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Neurochirurgie > Radiology > Flashcards

Radiology Flashcards

(112 cards)

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1
Q

What is the Rule of Spence?

A

If the sum total overhang of both C1 lateral masses on C2 is ≥ 7 mm, the transverse atlantal ligament is probably disrupted

This rule applies to AP or open-mouth odontoid X-ray.

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2
Q

What measurement indicates a disruption of the transverse atlantal ligament according to the Rule of Spence?

A

≥ 7 mm

This measurement refers to the sum total overhang of both C1 lateral masses on C2.

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3
Q

What is being measured in the Rule of Spence?

A

Lateral mass displacement (LMD) of C1 on C2

LMD is measured by the overhang of both lateral masses.

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4
Q

In which type of X-ray is the Rule of Spence applied?

A

AP or open-mouth odontoid X-ray

These X-ray types are used to visualize the relationship between C1 and C2.

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5
Q

What is the normal AP canal diameter on a plain lateral X-ray in an adult?

A

< 12 mm

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6
Q

What may indicate a fracture-dislocation or ligament disruption?

A

An interspinous distance that is 1.5 times that at both adjacent levels

This measurement is critical for diagnosing instability in spinal conditions.

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7
Q

What is the Water’s view in radiology?

A

Also known as submental vertex view, it involves angling the X-ray tube up 45° perpendicular to the clivus.

This view is used to visualize the facial structures and sinuses.

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8
Q

What is the Towne’s view in radiology?

A

An X-ray view where the tube is angled down 45° to visualize the occiput.

This view helps in assessing the occipital bone and the base of the skull.

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9
Q

What is platybasia?

A

Flattening of the skull base

Platybasia can be associated with various medical conditions affecting cranial structure.

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10
Q

What are the two subtypes of BI?

A

Type I and Type II

BI stands for Basilar Invagination.

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11
Q

What characterizes Type I BI?

A

BI without Chiari malformation; brainstem compression due to odontoid process invagination

85% can be reduced with traction.

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12
Q

What is the recommended treatment for Type I BI?

A

Transoral surgery, usually accompanied by posterior fusion

This treatment addresses the brainstem compression.

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13
Q

What characterizes Type II BI?

A

BI with Chiari malformation; brainstem compression due to reduced p-fossa volume

Chiari malformation is a condition where brain tissue extends into the spinal canal.

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14
Q

What is the appropriate treatment for Type II BI?

A

Foramen magnum decompression

This procedure alleviates pressure on the brainstem and spinal cord.

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15
Q

Fill in the blank: Type I BI is characterized by _____ malformation.

A

no Chiari

This distinguishes it from Type II BI.

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16
Q

Fill in the blank: Type II BI involves compression due to reduced _____ volume.

A

p-fossa

The p-fossa refers to the posterior fossa of the skull.

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17
Q

True or False: 85% of Type I BI cases can be reduced with traction.

A

True

This statistic indicates the effectiveness of non-surgical intervention for Type I BI.

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18
Q

What does CBV stand for?

A

Cerebral blood volume

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19
Q

What does CBF stand for?

A

Cerebral blood flow

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20
Q

What does MTT stand for?

A

Mean transit times

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21
Q

What does TTP stand for?

A

Time to peak

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22
Q

In ischemic stroke, MTT is almost always _______.

A

increased

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23
Q

In ischemic stroke, CBF is _______.

A

decreased

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24
Q

What is a key difference in acquisition between perfusion weighted MRI (PWI) and CTP?

A

PWI acquires multiple slices of the whole brain repeatedly, while CTP is limited to a given slice or several slices (usually 10–20 mm thick) that must be chosen.

