Neuroscience Week 6: Neuroradiology of vascular diseases Flashcards Preview

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Flashcards in Neuroscience Week 6: Neuroradiology of vascular diseases Deck (80):
1

CT displays images in gray-scale from whit to black, based on?

Materials density

2

Ischemic infarctions often cause brain edema resulting in what on CT?

increased water density which appears hypodense

3

Acute intracranial hemorrhage often appears what on CT?

Hyperdense

4

Identify

5

Epidural hemorrhage radiology

4 listed

6

Epidural hemorrhage common etiology

associated with trauma and calvarial fractures

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Subdural hemorrhage radiology

8

Epidural hemorrhage cross calvarial sutures?

No

9

Subdural hemorrhage cross calvarial sutures?

May cross calvarial sutures

10

Subdural hemorrhage cross falx cerebri and tentorium cerebelli?

Does not cross the falx cerebri and tentorium cerebelli

11

Does epidural Hemorrhage cross the falx cerebri and tentorium cerebelli?

May cross the falx cerebri and tentorium cerebelli

12

Subdural hemorrhage common causes

associated with trauma: tearing of the bridging veins

13

Subarachnoid hemorrhage radiology

14

Subarachnoid hemorrhage common causes

associated with trauma and aneurysms

15

Aneurysmal Subarachnoid hemorrhage common locations

Most commonly Saccular and arise from/near the circle of Willis

  • ACOM, PCOM and MCA bifurcation

16

Aneurysm definition

abnormal dilation or outpouching

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Aneurysmal Subarachnoid hemorrhage pattern: Supracellar cistern

  • IC
  • PCOM
  • ACOM

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Aneurysmal Subarachnoid hemorrhage pattern: Sylvian fissure

MCA bifurcation

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Aneurysmal Subarachnoid hemorrhage pattern: Prepontine cistern, cerebellopontine angle

  • PICA
  • Basilar tip
  • Vertebral

20

Identify

Aneurysmal subarachnoid hemorrhage

21

Identify

Aneurysmal subarachnoid hemorrhage

22

Identify

Aneurysmal subarachnoid hemorrhage

23

Identify

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Identify

25

Identify

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Identify

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Identify

28

Intraparenchymal hemorrhage: Hypertensive

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Intraparenchymal hemorrhage: Peripheral lobar

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Intraparenchymal hemorrhage: Traumatic (blunt)

31

Identify

Intraparenchymal hemorrhage shearing injury

32

Stroke definition

"clinical" acute nervous system injury/focal neurologic deficit with abrupt onset

33

Infarct definition

Pathologic/Radiologic

  • Brain cell death attributable to ischemia based on neuropathological, neuroimaging and/or clinical evidence of permanent injury

34

Hemorrhagic infarct

popped vessel

35

Ischemic infarct

Blocked vessel

36

Venous infarct

blocked or popped vein

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Transient ischemic attack

clinical diagnosis

temporary blocked vessel/temporary neurologic deficit (<1 hour)

38

Acute ischemia accounts for what % of all stroke?

~80%

39

Ischemic stroke scale

40

How is imaging helpful in stroke?

CT, MRI: Bleed or no bleed

CT, MRI, cerebral perfusion imaging: How large is the infarction? is there salvageable brain?

CTA, MRA, catheter angiogram: is there a large vessel occlusion

41

The primary goal for imaging in stroke is to?

  • Rapidly identify and triage patients for appropriate therapeutic intervention
  • Time = brain
  • Imaging approach dependent on resources and expertise

 

42

Recent imaging clinical trials

Recent clinical trials

  • Endovascular thrombectomy in large vessel occlusions
  • Expanded time window for therapy (role for cerebral perfusion imaging)

43

How is CT of head helpful?

bleed or no bleed

no large-volume infarction

44

No intracranial hemorrhage nor large volume infarction =

t-PA

45

How is CTA head and neck helpful?

  • Cardiac embolus
  • Atheromatous plaque
  • Vascular injury
  • Aneurysm

46

Proximal accessible large vessel occlusion =

endovascular thrombectomy

47

Aneurysm treatment

Surgical clipping or endovascular coiling

48

Ischemic infarct by CT features

4 listed

49

Ischemic infarct by MRI features

50

Ischemic infarct evolution: Ages

  • Hyperacute
  • Acute
  • Subacute
  • Chronic

51

Ischemic infarct evolution: CT features

Hyperdense artery sign is the earliest sign

Parenchymal hypodensity as early as 1 hour, up to 6 hours

  • lentiform nucleus hypodensity
  • Insular ribbon sign

Parenchymal swelling day 1-7

Volume loss and gliosis is the latest sign

52

Ischemic infarct evolution: MRI features

DWI: Bright from 0-14 days

ADC: Dark from 0 hrs to 10 days, normalizes 10-14 days

T2 Flair: bright from 2-6 hours up to 21 days

Cortical laminar necrosis: T1 bright after 14 days, as early as 3-5 days

Parenchymal enhancement: ~5-7 days to 8 months

53

Ischemic infarct evolution: Hemorrhagic transformation

2-5 days

54

Identify

Left MCA infarct, insular ribbon sign 18 hours later

55

Identify

Left MCA infarct, hyperdense MCA sign, carotid bulb thrombus

56

Identify

Global hypoxic ischemic injury

57

Identify

Herpes Encephalitis

58

Identify

59

Identify

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Identify

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Identify

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Identify

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Identify

73

Identify

74

Homunculus

75

Identify motor strip

right finger tapping

76

Identify motor strip

77

Identify area

Broca's Area

78

Identify area & function

  • Broca's Area
  • Naming objects

79

Identify Area & Function

  • Wernicke's Area 
  • Language comprehension

80

Where is the primary visual cortex?