FLAIR Favours white matter of centrum semiovale (Superior to lateral ventricles and CC) Spares ubcortical U fibers Associated with HTN >55yrs

Subcortical arteriosclerotic encephalopathy (SAE)/Binswanger

What do the following findings suggest?What do the following findings suggest? High T2/FLAIR Favours white matter of Frontal and temporal lobes Spares Occipital lobes Spares subcortical U fibers Associated with HTN <40yrs

CADASIL (Cerebral AD Arteriopathy with Subcortical infarcts and leukoencephalopathy

What do the following findings suggest? Hippocampal atrophy (Medial temporal) Also biparietal atrophy Low posterior temporoparietal region + Posterior cingulate FDG uptake

Alzheimer disease

What do the following findings suggest? Cortical infarcts and lacunar infarcts Generalised brain atrophy Multiple scattered areas of decreased activity on FDG pet, no lobar predominance Motor strip may be involved

Vascular dementia

What do the following findings suggest? Mild generalised atrophy without lobar predominance Hippocampi normal in size Decreased FDG uptake in lateral occipital cortex + Spares posterior cingulate gyrus DAT Scan - decreased striatal uptake (full stop not comma)

Dementia with Lewy Bodies

What do the following findings suggest? Younger patient Severe asymmetric atrophy of frontal lobes - Anterior/Posterior gradient Milder volume loss in temporal lobes Low FDG uptake in frontal + temporal lobes

Frontotemporal dementia

What do the following findings suggest? Extensive basal ganglia and thalamus calcification Extensive calcification in cerebellar dentate nuclei

Fahr disease

What do the following findings suggest? Iron in globus pallidus T2 dark medial basal ganglia with central dot high signal (Necrosis) - Eye of the tiger No enhancement No restricted diffusion

Hallervorden Spatz

What do the following findings suggest? Caudate atrophy Reduced FDG uptake Frontal horns enlarged and outwardly convex

Huntingdon disease

What do the following findings suggest? Elevated lactate peak on spectroscopy T2/FLAIR bright lesions in brainstem, basal ganglia and cerebral peduncles Restricted diffusion No enhancement

Leigh disease

What do the following findings suggest? Atypical strokes in cortical gray matter with non-vascular distribution Occipital and parietal distribution Underlying WM normal Elevated lactate peak on spectroscopy

MELAS syndrome (Mitochondrial Encelopathy lactic acidosis and stroke like episodes)

What do the following findings suggest? Macrocephaly with metopic beak Beaked inferior L1 anterior vertebral body Enlarged perivascular spaces

Hurler syndrome (Lysosomal storage disease)

What do the following findings suggest? Sparing of midbrain and superior cerebellar peduncles DAT scan periods

Parkinsons disease

How can Parkinson's be distinguished from MSA?

In MSA there is atrophy of the middle cerebellar peduncle and pons/cerebellum Atrophy of the Putamen with High T2 rim

What do the following findings suggest? Cerebellar hemisphere/peduncle atrophy Shrunken flat pons Enlarged 4th ventricle Hot cross bun sign - loss of transverse fibres

MSA (Multisystem Atrophy)

What do the following findings suggest? Tegmentum atrophy with sparing of the tectum and peduncles Midbrain volume loss with concave upper surface + relative sparing of the pons

PSP (Progressive supra nuclear palsy)

What do the following findings suggest? T1 and T2 bright basal ganglia T2 bright dorsal medial thalamus T2 bright tegmenjtum with normal dark nuclei & substantia nigra Cortical atrophy on CT

Wilson disease

What do the following findings suggest? High NAA peak

Canavans disease

What is a demyelinating disease? What is a dysmyelinating disease?

Demyelinating = Disease that destroys normal myelin Dysmyelinating = Disrupts normal formation and turnover of myelin (leukodystrophy)

What do the following findings suggest? X linked Normal head size Parieto-occipital predominance High FLAIR signal Extends across splenium of CC Can restrict and enhance

Adrenoleukodystrophy

What do the following findings suggest? Normal head size Frontal predominance and periventricular and deep white matter tigroid pattern high FLAIR signal U fibers spared

Metachromatic

What do the following findings suggest? big head Frontal predominance high FLAIR signal Can enhance

Alexander disease

What do the following findings suggest? Big head Diffuse bilateral subcortical U fibers high FLAIR signal Elevated NAA

Canavan disease

What do the following findings suggest? Small head Centrum semiovale and periventricular white matter with parieto-occipital predominance high FLAIR signal - High density foci on CT (Thalamus, caudate, white matter) Sparing of subcortical U fibers

Krabbe disease

The following suggests an extra-axial or intra-axial lesion? CSF cleft Displaced subarachnoid vessels Cortical gray matter between mass and white matter Broad dural base/tail

Extra-axial

What are the causes of haemorrhagic brain mets?

Melanoma Renal Carcinoid/Choriocarcinoma Thyroid

The following are associated with which syndrome? Optic glioma Astrocytoma

NF 1

The following are associated with which syndrome? Multiple schwannomas Meningiomas Ependymomas

NF2

The following are associated with which syndrome? Subependymal tubers SEGA

Tuberous Sclerosis

The following are associated with which syndrome? Haemnagioblastoma

VHL

The following are typically located where in the brain? PXA DNET Oligodendroglioma Ganglioglioma

Cortically based

What do the following findings suggest? Supratentorial tumour - temporal lobe Cyst with nodule No peritumeral T2 signal Age 10-20 Will enhance Dural tail + lepto/pachy-meningeal enhancement

Pleomorphic xanthoastrocytoma

What do the following findings suggest? Child <20 Seizures Temporal lobe Hypodense on CT High T2 signal bubbly/multicystic lesion, bright FLAIR Rim + loss of signal in bubbles Can have calcification Wedge shaped No enhancement, no restricted diffusion

DNET (Dysembryoplastic Neuroeptelial tumour)

What do the following findings suggest? >40yrs Calcification Frontal lobe Expands the cortex, cortical infiltration and marked thickening Can enhance No T2/FLAIR mismatch

Oligodendroglioma

What do the following findings suggest? Any age, usually young <30yrs Temporal lobe, or anywhere Seizures Cystic and solid with focal calcifications No oedema Calcification Can enhance

Ganglioglioma

The following lesions are found in which areas of the brain? Ependymoma Medulloblastoma SEGA Subependymoma Central neurocytoma

Ventricular wall & Septum pellucidum

The following lesions are found in which areas of the brain? Choroid plexus papilloma Choroid plexus carcinoma Xanthogranuloma

Choroid plexus

What do the following findings suggest? 6yrs or 30yrs Floor of 4th ventricle location, can extend to foramen of Magendie and Luschka Parenchymal supratentorial Large on presentation - well defined Cystic/haemorrhagic components Heterogenous enhancement Calcification

Ependymoma

What do the following findings suggest? <10yrs Cerebellar location - vermis/roof of 4th ventricle Projects into 4th ventricle Hyperdense on CT Heterogenous on T1 & T2, enhances homogeneously Restricted diffusion Can calcify Drop mets

Medulloblastoma

What do the following findings suggest? Medulloblastoma Dural calcifications Basal cell cancer Odontogenic cysts

Gorlin syndrome

What further imaging is required for a child with medulloblastoma or ependymoma?

