review Flashcards by Matt Skalski

LUCKENSCHADEL skull?

also known as lacunar skull
Seen almost exclusively with Chiari II malformations
The inner table is more affected than the outer, with regions of apparent thinning (corresponding to nonossified fibrous bone) of the skull vault.

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beaten brass skull?

The appearance of copper beaten skull is associated with raised intracranial pressure in children. Convolutional markings may be normal, but are usually confined to the posterior part of the skull’s inner table.

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Pacchionian granulation?

aka Arachnoid granulation

most frequently occurs in a parasagittal location and can cause an osteolytic, sharply circumscribed lucency on a skull x-rays, or a filling defect in dural venous sinuses, which can be mistaken for dural venous thrombosis. They increase in size with age and are seen in approximately two-thirds of patients.

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HYPEROSTOSIS FRONTALIS INTERNA, who gets it?

Older females (>35 yoa)

90% female

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DDx for wormian bones?

P—pyknodysostosis
O—osteogenesis imperfecta
R—rickets healing
K—kinky hair syndrome (menkes)
C—cleidocranial dysplasia
H—hypothyroidism/hypophosphatasia
O—otopalatodigital syndrome
P—primary acro-osteolysis (Hajdu-cheney)/pachydermoperiostosis
S—syndrome of down

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persistent metopic suture seen in what 3 conditions?

Can be seen in cleidocranial dysostosis, pyknodysostosis and downs syndrome

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Chamberalin’s and McGregor’s measurements?

3mm, 4.5mm (yochum says 7mm for McG, he is wrong, even by his own reference)

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2 most common syndromes associated with craniosynostosis are?

Aperts and Crouzons

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what synostosis is seen in apert’s?

coronal synostotis with an malformed and short cranial base resulting in a short and high skull (brachyturricephaly)

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3 metabolic conditions associated with premature suture fusion?

hyperthyroidism, hypercalcemia, hypophosphatasia

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MICROCEPHALY?

premature fusion of all sutures
Can get cloverleaf skull
MCC: defective development of brain which doesn’t require the skull to enlarge

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SCAPHOCEPHALY?

aka DOLICHOCEPHALY

Elongated head A-P due to premature closure of sagittal suture

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TRIGONOCEPHALY?

premature fusion of metopic suture, small pointed forehea

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BRACHYCEPHALY

Short AP diameter, wide transverse diameter

Bilateral coronal suture closer

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TURRICEPHALY?

Bilateral coronal and/or lambdoid synostosis, skull is shortened with upward growth (i.e. increased vertical diameter)

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PLAGIOCEPHALY?

Unilateral premature fusion of coronal or lambdoid suture (M/C synostosis)

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DYKE-DAVIDOFF-MASSON SYNDROME?

(1) Decrease size of ½ of cranium due to hypoplasia/atrophy of a cerebral hemisphere
(2) Mental retardation, Atrophy of body side opposite lesion
(3) Skull may be thickened to accommodate for small brain size

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defects in sphenoid bone and absent posteriosuperior orbital wall -> pulsating exopthalmos due to temporal meningocele/herniation

NEUROFIBROMATOSIS

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ddx for floating teeth?

EG, periodontitis, ameloblastoma, F/D, desmoplastic fibroma, HPT, Giant Cell reparative granuloma, odontogenic cyst (gorlins), Infection (actinomycosis)

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Battle’s sign?

ecchymosis over mastoids, indicates temporal bone fx

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Temportal bone fractures are longitudinal how often?

70-90% of temporal bone Fx’s

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M/C Fx of facial bones?

Tripod Fx
due to blow over malar eminence, primarily involves zygoma
affects zygomatic arch, orbital process, and maxillary process

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Dorsal induction abnormalities?

Anencephaly, Cephalocele, meningocele, encephalocystomeningocele

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Ventral induction abnormalities?

Holoprosencephaly, Dandy-Walker malformation, Cerebellar agenesis, Septo-optic dysplasia, Arhinencephaly

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What and when is dorsal induction?

When neural plate appears and forms rudimentary components of CNS Primary neurulation, 1st 3-4 wks Secondary neurulation, 4-5th wks

What and when is ventral induction?

5-10th wks | Anatomic components of brain formed (pros, tele, di, my and rhombencephalon, etc)

Prosencephalon divides into what?

Tele and diencephalon Teleencephalon is cortex, basal ganglia, etc Diencephalon is thalamus, etc

Mesencephalon includes what?