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25
Which imaging technique has more artifact?
PWI has more artifact than CTP.
26
What is the appearance of CSF in T1-weighted imaging (T1WI)?
Black ## Footnote This is a characteristic feature of T1-weighted MRI.
27
What is the appearance of subcutaneous fat in T1-weighted imaging (T1WI)?
White ## Footnote This is a characteristic feature of T1-weighted MRI.
28
In T1-weighted imaging, CSF appears _______.
black
29
In T1-weighted imaging, subcutaneous fat appears _______.
white
30
What color is CSF in T2WI?
White
31
What does FLAIR stand for in MRI imaging?
Fluid Attenuated Inversion Recovery ## Footnote FLAIR is a specific MRI technique used to suppress the signal from cerebrospinal fluid (CSF).
32
How does FLAIR imaging differ from T2-weighted imaging?
In FLAIR, the CSF is nulled out and appears dark ## Footnote This allows for better visualization of lesions in the brain.
33
What types of lesions appear bright on FLAIR images?
* MS plaques * Other white matter lesions * Tumors * Edema * Encephalomalacia * Gliosis * Acute infarcts ## Footnote These bright appearances assist in diagnosing various neurological conditions.
34
What imaging technique is improved by the use of T2* GRE MRI?
It improves MRI’s ability to delineate bony spurs ## Footnote T2* GRE MRI is specifically used in conjunction with cervical spine imaging.
35
How does T2* GRE MRI compare to FLAIR in terms of sensitivity for demonstrating intraparenchymal blood?
T2* GRE MRI is 3–4 times more sensitive than FLAIR ## Footnote This indicates that T2* GRE MRI is significantly better at detecting intraparenchymal blood.
36
Is T2* GRE MRI more sensitive than SWI?
No, it is not as sensitive as SWI (susceptibility weighted imaging) ## Footnote SWI is considered the most sensitive technique for detecting certain types of brain hemorrhages.
37
What does 'STIR' stand for in imaging?
'STIR' refers to Short Tau Inversion Recovery. ## Footnote STIR is a fat suppression technique used in MRI to enhance the visibility of certain tissues.
38
What is the purpose of fat suppression in imaging?
To enhance the visibility of other tissues by removing the signal from fat. ## Footnote This allows for clearer images of structures like bone and edema.
39
What can bone edema help with in spinal imaging?
Dating spine fractures. ## Footnote Bone edema indicates inflammation or injury, which can help determine the age of a fracture.
40
What type of lesions can STIR imaging help identify?
Periventricular lesions. ## Footnote These lesions are often associated with multiple sclerosis and other neurological conditions.
41
How does STIR imaging affect the appearance of cerebrospinal fluid (CSF)?
It subtracts out CSF from the images. ## Footnote This enhances the visibility of adjacent structures.
42
What type of pathology can be assessed using STIR imaging in the orbit?
Intra-orbital pathology. ## Footnote STIR imaging can help visualize conditions affecting the eye and surrounding tissues.
43
What does 3D CISS stand for?
Three-Dimensional Constructive Interference in Steady State ## Footnote 3D CISS is a magnetic resonance imaging technique used to visualize cranial nerves and other structures.
44
What is the primary application of 3D CISS imaging?
Imaging cranial nerves ## Footnote This technique is particularly useful for evaluating cranial nerve anatomy and pathologies.
45
What condition can 3D CISS help identify related to cerebrospinal fluid?
CSF leaks ## Footnote Cerebrospinal fluid leaks can occur due to various reasons, and 3D CISS can help visualize these leaks.
46
What type of obstruction can be assessed using 3D CISS imaging?
Aqueductal stenosis ## Footnote Aqueductal stenosis refers to the narrowing of the aqueduct of Sylvius, which can lead to hydrocephalus.
47
What is the primary use of diffusion-weighted imaging (DWI)?
Early detection of ischemia (stroke) and differentiating active MS plaques from old ones
48
DWI is based on which type of imaging?
T2WI
49
What does 'shine-through' refer to in DWI?
Bright areas on DWI that can also be bright on T2WI
50
What should be checked to differentiate between restricted diffusion and T2 'shine-through'?
ADC map
51
If an area is black on the ADC map, what does it likely represent?
True restricted diffusion (recent infarct)
52
What do intraparenchymal areas of bright signal on DWI that are not bright on the ADC map represent?
Regions of restricted diffusion such as acute stroke
53
What are the differential diagnoses for areas of increased signal (bright) on DWI?
* Ischemic brain: acute stroke and hypoperfusion (penumbra) * Cerebral abscess * Active MS plaque
54
What does restricted diffusion usually indicate?
Irreversible cell injury (death)
55
In what situation can restricted diffusion indicate tissue that is near cell death?
Penumbra
56
How quickly can acute brain ischemia be detected on DWI?
Within minutes
57
How long does the DWI abnormality persist after an acute stroke?
Approximately 1 month
58
When does the ADC map usually normalize after an acute stroke?
Approximately 1 week
59
What is the DWI and ADC map appearance for a cerebral abscess?
DWI = bright, ADC = dark
60
What is the appearance of active MS plaques on DWI?
Bright
61
Fill in the blank: The DWI abnormality will persist for approximately _______.
1 month
62
True or False: Old MS plaques will appear bright on DWI.
False
63
What does DWI stand for?
Diffusion Weighted Imaging ## Footnote DWI is a type of MRI that measures the diffusion of water molecules in tissue, which can indicate areas of ischemia or infarction.
64
What does PWI stand for?
Perfusion Weighted Imaging ## Footnote PWI is a type of MRI that assesses blood flow to tissues, helping to identify areas with reduced perfusion.
65
What is the purpose of combining DWI and PWI?
To locate areas of diffusion-perfusion mismatch ## Footnote This combination helps in identifying salvageable brain tissue at risk of infarction.
66
What is meant by 'penumbra' in the context of stroke?