Imaging of the whole neuraxis due to drop mets

What do the following findings suggest? Seizure Children Lateral wall of ventricle (Near foramen of Monro) Hydrocephalus Enhances homogeneously Calcification Will grow

SEGA

What do the following findings suggest? Seizure Children Ventricle location Hydrocephalus Enhances homogeneously Calcification Stays stable in size

Subependymal nodule

What do the following findings suggest? Young patient with subependymal nodules Enhancing, T1 + T2 heterogenous Partially calcified lesion Foramen of Monro >5 mm

SEGA

What do the following findings suggest? Adult Interventricular mass - Foramen of Monroe or 4th ventricle Well circumscribed, expansile Hydrocephalus Does not enhance T2 bright

Subependymoma

What do the following findings suggest? Adult Lateral ventricles around foramen of Monro Calcifications Cystic spaces on T2, heterogenous enhancement, Diffusion restriction of solid component

Central neurocytoma

What do the following findings suggest? adults Interventricular mass Hydrocephalus 4th ventricle or lateral ventricle Post contrast enhancement

Choroid plexus papilloma

What do the following findings suggest? <5yrs children Interventricular mass Hydrocephalus Trigone of lateral ventricle Solitary

Choroid plexus carcinoma

What do the following findings suggest? Cystic lesion with Restricted diffusion Choroid plexus mass Benign Adult

Choroid plexus Xanthogranuloma

What is the most common location of intraventircular mets?

Trigone of lateral ventricles

What do the following findings suggest? Anterior part of 3rd ventricle behind foramen of Monro T1 dark, T2 bright Round well circumscribed mass Hyperdense on CT

Colloid cyst

What do the following findings suggest? Anterior part of 3rd ventricle behind foramen of monro T1 bright T2 dark Round well circumscribed mass Hyperdense on CT

Cholesterol colloid cyst

How can colloid cysts cause death?

Via acute onset hydrocephalus, assess for transepedymal oedema

What do the following findings suggest? Trigone of lateral ventricles or any intraventricular location Homogenously enhancing mass

Intraventricular meningioma

What are the differentials for a mass in the trigone of the lateral ventricle in a person >40yrs?

Mets Lymphoma Meningioma

What do the following findings suggest? CP Angle location Enhances strongly & Heterogenous Widens porus acousticus - ice cream cone IAC Can have cystic degeneration/haemorhhage Acute angle with petrous temporal bone

Vestibular Schwannoma

What do the following findings suggest? CP Angle location Enhances homogeneously Doesn't invade the IAC Calcification Dural tail, hyperostosis at tail Obtuse angle with petrous temporal bone

CP Angle meningioma

What do the following findings suggest? Off midline Follow CSF density on CT and MRI Bright on FLAIR Restrict diffusion

Epidermoid

The following lesions are found in which location commonly? Vestibular Schwannoma Meningioma Epidermoid Dermoid cyst Arachnoid cyst

CP Angle

What do the following findings suggest? Kids/Young adults Midline Suprasellar cistern/Posterior fossa Hypodense on CT Bright on T1

Dermoid cyst

What is the most common location for a dermoid cyst?

Suprasellar cistern

What do the following findings suggest? Fat droplets (Low on CT or High on T1) Floating in the ventricles or subarachnoid space

Ruptured dermoid

How do you differentiate a dermoid from an epidermoid?

Epidermoid behaves like CSF Dermoid behaves like fat

What do the following findings suggest? CP angle location T1 bright Fat saturation May have SNHL

IAC Lipoma

What do the following findings suggest? Subarachnoid space location CSF signal on all sequences No restricted diffusion Dark on FLAIR Well defined cystic lesion

Arachnoid cyst

What is the common location of the following lesions? Atypical teratoma/Rhabdoid tumour Medulloblastoma/Ependymoma JPA Haemangioblastoma

Infratentorial

What do the following findings suggest? <6yrs Supra or infratentorial location Most common in cerebellum Large Necrotic features Heterogenous enhancement Calcifications

Atypical teratoma/Rhabdoid tumour

What do the following findings suggest? Cyst with nodule Child <15yrs No flow voids, cyst wall enhances Enhancing nodule Posterior fossa or optic chiasm T2 bright

Juvenile pilocytic astrocytoma (JPA)

What do the following findings suggest? Adult Cyst with nodule Nodule is isodense on CT, Low T1, T2 high, contrast enhancement Flow voids along periphery of cyst Cerebellum

Haemangioblastoma

What do the following findings suggest? <10yrs Pons T2 bright Subtle or no enhancement Flattens 4th ventricle

Diffuse pontine glioma

What is the most common brain tumour in adults?

Astrocytoma

What do the following findings suggest? No or mild enhancement Diffuse white matter T2 high signal Vasogenic oedema FLAIR Iso intense - bright rim to lesion Expansile lesion, subcortical

Astrocytoma - G2/3 or Anaplastic astrocytoma

What do the following findings suggest? White matter T2 high signal Can cross midline Ring enhancement/Diffuse enhancement FLAIR bright

GBM (G4 astrocytoma)

What do the following findings suggest? Diffuse glioma with extensive infiltration At least 3 lobes involved Bilateral Blurring of GW differentiation on CT Extensive T2 high signal and little mass effect on MR No enhancement if low grade

Gliomatosis cerebri

What do the following findings suggest? Irregular margin brain lesion Multifocal Favours GW matter junction

Metastases

What do the following findings suggest? AIDS/Post transplant Necrotic haemorrhagic lesion with peripheral enhancement Heterogenous Multifocal

Immunodefieincy associated CNS lymphoma

What do the following findings suggest? Immunocompetent Parenchymal mass abutting ventricular surface + Solitary (Periventricular) Hyperdense on CT Intensely enhancing homogenous solid mass with enhancement + restricted diffusion Thick and irregular periventricular enhancement

Primary CNS lymphoma

What do the following findings suggest? Thin smooth linear periventricular enhancement

Ependymitis e.g. CMV

What is the most common type of primary CNS lymphoma?

Non hodgkin B cell

What do the following findings suggest? Large cystic tumour Superficial cerebral cortex/Leptomeninges Supratentorial location Involve >1 lobe <1yr old child Rapidly increasing head circumference

Desmoblastic infantile ganglioma

What do the following findings suggest? Midline (Clivus or C2 or Sacrum) T2 bright lesion

Chordoma

What do meningiomas over the cerebral convexity cause?

Hyperostosis

What do the following findings suggest? Soft tissue extra-axial lesion Enhance homogeneously Dural tail with narrow base of dural attachment No calcification No hyperostosis Invasion of skull Lobulated with vessels along periphery

Haemangiopericytoma

What is the most common primary cancer to metastasise to the dura?

Breast cancer

The following lesions are found in which intracranial location? Pituitary adenoma Pituitary apoplexy Rathke cleft cyst Epidermoid Cranioparyngioma

Sella/Parasella

What do the following findings suggest? Sella location may extend to suprasellar Gland & mass inseparable T1 dark T2 bright lesion Uptake contrast slower than normal pituitary

Pituitary adenoma

What distinguishes a macro- from micro- adenoma?

Macroadenoma > 10 mm Microadenoma <10 mm

Where do microadenomas typically form?

