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neuro rads head and brain Flashcards

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1
Q

intersection of the Frontal, Parietal, Temporal and Sphenoid bones

A

● Pterion​:

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2
Q

Thinnest part of the skull

A

Pterion

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3
Q

trauma in the pterion can cause

A

○ Trauma here may cause epidural hematoma because the Middle meningeal artery courses through this area

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4
Q

abbreviations of the sutures

A

Squamosal = Parietal = P Occipital = O Lamboidal = L Coronal = C Sagittal = S Dotted line = anterior fontanelle

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5
Q

standard and customary to only get _____ sliclies with a CT of the head

A

axial need to request reconstructions

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6
Q

what are we looking for with CT

A

Symmetry, densities, lucencies ○ Blood: new, old - in trauma, hemorrhage ○ Ischemia, infarction, edema ○ Tumors, metastases ○ Hydrocephalus ○ Bony windows - skull fractures

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7
Q

how wide are

A

typically between 3-5 mm from the base of the skull to the vertex should be able to see the frontal sinuses

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8
Q

white matter on CTS

A

appears darker than grey

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9
Q
A
  1. eye
  2. sphenoid sinus
  3. temporal lobe
  4. mastoid oracle of the ear (pinna) can be seen outside
  5. Pons
  6. 4TH VENTRICLE
  7. cerebellum
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10
Q
A

A. forntal lobe

b. sylvian fissure

c

temporal love

d. suprasella cistern
e. midbrain
f. 4th vent
g. cerebullum

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11
Q
A

A. sup sagitaal sinus

b. frontal lobe
c. laterla vantricle
d. 3rd vent

e 4th vent

f cerebellum

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12
Q

gryi

A

● Grooves = elevations (worms)

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13
Q

sulci

A

● Sulci = grooves (space btw the worms)

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14
Q

out to in brain layers

A

skull

epidural

DAP

DURA

subdural

ARACHNOID

PIA

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15
Q

what kind of contrast do we have with CT

A

IV not PO

get a creatinin

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16
Q

what is standard ct? CON or NAH

A

non con is standard

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17
Q

when would you get a non con CT

A

Suspected acute CVA/TIA, focal neuro deficit

● Headache - atypical, worst of life

● Delirium* ○ If delirium has obvious cause – infection, etc…CT may not be ordered ● HA + fever: Meningitis/Abscess/Encephalitis

● Seizure - first one

● Vertigo/Dizziness w/ central sx’s*

○ Central vertigo – MRI best. CT considered if cannot obtain MRI readily

● Cancer Hx w/ new headache, HIV w/ new HA, ALOC (altered level of consciouness), focal neuro findin

○ Vomiting w/o abdominal sx’s (vomiting is often first sign of increased ICP)

○ Suspected child abuse

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18
Q

when do you get a CTA for a strok pt

A

if the person has a stroke we can interviene

ALWAYS get a non con CT for stroked person first to determine ischemic or hemorrahgic

if their stroke score if very high you get NON con first

THN you get a CTA of the head and neck

contrast makes everything look white and blood is white you don’t want to confuse a ischemic with a hemorrahgic

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19
Q

other than stroke pts when do we have CTA for pts

A

Tumors ● Brain abscess, encephalitis ● MRI now often utilized in these conditions

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20
Q

Hypoattenuation

A

Hypoattenuation (gray) ○ Edema, ischemia, ol

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21
Q

Hyperattenuation

A

white

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22
Q

system for CT

A

Check name, date, study, rotation (contrast?)

● Check symmetry ○ Midline shift (mass effect)? Effacement? ○ Effacement​ = narrowing, obliteration of sulci, ventricles - literally they are squished from mass effect, edema

● Hyperattenuation (white) ○ Acute bleed, calcifications, FB’s

● Hypoattenuation (gray)

○ Edema, ischemia, old blood, tumor, air

● Cisterns, CSF spaces

● Ventricle size, symmetry

● Gyri, sulci symmetric? Edema? Atrophy?

● Soft tissue, sinuses, mastoids

● Bone Windows

● *Always interpret with attending physician, confirm with radiologist

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23
Q

B​lood C​an B​e V​ery B​ad stands for

A

Blood, Cisterns, Brain, Ventricles, Bones/Bony Windows

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24
Q

blown pupil

A

brain can come from the foramen magnum and squeeze the 3rd ventricle and cause a blown pupil