Salvageable brain tissue at risk of infarction ## Footnote The penumbra refers to the area surrounding an infarcted region where tissue is still viable but at risk of dying.
67
What is the significance of identifying the penumbra?
To screen for potential candidates for thrombolytic therapy ## Footnote Thrombolytic therapy can help restore blood flow in patients with ischemic strokes if administered promptly.
68
Fill in the blank: DWI and PWI may be combined to locate areas of _______.
diffusion-perfusion mismatch
69
True or False: The deficit on PWI should be less than the zone of diffusion deficit on DWI to identify salvageable tissue.
False ## Footnote The deficit on PWI must exceed the zone of diffusion deficit on DWI to identify salvageable brain tissue.
70
What are projection fibers oriented towards?
Rostro-caudally
71
What structure does the corticospinal tract coalesce into?
Corona radiata, which funnels into internal capsule and forms pyramidal tract
72
What is the orientation of commissural fibers?
Mediolaterally oriented
73
Name two examples of commissural fibers.
* Corpus callosum * Anterior commissure * Posterior commissure
74
What do association fibers connect?
Regions within the same hemisphere
75
What are U-fibers responsible for connecting?
Adjacent gyri
76
What do long association fibers connect?
More distant areas
77
What do optic radiations connect?
Lateral geniculate bodies to visual cortex
78
Where do optic radiations pass in the brain?
Lateral to the body of the lateral ventricles
79
What does the uncinate fasciculus connect?
Anterior temporal lobe to inferior frontal gyrus
80
What can damage to the uncinate fasciculus cause?
Language deficits
81
What regions does the superior longitudinal fasciculus (SLF) connect?
Frontal lobe to temporal and occipital lobes
82
What can injury to the SLF cause?
Language deficits
83
What is the arcuate fasciculus?
Part of SLF connecting Broca’s area to Wernicke’s area
84
What type of aphasia is caused by injury to the arcuate fasciculus?
Conduction aphasia
85
What does the inferior longitudinal fasciculus (ILF) connect?
Temporal and occipital lobes at the level of the optic radiation
86
What deficits can injury to the ILF cause?
* Object recognition deficits * Visual agnosias * Prosopagnosia (face blindness)
87
What is the cingulum's function?
Projects from cingulate gyrus to the entorhinal cortex as part of the limbic system
88
What is the first criterion that triggers a notification of the surgeon in EP change?
50% decrease in peak signal amplitude from baseline ## Footnote This indicates a significant reduction in the electrical activity being monitored.
89
What is the second criterion that triggers a notification of the surgeon in EP change?
Increase in peak latency > 10% ## Footnote This suggests a delay in the neural response, which may indicate potential issues.
90
What is the third criterion that triggers a notification of the surgeon in EP change?
Complete loss of a waveform ## Footnote This indicates a total failure in the expected electrical signal, warranting immediate attention.
91
What does SNAP stand for?
Sensory nerve action potential ## Footnote SNAP refers to the electrical signals generated by sensory nerves in response to stimuli.
92
Where does the ganglion of the sensory nerves lie?
Within the neural foramen
93
What type of lesions do not affect the cell body of sensory nerves?
Preganglionic lesions
94
What can cause preganglionic lesions?
Root compression by herniated disc or root avulsion
95
What is the effect of preganglionic lesions on distal SNAP?
Distal SNAP is unaffected
96
What type of lesions reduce SNAP amplitudes and/or slows sensory conduction velocity?
Postganglionic lesions
97
Where do postganglionic lesions occur in relation to the neural foramen?
Distal to the neural foramen
98
What type of injury is an example of a postganglionic lesion?
Peripheral nerve injury
99
Fill in the blank: Preganglionic lesions do not affect the _______.
Cell body
100
True or False: Postganglionic lesions do not affect SNAP amplitudes.
False
101
What happens to SNAP amplitudes in postganglionic lesions?
Reduces SNAP amplitudes
102
What is the result of root avulsion?
Preganglionic lesion
103
What is an F-wave?
An F-wave is produced when stimulation of a nerve causes both orthodromic and antidromic conduction.
104
What does orthodromic conduction refer to?
Orthodromic conduction refers to normal conduction along the axon away from the cell body.
105
What is meant by antidromic conduction?
Antidromic conduction refers to conduction that travels back towards the cell body.
106
What happens to some anterior horn cells during F-wave production?
Some anterior horn cells that are stimulated antidromically will fire orthodromically, producing the F-wave.
107
How can F-wave latency be affected in certain conditions?
F-wave latency may be prolonged in multilevel radiculopathy.
108
Is F-wave latency sensitive to multilevel radiculopathy?
No, F-wave latency is not sensitive to multilevel radiculopathy.
109
What is a motor unit action potential (MUAP)?
An electrical signal generated by a motor unit during muscle contraction ## Footnote A motor unit consists of a motor neuron and the muscle fibers it innervates.
110
How can a motor unit action potential (MUAP) be assessed?
Only with voluntary muscle contraction by the patient ## Footnote This assessment is crucial for evaluating neuromuscular function.
111
What is the primary EMG criterion for diagnosing radiculopathy?
Fibrillations and/or positive sharp waves in at least 2 muscles innervated by a single nerve root in question, but by 2 different peripheral nerves ## Footnote This indicates that there is damage to the nerve root affecting the muscles.
112
What role do abnormal paraspinals play in the diagnosis of radiculopathy?
They support the diagnosis, but are not required since paraspinals will be normal in approximately 50% of cases ## Footnote This means that the absence of abnormalities in paraspinal muscles does not rule out radiculopathy.

Neurochirurgie (13 decks)

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