Adenohypophysis (Anterior 2/3)

What do the following findings suggest? T1 bright pituitary (Haemorrhage) Pituitary enlargement

Pituitary apoplexy

What do the following findings suggest? Lesion between anterior and posterior pituitary Cystic + Intra-cystic nodule Bright T1 + Dark on T2 T1 variable T2 very bright No enhancement of cyst

Rathke cleft cyst

What do the following findings suggest? Adult Solid lesion No calcifications Strong enhancement Along the infundibulum

Papillary Craniopharyngioma

Which type of craniopharyngioma is found in adults?

Papillary - less common

What do the following findings suggest? Child Calcified + cystic Sella turcica region - displaces pituitary gland T1 bright, T2 bright, Enhance strongly Solid lesion

Adamantinomatous craniopharyngioma

What do the following findings suggest? Hamartoma of tuber cinereum - hypothalamus b/w mamillary bodies and optic chiasm T1 iso, T2, iso, no enhancement Gelastic seizures + Precocious puberty

Hypothalamic hamartoma

When a patient presents with vertical gaze palsy what are the differentials?

Germinoma Pineoblastoma Pineocytoma Pineal cyst

What do the following findings suggest? Pineal region Precocious puberty Mass containing fat and central calcification Variable contrast enhancement Heterogenous on T1 and T2 (Mixed)

Germinoma

What do the following findings suggest? Childhood Pineal region Invasive Associated with retinoblastoma Heterogenous Enhance vividly Peripheral calcifications (Expanded)

Pineoblastoma

What do the following findings suggest? Adult Pineal region Well circumscribed Non-invasive Solid with expanded calcification pattern Enhancement of solid components

Pineocytoma

What do the following findings suggest? Cystic lesion in pineal region May have thin enhancement T1 dark T2 bright

Pineal cyst

If you have a supratentorial lesion with diffusion restriction what are the differentials?

Abscess Lymphoma

What are the differentials for a lesion that crosses the midline in the brain?

GBM Lymphoma MS

What causes T1 brightness, and what are the differentials?

Fat - dermoid + lipoma Melanin - Melanoma Blood - Bleeding met/tumour Cholesterol - Colloid cyst

What do the following findings suggest? Dysplastic cerebellar gangliocytoma Breast cancer

Cowdens

What do the following findings suggest? Tiger stripe mass in one cerebellar hemisphere

Dysplastic cerebellar gangliocytoma (Lhermitte duclos) Think breast cancer (Cowdens)

What do the following findings suggest? Periventricular tissue necrosis Periventricular calcifications Polymicrogyria

CMV (Neonatal)

What do the following findings suggest? Random calcification pattern + Basal ganglia calcifications Hydrocephalus

Toxoplasmosis (Neonatal)

What do the following findings suggest? Neonate Subependymal cysts Haemorrhage Focal high T2 signal in white matter Vasculopathy and ischaemia Fewer calcifications

Rubella

What do the following findings suggest? Neonate Thrombus and haemorrhagic infarct with encephalomalacia and atrophy Hydranencephaly

HSV 2

What do the following findings suggest? Neonate Faint basal ganglia enhancement on CT/MR Brain atrophy favouring frontal lobes Fusiform aneurysms

HIV

What is the most common opportunistic infection in AIDS?

Toxoplasmosis

What do the following findings suggest? Adult Symmetric increased T2/FLAIR in the deep white matter Normal T1 Basal ganglia calcifications Spares subcortical U fibers No enhancement Associated brain atrophy

HIV Encephalitis

What do the following findings suggest? Adult Single/multiple scattered hypodensities with T1 hypo density T2/FLAIR high signal out of proportion with mass effect Involves subcortical U fibers Bilateral, peripheral & Asymmetrical Parieto-occipital signal crossing splenium of CC

Progressive multifocal leukoencephalopathy (Caused by JC virus)

What do the following findings suggest? Brain atrophy - cerebellar Periventricular hypo densities T2/FLAIR high signal Thin ependymal enhancement Adult

CMV

What do the following findings suggest? Leptomeningeal enhancement Dilated perivascular spaces filled with mucoid material that doesn't enhance Basal ganglia lesions - T1 dark T2 bright, ring enhancement

Cryptococcus

What do the following findings suggest? T1 dark, T2 bright ring enhancing lesions Target sign on FLAIR No restricted diffusion Perilesional oedema

Toxoplasmosis

What do the following findings suggest? Basal cisterns - enhancement of basilar meninges with minimal nodularity Dystrophic calcifications Hydrocephalus

TB Meningitis or sarcoid

What type of HSV is found in adults v neonates?

Adults = HSV 1 Neonates = HSV 2

What do the following findings suggest? Oedema in temporal lobe (Medial), inferior frontal lobes T2 high signal - may be bilateral Spares basal ganglia Enhancement + Leptomeningeal enhancement Restricted diffusion in region of oedema Blooming due to haemorrhage

HSV 1 Encephalitis

What do the following findings suggest? Oedema in temporal lobe (Medial) T2 high signal - may be bilateral Spares basal ganglia Restricted diffusion in region of oedema May have blooming due to haemorrhage HSV negative

Limbic Encephalitis (Paraneoplastic syndrome)

What do the following findings suggest? T2 bright basal ganglia and thalamus Restricted diffusion May have haemorrhage

West nile virus encephalitis

What do the following findings suggest? Cortical gyriform restricted diffusion May involve basal ganglia Bilateral FLAIR bright dorsal medial thalamus Bilateral FLAIR bright posterior thalamus Rapidly progressive atrophy No enhancement or white matter involvement

CJD

What do the following findings suggest? Cystic lesions + internal nodule (enhances) Hyperdense cyst Oedema May have calcification and blooming on SWI

Neurocysticercosis

What do the following findings suggest? Thick leptomeningeal enhancement

Meningitis

What is meant by: Leptomeningeal Pachymeningeal

Leptomeningeal = Pia + Arachnoid Pachymeningeal = Dura

What do the following findings suggest? Enhancement of the meninges that does not extend to the sulci

Pachymeningeal enhancement

What are the causes of pachymeningeal enhancement?

Intracranial hypotension Dural attachment of meningioma Sarcoid TB Wegeners

What do the following findings suggest? Dural enhancement with contrast rim Restricted diffusion Subdural/Epidural collection

Dural Empyema

What do the following findings suggest? CT - focal area of low density with surrounding low density vasogenic oedema MR - Smooth ring enhancement, T2 high signal within lesions and oedema Restricted diffusion internally

Bacterial abscess

What is suggested by the following forms of ring enhancement Smooth ring Irregular ring

Smooth ring = Abscess Irregular ring = Tumour

What do the following findings suggest? Vasogenic oedema without well defined central enhancing lesion Spotty restricted diffusion Infective symptoms/signs

Cerebritis

What do the following enhancement patterns suggest as the pathology? Heterogenous Ring Incomplete ring Gyriform

Heterogenous = Tumour Ring = Abscess/Tumour Incomplete ring = Demylinating lesion Gyriform = Subacute stroke

What do the following findings suggest? Hyperdensity +/- hypointense oedema Anterior temporal lobes Inferior frontal lobes

Parenchymal contusion

What do the following findings suggest? May have normal CT Head Posterior CC, Frontal and Temporal lobe location GW matter location Multiple small T2 high signal foci

Diffuse axonal injury

What do the following findings suggest? Crescent shape hyper dense collection Crosses sutures Does not cross the midline

Subdural haematoma

What do the following findings suggest? Lens shaped Skull fracture Does not cross sutures Can cross midline

Epidural haematoma

What is the age of the following haemorrhage? Hypodense on CT

Hyperacute <1hr Chronic >3 weeks

What is the age of the following haemorrhage? Hyperdense on CT

Acute (1hr - 3 days)

What is the age of the following haemorrhage? Less dense on CT, becoming isodense to brain May have peripheral rim enhancement

Subacute (4 days - 3 weeks)

What is the pneumonic for MR signal of haemorrhage?