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25
official medical term for squished brain
effaced effacement
26
“White things” without IV contrast
Abnormal = **blood**, calcified masses * acute bleeding or recent bleeding is white * tumors can be calicified Normal = bone, typical calcifications * pineal gland, choroid plexus, falx, basal ganglia * therse
27
“White things” with IV contrast
Normal = vasculature, choroid plexus, pituitary Abnormal = blood, tumor/mass/infection
28
"Dark things”:
: Cisterns, CSF spaces Abnormal = air, edema, ischemia, encephalomalacia * air from entery point of fracutred skull * encephalomalacia * defined as soft brain * comes from brain degeneration due to lack of vascular supply * Artifacts: Motion, Metal - scatter effect, streaks
29
what can efface your sulci
edema
30
what type of CT would you get for head trauma
NON ct
31
what are you looking for with a CT trauma
Subdural Hematoma Epidural Hematoma Intracerebral Hemorrhage Cerebral Contusion
32
indications for CT trauma
Focal neuro finding GCS \<8 Loss of consciousness Altered level of consciousness Skull penetration Worsening HA, vomiting after head trauma Post-traumatic seizure Suspected child abuse Coagulopathy + trauma Significant mechanism
33
why can people walk around with subdural hematomas
venous hemorrhage damage is with the bridging veins between the dura and the arachnoid shapped like a crescent
34
subdural hematoma cross the medline T or F
Does not cross midline ● May cross suture lines doesn't wrap around the scull
35
what does acute blood look like on non contrast ct
acute blood is white on non-contrast head CT. Midline shift present
36
after about a week after a subdural hematoma
Subacute subdural – blood becomes more isodense. Midline shift present
37
what does a chronic subdural hematoma look like on a CT
acute on chronic subdural – new, hyperdense blood seen in old subdural. Subtle midline shift present
38
Epidural Hematoma occurs between wehat
Hemorrhage between dura and skull table
39
what shape and color do you see with epidural hematoma
Lens shape, biconvex Hyperattenuation
40
why do we see regain consciousness with epidural hematoma followed by sudden death
when the bleeding occurs and accumulates you get effacement of the ventricles and eventually the brain will herniate and person will die in respiratory failure
41
what is characteristic of the movement of epidural hematoma
Does not cross suture lines exapnding arterial hematoma
42
what is the most common hematoma
traumatic subarachnoid hematoma is the most common
43
Coup-contrecoup injury
= damage to the brain on both sides: the side that received the initial impact (coup) or blow and the side opposite the initial impact (countrecoup) ○ Common in boxing
44
Cerebral contusions:
Significant head trauma, coup-contrecoup mechanism common ○ Cerebral contusions often frontal or at periphery ○ Edema is common
45
who get's a CT scan for a HA
Indications for CT in headache ○ Focal neuro findings + HA ○ ALOC + HA ○ Fever + HA ○ Vomiting (atypical) + HA ○ HA + vomiting after head trauma ○ Severe, persistent, new HA ○ “Worst HA of my life” headache in young obese female with vision changes n/v BIH pesudotumor cerebry
46
Idiopathic intracranial hypertension
pseudotumor cerebri obese woman n/v HA
47
how do you dx subarachnoid hemorrhage
are there white things are where are they? Hyperattenuation (non-contrast CT scan) ● Suprasellar cisterns (Circle of Willis) or other basilar cisterns ● Sulci look white, effacement of sulci ● “Worst HA of life” ● Causes: aneurysm, AV malform tumors, **trauma \*** **MCC** ● Common to see subarachnoid hemorrhage in the **Sylvian fissure**
48
Increased Intracranial Pressure comes from
mass effect or brain swelling cerebral edema
49
first thing you will see on Increased intracranial pressure CT
■ First thing you lose is normal definition of gyri/sulci ■ Infection, reactive, malignancy, toxic, anoxic (don’t have O2)
50
Hydrocephalus seen with Increased Intracranial Pressure
from CSF
51
vasogenic type cerebral edema
edema is an area of hypoattenuation that is not as dark as air and surrounds whatever is going on ● Local edema around infection, malignancy ● Vasogenic edema around acute hemorrhage ● Possible midline shift, herniation ● Predominantly affects white matter
52
Cytotoxic Cerebral Edema
Hypoattenuation ● Cell death after cerebral ischemia (infarct) ● Possible midline shift, herniation ● Affects **both** white and grey matter
53
● Dilated ventricles, temporal horns visible
Hydrocephalus
54
two types of hydrocephalus
Communicating:extraventricular cause 2) Non-communicating​ - intraventricular cause
55
describe communicating hydrocephalus classic finding\*
Decreased reabsorption of CSF ■ Acute/chronic, affects the entire ventricular system ● **Hallmark = 4th ventricle enlarged** ■ Normal Pressure Hydrocephalus
56
■ Normal Pressure Hydrocephalus is what type of hydrocephalus
Communicating​ - extraventricular cause
57
CT findings with non-communicating​ - intraventricular cause
Obstruction of outflow of CSF - usually d/t tumor or mass Narrow site - 3rd or 4th vent, fora **■ 4th ventricle normal sized, sulci normal**
58
\>50 years old ○ Gait disturbance ○ Dementia ○ Urinary incontinence classic presentation of