I Bleed, I Die, Bleed Die, Bleed Bleed, Die Die

What do the following findings in haemorrhage suggest? T1 Iso T2 Bright

Hyperacute haemorrhage <24hrs Oxyhemoglobin + Intracellular

What dot the following findings in haemorrhage suggest? T1 iso T2 Dark

Acute haemorrhage <3 days Deoxyhaemoglobin + Intracellular

The following bleed appears as what signal on MR? Early subacute >3 days Methaemoglobin Intracellular

T1 Bright T2 Dark

How does the following bleed appear on MRI? Late subacute >7 days Methemoglobin Extracellular

T1 Bright T2 Bright

What does the following bleed present as on MRI Chronic >14 days Haemosiderrin, Extracellular

T1 Dark T2 Dark Centre - is high on T2

What is the most sensitive sequence on MRI for SAH?

FLAIR

What do the following findings suggest? Haemorrhage in midbrain and pons without extension to lateral Sylvia cisterns or interhemispheric fissure (Anterior to brainstem)

Benign Perimesencephalic haemorrhage

What do the following findings suggest? Repeated SAH Curvilinear low signal on GE coating surface of brain SNHL Ataxia

Superficial siderosis

What do the following findings suggest? Diffuse cerebral oedema - low attenuation brain Collapse of subarachnoid spaces appearing hyper density

Pseudosubarachnoid haemorrhage

What do the following findings suggest? Multiple dark spots on GE imaging Young patient Multiple central haemorrhagic foci in hypertensive young patient

Hypertensive microangiopathy

What do the following findings suggest? Basal ganglia, pons, cerebellum hyperdensity on CT

Hypertensive haemorrhage

What do the following findings suggest? Multiple dark spots on GE imaging Older patient Multiple peripheral haemorrhagic foci in normotensive elderly patient Convexity SAH

Amyloid angiopathy

What do the following findings suggest? Multiple small foci of restricted diffusion GWM interface and basal ganglia

Septic emboli

The following parts of the brain are supplied by which vessel? Parietal lobe

MCA

The following parts of the brain are supplied by which vessel? Medial frontal and parietal lobes

ACA

The following parts of the brain are supplied by which vessel? Occipital lobe

PCA

What do the following findings suggest? Dense MCA sign Insular ribbon sign Loss of GWM differentiation

Subacute infarct

What do the following findings suggest? Bilateral thalamic hypo densities

Artery of Percheron infarct or Basilar tip thrombus

What do the following findings suggest? Caudate hypo density

Recurrent artery of heubner infarct

What do the following findings suggest? Dense venous sinus on non-con CT Empty delta on Contrast enhanced CT Heterogenous diffusion restriction

Venous infarct

What do the following findings suggest? Reduced CBF Increased CBV Increased MTT

Infarct penumbra (May benefit from reperfusion)

What do the following findings suggest? Reduced CBF Reduced CBV

Infarct core

What is the most common site of cerebral aneurysm?

Anterior communicating artery

What do the following findings suggest? Widened elongated twisty appearance of the basilar artery

Dolichoectasia of the basilar artery

What are the common sites of saccular aneurysms?

ACA M1/M2 junction ICA/PComm junction Basilar tip PICA

What do the following findings suggest? Fusiform aneurysm

Vasculitidites - PAN, Syphillis

The following locations of bleeding suggest aneurysms in which location? Interhemispheric fissure Ipsilateral basal cistern Sylvian fissure

Interhemispheric fissure = ACOM Ipsilateral basal cistern = PCOM Sylvian fissure = MCA Trifurcation

The following locations of bleeding suggest aneurysms in which location? - Interpeduncular cistern or intraventricular - Posterior Fossa

Basilar tip = Interpeduncular cistern or intraventricular PICA = Posterior Fossa

What do the following findings suggest? Supratentorial location Arterial component Nidus - calcified Draining veins Adjacent vein may be gliotic (T2 bright) and atrophic

High flow AVM

What do the following findings suggest? High/Low flow No nidus Acquired

Dural AVF

What is the most common high flow vascular malformation?

High flow AVM

What is the most common type of AVF?

Spinal AVF

What do the following findings suggest? Caput medusa - collection of vessels converging towards enlarged vein on venous phase Halo of T2 bright gliosis

DVA

What should be considered if a patient has a bleeding DVA?

There is an associated cavernoma

What do the following findings suggest? Popcorn like peripheral rim of haemosiderin on GE No intervening normal tissue Fluid fluid level = intralesional haemorrhage

Cavernous malformation - cavernoma

What do the following findings suggest? Brush like or stippled pattern enhancement GE - blooming Low flow with intervening normal tissue Single lesion in pons is most common Doesn't bleed

Capillary telangiectasia

Is choroid plexus found in the following locations? Frontal/Occipital horn of lateral ventricles Cerebral aqueduct

What do the following findings suggest? Calcifications of subependymal nodules Caudothalamic groove/atrium Older patient

Tuberous Sclerosis

What do the following findings suggest? subcortical calcification (seen at an earlier age than plain film) and associated parenchymal volume loss Tram track/double lined gyriform pattern parallel to cerebral folds

Sturge weber

Which brain tumours calcify?

Oligodendroglioma Ependymoma Astrocytoma Glioblastoma

What do the following findings suggest? Smooth long segments of intracranial vessel stenosis Post SAH Multiple vascular territories

Vasospasm

What do the following findings suggest? T1 bright intramural blood adjacent to vessel (Crescent sign)

Vascular dissection

Which systemic vasculitides can have CNS involvement?

PAN Temporal arteritis Wegeners Takayasu's

What do the following findings suggest? Multiple segmental areas of vessel narrowing Alternating dilation (Beaded appearance) Focal areas of vascular occlusion

Vasculitis

What is the most common systemic vasculitis to involve the CNS?

PAN

What do the following findings suggest? Progressive non-atherosclerotic stenosis of the supraclinoid ICA May lead to occlusion Enlargement of basal perforating arteries - puff of smoke

Moyamoya

In a child what is the common cause for Moyamoya?

Sickle cell

What do the following findings suggest? Depressed blood flow and metabolism affecting the cerebellar hemisphere after contralateral supratentorial insult (Infarct, tumour resection/radiation) On FDG PET - criss crossed hypo metabolic appearance

Crossed cerebellar diaschisis

What do the following findings suggest? Face separated from cranium Zygomatic arch and lateral orbital rim wall

Le Fort 3 fracture

What do the following findings suggest? Maxilla separated from face Inferior orbital rim and orbital floor

Le Fort 2 fracture

What do the following findings suggest? Palate separated from maxilla Anterolateral margin of nasal fossa

Le Fort 1 fracture

Which fracture is shared by all 3 Le fort fractures?

Pterygoid process fracture

What do the following findings suggest? Airless expanded sinus T1 bright Thin rim of enhancement Frontal sinus

Mucocele

What type of temporal bone fracture is this? Long axis of Temporal bone More common Ossicular dislocation Conductive hearing loss

Longitudinal temporal bone fracture

What type of temporal bone fracture is this? Short axis of temporal bone Less common Vascular injury (Carotid/jugular) Facial nerve injury SNHL

Transverse temporal fracture

What is the location of the pars flaccida and tensa?

Pars Flaccida = Top Pars Tensa = Bottom

What do the following findings suggest? Grows at top of tympanic membrane in prussaks space Scutum eroded early Malleus displaced medially Long process of incus eroded Restricted diffusion CT - Soft tissue density

Pars Flaccida Cholesteatoma

What do the following findings suggest? Bony defect creating abnormal communication between inner ear and tympanic cavity Associated with cholesteatoma - affects Lateral SCC Air in semicircular canal

Labyrinthine fistula

What do the following findings suggest? Poorly pneumatised mastoid air cells Middle ear opacification Thickened mucosa No displacement of ossicular chain

Chronic otitis media

What do the following findings suggest? Hx of childhood meningitis Ossification of the membranous labyrinth SNHL

Labryrinthitis Ossificans

What do the following findings suggest? Cochlea and SCC show enhancing on T1 post contrast

Labrynthitis

Is enhancement of these segments of the facial nerve normal or abnormal? Tympanic and mastoid segments, Labryinthine segments

Normal

Is enhancement of these segments of the facial nerve normal or abnormal? Cisternal Cannalicular Extratemporal

Abnormal (Bells palsy, cancer, Lymes, Ramsey Hunt)

What do the following findings suggest? Viral Abnormal enhancement in canalicular segment of CN 7 (In IAC)

Bells palsy

What do the following findings suggest? Abnormal enhancement of CN7 (Canalicular segment) and CN 5 Rash around ear

Ramsey Hunt (Reactivation of VZV virus)

What do the following findings suggest? Bony resorption (Lytic) anterior to the oval window

Fenestral otosclerosis

What do the following findings suggest? More severe Demineralisation around the cochlea Lytic bone resorption SNHL Bilateral and symmetric

Retrofenestral otosclerosis

What do the following findings suggest? Absence of bony covering of the superior SCC Noise induced vertigo

Superior semicircular canal dehiscence

What do the following findings suggest? Enlargement of the vestibular aqueduct (>1.5mm) Progressive SNHL Bilateral usually

Large vestibular aqueduct syndrome (Failure of endolymphatic sac to resorb endolymph)

What do the following findings suggest? Basal turn is normal Middle and apical turns fuse into cystic apex (1.5 turns) SNHL - high frequency preserved Large vestibular aqueduct and vestibule Common

Mondini malformation

What do the following findings suggest? Total deafness Absent cochlea, vestibule, and vestibular aqueduct Rare

Michaels Aplasia/Complete labyrinthine aplasia

What do the following findings suggest? Internal amorphous calcifications on CT T2 bright intense enhancement Vascular, flow voids

Endolymphatic sac tumour

What are endolymphatic sac tumours associated with?

VHL

What do the following findings suggest? Avid enhancement of lesion in the jugular fossa Salt and pepper appearance - flow voids on MR Permeative bone destruction FDG avid

Paraganglioma

What do the following findings suggest? Hypertrophied arterial vessel running from tympanic cavity to join horizontal carotid canal Pulsatile tinnitus

Aberrant internal carotid artery

What do the following findings suggest? Otomastoiditis Trigeminal neuropathy Lateral rectus palsy

Gradenigo syndrome (Infection of Dorellos canal - most medial point of petrous ridge)

What do the following findings suggest? Lesion in petrous apex well defined on CT T1 & T2 bright, T2 dark haemosiderin rim Faint peripheral enhancement No restriction Smooth expansile bony change

Cholesterol granuloma

What do the following findings suggest? Petrous apex lesion T1 dark T2 bright Restricted diffusion Smooth expansile bony change

Cholesteatoma (Epidermoid)

What do the following findings suggest? Swollen EAC soft tissues Small abscess in EAC Adjacent bony destruction

Otitis externa

What do the following findings suggest? Overgrowth of tissue in the ear canal Bilateral Can look like bone if chronic

External auditory canal exostosis

What do the following findings suggest? Overgrowth of normal bone in the EAC Unilateral

External auditory canal osteoma

What do the following findings suggest? EAC doesn't form Conductive deafness

EAC Atresia

What are the differentials for a hyperdense sinus?

Blood Inspissated secretions Fungus

What do the following findings suggest? Opacification of multiple sinuses usually bilateral Favours ethmoid & maxillary sinus Normal immune system CT - Hyperdense centrally with layers, can erode and remodel walls if chronic T1/T2 dark If mucosa inflamed - enhancement, but not the hyper density

Allergic fungal sinusitis

What do the following findings suggest? Opacification of multiple sinuses Stranding/extension into fat around sinuses Immunocompromised CT - Opacified sinus (Not hyaperdense), fat stranding in orbit, may not be bone destruction MR - T1/T2 dark, turbinate mucosa may not enhance (Necrotic- black turbinate), extension outside sinus High on STIR and enhancing

Acute Invasive fungal sinusitis

What do the following findings suggest? Inflammation of paranasal sinuses lasting >12 weeks May cause obstruction of the sinus ostia

Chronic inflammatory sinonasal disease

What do the following findings suggest? Inflammation of paranasal sinuses Limited to maxillary sinus Due to obstruction at ipsilateral ostium/infundibulum

Infundibular chronic inflammatory sinonasal disease (Most common)

What do the following findings suggest? Inflammation of paranasal sinuses - ipsilateral maxillary, frontal and ethmoid Centered on middle meatus

Ostiomeatal unit pattern chronic inflammatory sinonasal disease

What do the following findings suggest? Inflammation of paranasal sinuses Bony remodelling and erosion Widening of the infundibulum

Sinonasal polyposis (Associated with CF/Aspirin sensitivity)

What do the following findings suggest? Maxillary sinus opacification, passes through and enlarges sinus ostium Widening of maxillary ostium No bony destruction Peripheral enhancement

Antrochoanal polyp

What do the following findings suggest? Young male Nidus centered on sphenopalatine foramen Bone remodelling - bowing of posterior maxillary wall, no destruction Vascular (Enhancing) + Flow voids on MR

Juvenile Nasal Angiofibroma

What do the following findings suggest? Lateral wall of nasal cavity Middle turbinate Focal hyperostosis at tumour origin Cerebriform pattern on MR - T1/T2 similar to brain, high/low signal lines

Inverted Papilloma

What cancer is associated with inverted papilloma?

Squamous cell cancer

What do the following findings suggest? Cribiform plate location Dumbell appearance grows into skull and sinuses Cystic solid lesion

Esthesioneuroblastoma

What is the most common head and neck cancer?

Squamous cell cancer

What do the following findings suggest? Maxillary antrum lesion Low T2 Enhances less than other sinuses

Squamous cell cancer

Which part of the nose is typically involved in nasal septal perforation?

Anterior septal cartilaginous area

What is the most common salivary duct affected by sialolithiasis?