Normal Pressure Hydrocephalus Special hydrocephalus – Communicating type
59
Normal Pressure Hydrocephalus is caused by
Dilated ventricles out of proportion to atrophy Giant ventricle but normal sulci
60
Diffuse prominence of sulci, ventricles ● Space between edges of brain and skull table ● Normal CSF production, absorption ● Incidental finding, chronic (happens over time) all characteristic of
Cerebral Atrophy
61
Cerebral Atrophy seen most commonly
dementia (Alzheimer’s), alcoholism (cerebellar) higher incidence of subdural hematoma
62
what window period might we see a falsely negative CT with a CVA
\<6hrs sx’s, CT often falsely negative if ischemic ○ MRI more sensitive early on if ischemic
63
Hemorrhagic CVA →
call neurosurgeon may have to have surgery to stop the bleed
64
Ischemic CVA (negative CT)
call neurologist for stent or TPA
65
Acute: hyperattenuation: collections of blood seen without a shift and with edema
could be a hemorrhagic stroke
66
what spots of the brain does hemorrahgic stroke favor
● Favor basal ganglia, thalamus, pons, cerebellum
67
Local vasogenic edema ● Effacement of gyri/sulci & midline shift common ● Risks: HTN, coagulopathy, stimulants (cocaine, meth ) ● Less common than ischemic; more morbidity/mortality
Hemorrhagic CVA
68
more sensitivity with this type of imaging in ischemic CVA
● MRI more sensitive early
69
Vascular watershed” distribution of ischemia seen in
ischemic CVA
70
4 subtle CVA signs
1. Hyperdense vessel sign 2. Loss of “insular ribbon” - grey matter stripe or interface with white matter 3. Lentiform nucleus and caudate nucleus are not distinctly visible 4. Effacement of sulci
71
lacunar infarcs
very very deep seen as a deep area of hypoattunation DM, HTN pts, not horribly insignificant unless there are many occur with tiny vessels
72
intra-axial tumor is
within brain parenchyma ■ Glioma, astrocytoma, etc
73
extra axial tumors on CT are located
outside of brain itself ■ Meningioma, acoustic neuroma
74
Big, round, multiple, enhance w/ contrast
METS
75
Glioma and astrocytoma are both what type of tumor (location)
intra axial
76
sxs of braintumors
HA, vomitting, altered mental status or nothing
77
neurocystocitosis !
first time seizure in an otherwise well person in an endemic area casued by a worm in the brain cysticercosis cyst with edema parascitic agent
78
Weighting: ​T1 or T2? ■ CSF is WHITE on \_\_\_\_\_\_\_
Weighting: ​T1 or T2? ■ CSF is WHITE on T2-weighted image
79
indications for MRI
More sensitive than CT for cerebellar lesions, central vertigo, multiple sclerosis (test of choice along with an LP), diffuse axonal injury, tumors ○ \*Need an MRI for the diagnosis of multiple sclerosis → looking for MS plaques (not found on CT) seen as plawues with MRI also need a lumbar puncture
80
EDH is usually due to injury to the _______ secondary to an \_\_\_\_\_\_\_
EDH is usually due to injury to the middle meningeal artery or vein secondary to an associated skull fracture. Unlike subdural hematoma, EDHs do not cross suture lines, but can cross the tentorium.
81
high density, extra-axial, biconvex lens- shaped mass lesion usually in the temporal-parietal region of the brain
EDH
82
MCC of SAH
Rupture of an aneurysm is the most common cause of a SAH (50-70%)
83
Suprasellar cisterns (Circle of Willis) or other basilar cisterns ● Sulci look white, effacement of sulci
SAH worst ha of my life
84
Rupture of an aneurysm is the most common cause of a SAH (50-70%) but not the only cause as trauma these tow things can also produce a SAH
, arteriovenous malformations or breakthrough of an intraparenchymal bleed can also produce subarachnoid hemorrhage.
85
a shift of the frontal horns of the lateral ventricles (o the right of midline (dotted line), would indicats the presence of\_\_\_\_\_\_\_\_\_\_
a shift of the frontal horns of the lateral ventricles (o the right of midline (dotted line), would indicats the presence of subfalcine herniation.
86
Communicating hydrocephalus is due to abnormalities that inhibit \_\_\_\_\_\_\_, most often at the level of the \_\_\_\_\_\_\_and is usually treated with a ventricular shunt.
Communicating hydrocephalus is due to abnormalities that inhibit the resorption of cerebrospinal fluid, most often at the level of the arachnoid villi and is usually treated with a ventricular shunt.
87
the thalami are on either side of the \_\_\_\_, and the caudate nuclei (C) are on either side of the \_\_\_\_\_\_\_\_\_\_
the thalami are on either side of the third ventricle (black arrow), and the caudate nuclei (C) are on either side of the frontal horns of the lateral ventricles.
88
Headache in young, obese female with vision changes, n/v
Benign Intracrainial Hypertension or Pseudotumor Cerebri
89
Hypoattenuation from encephalomalacia is typically seen as this type of edema
Cytotoxic Cerebral Edema
90
Dilated ventricles, temporal horns visible seen with this type of edema
Hydrocephalus
91
CSF build up in the brain = non communicating Hydrocephalus you can tell because the fourth ventricle is not enlarged
92
diffuse prominent sulci and ventricles are characteristic of
cerberal atrophy
93
deep in the brain HTN DM

radiology (13 decks)

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