Submandibular gland (Whartons)

What do the following findings suggest? Infection involving submandibular space and sublingual space Gas present in these spaces Fat stranding

Ludwigs Angina (Floor of mouth cellulitis)

What do the following findings suggest? Bony exostosis coming off hard palate in midline

Torus Palatinus (Normal variant)

What do the following findings suggest? Lucency in the mandible Previous bisphosphonate treatment

Osteonecrosis of the mandible

What do the following findings suggest? Cystic lesion Lateral - arising from sublingual gland/space Plunging under mylohyoid muscle into submandibular space

Ranula

What do the following findings suggest? Midline Cystic mass - thin walled

Thyroglossal duct cyst

What do the following findings suggest? Sac of marbles - fluid sac with globules of fat Midline

Floor of mouth dermoid/epidermoid

What do the following findings suggest? Young adult with new level II neck mass (Necrotic nodes)

HPV related Squamous cell carcinoma

What do the following findings suggest? Inflammation from dental caries around root Cystic degeneration around periodontal ligament Apex of non-vital tooth Well corticated border <2cm

Periapical cyst (Radicular cyst)

What do the following findings suggest? Cyst forming around crown of un-erupted tooth Expansile and unilocular Displace and resorb teeth adjacent to it

Dentigerous cyst

What do the following findings suggest? Mandibular ramus or body Uni/Multilocular Expansile, sharp margins Associated with root, no infection Along length of bone, no significant cortical expansion

Keratogenic Odontogenic tumour

What do the following findings suggest? Multicystic with solid components - soap bubbles Expansion of the mandible Tooth root absorption Permeative cortical bone erosion

Ameloblastoma (Adamantinoma of jaw)

What do the following findings suggest? Start out lucent then becomes solid when mature Radiodense with lucent rim Large with fluffy calcifications

Odontoma

What do the following findings suggest? 30-40yrs Osteoid matrix lesion Wide zone of transition

Osteosarcoma of Mandible

The following are found in which neck space? Parotid gland CN 7 Retromandibular vein

Parotid space

What do the following findings suggest? Most common in parotid (Superficial lobe) Hypoechoic with posterior acoustic enhancement T1 low, T2 high signal, rim of low signal, homogenous enhancement

Pleomorphic adenoma

How is the parotid gland divided into superficial and deep?

Superficial = Lateral to facial nerve Deep = Medial to facial nerve

What do the following findings suggest? Parotid gland - Tail Male smoker Solid cystic, bilateral US: ovoid, with well-defined margins and multiple irregular, small, sponge-like anechoic areas T1: low to intermediate signal T2: heterogeneous T1 C+ (Gd): cystic components do not take up contrast while solid parts usually enhance

Warthins tumour

Between Pleomorphic adenoma and Warthins, which only occurs in the parotid gland?

Warthins tumours

What is the most common malignant tumour of the minor salivary glands?

Mucoepidermoid carcinoma

Which salivary gland tumour is associated with perineural spread?

Adenoid cystic carcinoma

What do the following findings suggest? Bilateral homogenous parotid gland lesions

Lymphoma (Associated with Sjogrens disease)

What do the following findings suggest? Dry eyes and mouth Female 60s Honeycombed appearance of salivary glands

Sjogrens disease

What do the following findings suggest? Bilateral mixed solid and cystic lesions Diffusely enlarged parotid glands HIV Painless

Benign lymphoepithelial disease

What do the following findings suggest? Painful parotid gland Duct dilatation Heterogenous parotid gland Diffusely enlarged parotid

Acute parotitis

What neck space contains these? Fat Branches of CN 5 Pterygoid veins

Parapharyngeal space

If there is a mass in the carotid space, which direction will it displace the parapharyngeal space?

Anterior displacement

If there is a mass in the Parotid space, which direction will it displace the parapharyngeal space?

Medial displacement

If there is a mass in the Masticator space, which direction will it displace the parapharyngeal space?

Posterior + Medial displacement

If there is a mass in the Superficial mucosal space, which direction will it displace the parapharyngeal space?

Lateral displacement

What neck space contains these? Carotid artery Jugular vein CN9, 10, 11 Internal jugular chain lymph nodes

Carotid space

What do the following findings suggest? Salt and pepper on MRI Carotid bifurcation location Splaying of ECA & ICA

Carotid body tumour

What do the following findings suggest? Salt and pepper on MRI Skull base Destruction of jugular foramen Middle ear floor destroyed

Glomus Jugulare

What do the following findings suggest? Salt and pepper on MRI Above carotid bifurcation, below jugular foramen

Glomus vagale

What do the following findings suggest? Salt and pepper on MRI Confined to middle ear Overlies cochlear promotory Middle ear floor intact

Glomus tympanicum

What do the following findings suggest? Oval mass Heterogenous (Cystic and solid) Heterogenous high T2 signal Solid component enhancement

Schwannoma

What do the following findings suggest? Homogenous lesion T2 with decreased central signal + bright rim Mild heterogenous enhancement

Neurofibroma

What do the following findings suggest? Torticollis with Atlanto-axial joint inflammation Retropharyngeal abscess

Grisels syndrome

Which space contains the following: Muscles of mastication Angle + Ramus of mandible Inferior alveolar nerve

Masticator space

Where is the danger space?

Posterior retropharygeal space and behind alar fascia

What is the risk of infection in the danger space/retropharyngeal?

Can spread into the mediastinum

What are the nodes located in the lateral retropharyngeal region called?

Nodes of Rouviere

What is the most common location for nasopharyngeal cancer?

Fossa of Rosenmuller

What should be considered if a patient presents with Hoarse voice?

Recurrent laryngeal nerve compression in AP window (Mass/node/Aortic pathology) Laryngeal cancer

What is the most common cause of laryngeal cancer? What is the most common location?

Squamous cell carcinoma Glottic region

What do the following findings suggest? Orbital mass Calcification in the globe Normal or big globe <3yrs Can be bilateral

Retinoblastoma

What do the following findings suggest? Orbital mass Small globe Boys, unilateral No calcification CT - Dense T1 + T2 high signal

Coats disease (Retinal telangectasia leading to leaky blood and exudate)

What do the following findings suggest? Small eye Increased density of vitreous humour No calcification

Persistent hyper plastic primary vitreous (Failure of embryonic occular blood supply to regress)

What do the following findings suggest? V shaped retina

Retinal detachment

What is the most common intra-ocular lesion in an adult? Enhancing soft tissue mass in back of eye

Melanoma

What do the following findings suggest? <20 yrs Expansion and enlargement of entire optic nerve

Optic nerve glioma

What do the following findings suggest? Tram track calcifications of the optic nerve Circumferential enhancement around the optic nerve

Optic nerve sheath meningioma

What is the most common congenital orbital mass?

Dermoid

What do the following findings suggest? Superior and lateral orbit Arises from frontozygomatic suture <10yrs Fat within it

Orbital dermoid

What do the following findings suggest? Superior-medial orbit Bone destruction Bulky orbital mass <7yrs

Rhabdomyosarcoma

What do the following findings suggest? Upper outer orbit associated with lacrimal gland Enhances homogeneously Restricts diffusion

Orbital lymphoma

What do the following findings suggest? Bilateral sphenoid wing invasion

Neuroblastoma

What do the following findings suggest? Unilateral sphenoid wing invasion

Ewings sarcoma

What do the following findings suggest? Proptosis Desmoplastic reaction Enopthalmos - posterior displacement of globe Infiltrative retrobulbar mass

Scirrhous carcinoma of breast

What do the following findings suggest? Expanded extra-occular muscle Painful Unilateral + Anterior tendon Lateral & Superior rectus rectus Does not spare muscle insertions T2 dark Contrast enhancement

Idiopathic orbital inflammation

What do the following findings suggest? Expanded extra-ocular muscle Not painful Bilateral Spares muscle tendons T2 dark Contrast enhancement

Thyroid orbitopathy

Tolosa Hunt syndrome

What do the following findings suggest? Can involve any part of the orbit Bilateral Lacrimal gland and Lateral rectus Spares anterior tendon Bilateral involvement of V2 - infraorbital nerve Not painful

IgG4 Orbital disease

What is the order of involvement of the orbital muscles in thyroid orbitopathy?

IMSLO Inferior Medial Superior Lateral Oblique

What do the following findings suggest? Ill defined, lack capsule Infiltrative lesion Fluid-fluid levels Does not distend with valsalva

Lymphangioma (Venous lymphatic malformation)

What do the following findings suggest? Ill defined, lack capsule Infiltrative lesion Fluid-fluid levels Distends with valsalva

Orbital varix

What do the following findings suggest? Post traumatic Orbital fat stranding Diffuse extra-orbital muscle enlargement Pulsatile exophthalmos Prominent superior ophthalmic vein with proptosis Prominent cavernous sinus

Carotid-Cavernous fistula

What is the intraconal space?

Space inside rectus muscle pyramid

What is the extraconal space?

Space outside the rectus muscle pyramid

What do the following findings suggest? Inflammation and dilatation of the lacrimal sac Well circumscribed, round rim enhancing lesion centered on lacrimal fossa Fat stranding

Dacrocystitis

What do the following findings suggest? Enhancement of optic nerve without enlargement of the nerve/sheath complex Unilateral Painful

Optic neuritis

What do the following findings suggest? Focal discontinuity of globe Posterior

Coloboma

What is CHARGE syndrome?

Bilateral Coloboma Heart GU Ears

Where does the artery of Adamkiewicz originate?

Left side of aorta between T8 and T11

What is the normal termination of the conus medullaris?

What do the following findings suggest? Vertebral body Horizontal and oblique with claw like appearance At vertebral margin

Vertebral osteophytes

What do the following findings suggest? Vertebral body Vertical symmetric and thinner Ossification of annulus fibrosis Associated with Ank Spond

Syndesmophytes

What do the following findings suggest? Vertebral body endplates T1 dark T2 bright

Modic I (Oedema)

What do the following findings suggest? Vertebral body endplates T1 bright T2 bright

Modic II (Fat)

What do the following findings suggest? Vertebral body endplates T1 dark T2 dark

Modic III (Scar/Fibrosis)

What do the following findings suggest? High T2 signal within the IV disc

Annular fissure

What do the following findings suggest? Herniation of disc into the VB endplate High T2, Low T1

Schmorls node

What do the following findings suggest? Displacement of <25% of disc material beyond limits of disc space

Disc herniation

What do the following findings suggest? Displacement of >25% of disc material beyond disc space

Disc bulge

What do the following findings suggest? Disc base wider than herniation

Disc protrusion

What do the following findings suggest? Disc neck is narrower than the herniation

Disc Extrusion

What do the following findings suggest? Disc herniation fragment is broken off

Disc Sequestration

What is the most common location of disc herniation?

Subarticular

What do the following findings suggest? 2 nerve roots arise from a single dural sleeve

Conjoined nerve root

What do the following findings suggest? Collection around VB Post surgery Lacks enhancement

Recurrent residual disc

What do the following findings suggest? Collection around VB Post surgery Enhancement homogeneously

Epidural fibrosis (Scar)

What do the following findings suggest? Clumped nerve roots Empty thecal sac

Arachnoiditis If enhancement >6 weeks post surgery = infection

What do the following findings suggest? Fracture at upper part of odontoid peg

Type I odontoid peg fracture (Stable)

What do the following findings suggest? Fracture at base

Type II Odontoid peg fracture (Unstable)

What do the following findings suggest? Fracture through dens into body of C2

Type III Odontoid peg fracture (Unstable)

What do the following findings suggest? Axial loading injury Anterior & Posterior C1 arch fracture Lateral displacement of fracture fragments Increased distance between lateral masses of C1 and odontoid peg

Jefferson fracture

What do the following findings suggest? Fracture through bilateral pars at C2 Anterior subluxation of C2/3 >2mm Associated anterior inferior C2 corner fracture

Hangmans fracture

What do the following findings suggest? Impaction Hyperflexion injury Fragment of anterior inferior vertebral body

Flexion teardrop injury

What is the risk of a flexion teardrop injury?

Unstable Associated with anterior cord syndrome

What do the following findings suggest? Anterior inferior teardrop fracture fragment Avulsion of ALL Distraction injury Hyperextension injury

Extension teardrop

What do the following findings suggest? Avulsion injury of lower C/T spinous process Hyperflexion

Clay Shovelers fracture

What do the following findings suggest? Flexion distraction fracture 3 column fracture

Chance fracture

What do the following findings suggest? Distance between anterior arch and dense >5 mm

Atlantoaxial instability

Which column of the spine is this describing? ALL Anterior 2/3 VB

Anterior column

Which column of the spine is this describing? PLL Posterior 1/3 VB

Middle column

Which column of the spine is this describing? Posterior ligaments Pedicles, Facets, Lamina, Spinous process

Posterior column

Which spinal cord injury is being described here? Upper extremity deficit worse than lower

Central cord

Which spinal cord injury is being described here? Immediate paralysis - motor, pain and temp loss

Anterior cord

Which spinal cord injury is being described here? One side motor deficit, other side sensory deficits

Brown sequard - One hemicord

Which spinal cord injury is being described here? Prorioception gone

Posterior cord

What is the following describing? Most common in thoracic cord High T2 in central cord Swollen central cord Serpentine perimedullary flow voids - usually dorsal

AVF/AVM

What is the following describing? Increased T2 signal (Conus/Lower T spine) Prominent vessels (Flow voids) 40yr male Lower extremity weakness and sensory deficits Dural AVF

Foix Alajouanine syndrome

What is the following describing? High T2 signal in central cord Surrounded by normal cord No enhancement

Spinal Syrinx

What is the following describing? Central cord/anterior horn high signal T2 Owls eye sign Long segment >2 segments Diffusion restriction

Spinal cord infarct

What is the following describing? Short segment T2 high signal affecting only half/part of cord Cervical cord May have brain lesions Enhancing lesion if acute

Spinal MS lesion

What is the following describing? 2/3 cross sectional area of cord involved Focal enlargement of cord High T2 signal

Transverse myelitis

What is the following describing? Young person Post viral illness or vaccination High T2 signal Dorsal white matter

ADEM

What is the following describing? Longer T2 high signal segment Full transverse diameter of cord Mild cord swelling Thoracic cord Bright focal T2 high signal

NMO (Neuromyelitis optica)

What is the following describing? Bilateral, symmetrical Increased High T2 signal in dorsal columns (Inverted V) No enhancement Upper thoracic, ascending/descending

Subacute Combined degeneration (B12 deficiency)

What is the following describing? Bilateral, symmetrical High T2 signal in dorsal columns (Inverted V) No enhancement AIDS untreated

HIV Vacuolar myelopathy

What is the following describing? Expanded swollen cord Can enhance

Malignant cord lesion

What is the following describing? Enhancement of nerve roots of the cauda equina Anterior roots enhance > posterior

Guillain Barre syndrome (GBS)

What is the following describing? Thickened, enhancing onion bulb nerve roots

Chronic inflammatory demyelinating polyneuropathy (Chronic GBS)

The following spinal tumours are typically found where? Astrocytoma Ependymoma Haemnagioblastoma

Intramedullary

The following spinal tumours are typically found where? Schwannoma Meningioma Neurofibroma Drop mets

Extramedullary intramural

The following spinal tumours are typically found where? Disc disease Bone tumours Mets Lymphoma

Extradural

What is the following describing? Children Upper thoracic spine Fusiform dilatation of the cord over multiple segments Eccentric T1 dark, T2 bright, heterogenous enhancement Syrinx

Spinal Astrocytoma

What is the following describing? Adult Central Homogenous enhancement May be haemorrhagic

Ependymoma

What is the most common primary cord tumour of the lower spinal cord and conus?

Ependymoma

What is the following describing? Conus/Filum terminale (Extramedullary) Haemorrhagic Dark cap on T2 Long segment

Myxopapillary ependymoma

What is the following describing? Thoracic cord Wide cord Oedema Serpiginous draining meningeal varicosities Hypervascular enhancing pial tumour - cerebellum or cord Cyst with nodule

Spinal Haemangioblastoma

What are the most common intramedullary mets?

Lung cancer

What is the following describing? Solitary Arise from dorsal nerve roots Dumbell with skinny handle (Intraforaminal component) Doesn't envelop adjacent nerve root T1 dark, T2 bright, Enhancement Cystic change/haemorrhage

Schwannoma

What is the following describing? Solitary Envelops the adjacent nerve root High signal T2 rim with central area of low signal

Neurofibroma

What is the following describing? Posterior lateral thoracic spine, anterior C spine Enhance brightly and homogeneously T1 iso to low, T2 high Calcifications

Spinal meningioma

What are the most common extra medullary intramural metastases?

Medulloblastoma Breast cancer

What is the following describing? Extradural Thickened trabeculae - parallel linear densities (Corduroy) T1 bright, T2 bright in bone T2 bright T1 iso if extra-osseous

Vertebral haemangioma

What is the following describing? Extradural Midline mass on sacrum Sclerotic on CT No enhancement

Benign notochordal cell tumour

What are the most common extradural metastatic lesions?

Prostate Breast Lung Lymphoma

What is the following describing? T1 low signal lesion in VB Cortical breakthrough or adjacent paravertebral soft tissue

Vertebral body Metastases

The following cranial nerves arise from where? CN 1 + 2

Cerebrum

The following cranial nerves arise from where? CN 3 + 4

Midbrain

The following cranial nerves arise from where? CN 5-8

Pons

The following cranial nerves arise from where? CN 9 - 12

Medulla

What do the following findings suggest? HIV positive Diffuse and symmetric cerebral atrophy out of proportion to patient age Symmetrical periventricular hypoattenuation on CT Low T1 + T2 high signal on MR - sparing of subcortical structures No contrast enhancement

HIV Dementia

During FESS which access to which structure can lead to optic nerve or ICA injury?

Anodi Cells (Sphenoethmoidal air cells)

What does the following describe? Ethmoid air cells extending into the inferomedial orbital floor, which can cause injury to the orbital contents during surgery

Haller cells

What does the following describe? Cord focally indented and displaced anteriorly Widened dorsal CSF space (Scalpel sign)

Arachnoid web (Thickened band of arachnoid over dorsal cord)

What is the normal perivertebral distance at: C2 C6

C2 = 6 mm C6 = 18 mm

What typically causes the following changes: Combined cerebellar and cerebral atrophy

Senile brain atrophy

The following cause what change in which area of the brain? Wilsons Central pontine myelinolysis Carbon monoxide poisoning Huntingdons Fabrys disease

Low attenuation - Basal ganglia

What do the following suggest? well-circumscribed hypoechoic cystic spaces may demonstrate thin rim enhancement on postcontrast MRI

Benign Lymphoepithelial lesion

What do the following findings suggest? Pain and swelling US - Large, Hypoechoic, hyperaemic CT - Dilated duct, enhancing abscess

Acute sialadenitis

What do the following findings suggest? Multiple hypoechoic cystic lesions in the salivary gland Non enhancing cysts Heterogenous parenchyma

Chronic Sialadenitis - - Sjogrens - IgG4 (Kuttner - Chronic sclerosing sialadenitis) - Recurrent parotid abscess

What do the following findings suggest? Posterior ethmoid involving roof of sphenoid sinus Risk of damage to optic nerves

Onodi cell

What do the following findings suggest? Biparietal atrophy Low posterior temporoparietal region + Posterior cingulate FDG uptake

Early onset Alzheimers (<65yrs)

What do the following findings suggest? Bulky flowing Anterior IV ossification Right sided Thoracic Normal SIJ and facet and costovertebral joints Minimal disc degeneration

DISH

What do the following findings suggest? Vertebral body squaring Thin IV syndesmophytes (Bamboo spine) Dagger spine - ossification of spinal ligaments Romanus lesions Symmetrical bilateral sacro-ilitis Ankylosis of facet and costovertebral joints

Ankylosing spondylitis

The following optic nerve findings are found in which type of demyelinating disease? Painful visual loss Short segment Anterior, unilateral Enhancing swollen, T2 high signal

The following optic nerve findings are found in which type of demyelinating disease? Long segment Bilateral Posterior Chiasm involvement Cord swelling and high T2

NMOSD

The following optic nerve findings are found in which type of demyelinating disease? Bilateral long segment anterior nerve (Intra-orbital) or optic perineuritis

MOGAD

What is the following describing? Child and young adult Longitudinally extensive lower cord lesion Conus Central grey matter involvement - H pattern

MOGAD

What is the most common intramedullary mass in the spine for: Children Adults

Children - Astrocytoma Adults - Ependymoma

What do the following findings suggest? Thoracic spine more than Lumbar Spares IV discs Bone destruction Multilevel disease, sub ligamentous spread Large paraspinal abscess, thin walled calcified Gibbus deformity

TB (Or Brucellosis)

What do the following findings suggest? Lumbar spine favoured Primary involvement of disc Single level disease Smaller paraspinal abscess Thick walled, no calcification

Pyogenic discitis

Are the following measurements from a lateral C spine normal or abnormal? Predental space <3 mm in adults Nasopharyngeal space (anterior to C1) <10 mm Retropharyngeal space (C2–C4) <7 mm Retrotracheal space (C5–C7) <22 mm

Normal

What do the following findings suggest? Large or small vessel occlusion High signal on T2/DWI Chronic volume loss/gliosis Post op/Trauma with Hx of long bone fractures

Fat embolism - Hypoxic brain injury

In proton spectroscopy what is the function of NAA

Marker of neuronal viability Reduced in neurodestructive processes

In proton spectroscopy what is the function of Choline

Marker of cell membrane turnover. Elevated in tumours/demylination

In proton spectroscopy what is the function of Lipids & lactate

Marker of severe tissue damage. Increased in infarct/abscess/GBM

What are the most common primaries to metastasise to the brain?

Lung Breast Melanoma

Neuro + Head & Neck Flashcards

(542 cards)