Tectum, Cerebral peduncle, Pretectum, cerebral aqueduct

Rhombencephalon divides into what?

Met and myelencephalon Metencephalon: Pons, Cerebellum myelencephalon: Medulla Oblongata

Neuronal proliferation abnormalities?

Neuronal proliferation occurs in the 2nd-4th months The phacomatoses are examples

Migration abnormalities?

Occurs in the 2nd-5th months Examples include: Lissencephaly (agyria), Pachygyria, Polymicrogyria, Schizencephaly, Heterotopias

Common associated finding with septo-optic dysplasia?

50-67% have diabetes insipidus | schizencephaly ~50%

septo-optic dysplasia AKA?

de Morsier syndrome

Lisch nodules?

small hamartomas/low grade malignancies on anterior iris, seen in 90% of those with NF

Ventral induction abnormalities?

Holoprosencephaly, Dandy-Walker, other cerebellar dysplasias, septo-optic dysplasia, arhinencephaly

% of NF's that malignantly degenerate?

5-15(or up to 30)% (neurofibrosarcoma)

In NF, 5. Multifocal high signal lesions on T2 in globus pallidus, brainstem, cerebellum, thalamus, internal capsule are probably what?

M/C low grade benign astrocytomas or hamartomas

intramedullary tumors in NF 2?

ependymomas

Sturge-Weber syndrome AKA?

encephalotrigeminal angiomatosis

30% of SW pts have what ipsilateral to facial nevus?

scleral angiomatosis

Tuberous sclerosis aka?

Bourneville’s

Locations of hamartomas in TS?

brain & retina, skin, Heart, Kidney

e Subependymal nodules?

Tuberous Sclerosis | 90% of pts on CT, iso to grey matter, 88% have calcification on CT, 31% have ring enhancement on MR

Subependymal giant cell astrocytoma - who, what, where, what do they look like?

benign tumour, seen almost exclusively in tuberous sclerosis (but <10% have them) M/C at foramen of Monro (subependymal), homogeneous enhancement, can obstruct foramen 90% have partial calcification, iso to parenchyma on T1, hyper T2

Clinical findings in VHL?

increased intracranial pressure, cerebellar dysfunction, subarachnoid hemorrhage, polycythemia

associated findings/malignancies with VHL?

Renal cell carcinoma (25-40%), pheochromocytomas (10%), cystic disease of Kidney/pancreas/Liver (50-70%)

types of schizencephally?

Type I – closed-lip – cleft walls are in apposition | Type II – open-lip – walls are separated, M/C

Major ddx for schiz?

porencephalic cyst – due to insult to normally developing brain, line with white matter, not grey

% of low grad astrocytomas that progress?

50% of surgically Tx’d lesions evolve into anaplastic astrocytomas or GBMs (M/C/C of death = degeneration into a higher-grade tumor)

Oligodendroglioma's are MC found where?

MC frontal lobes, occasionally parietal. 85% supratentorial

40% of all pineal region neoplasms?

Germinomas

possible lab finding in germinoma, teratoma & Choriocarcinoma?

May produce beta-HCG in CSF, serum

15% of pineal masses?

teratomas (MC male, up to 8:1)

only pineal region tumor to undergo spontaneous hemorrhage?

Choriocarcinoma

2nd M/C tumor in pineal region?

Glial neoplasms, M/C astrocytoma

size cutoff for micro vs macroadenomas?

10mm

ddx for craniopharyngioma?

Rathke’s cleft cyst, necrotic pituitary adenoma, thrombosed aneurysm, cystic hypothalamic or opticochiasmatic glioma

ependymoma found where in kids and adults

More common in 4th ventricle in kids More common in supratentorial parenchyma in adults, ventricular lesions in adults occur in body or trigone of lateral ventricle

M/C brain tumor in kids <2 yoa, 86% occur before 5yoa?

Chroid plexus papilloma

Chroid plexus papilloma location in kids vs adults?

4th ventricle is M/C in adults, 2nd M/C kids (40%) | lateral ventricles are 2nd M/C in adults but M/C in kids (50%)

Hemangioblastoma may secrete what and do what to the blood?

polycythemia due to erythropoietic factor within neoplasm

If AVM is in the temporal lobe, greater risk for what?

8% of pts >20 yoa with and AVM develop epilepsy, 37% if the AVM is in the temporal lobe

CSF signal mass that displaces vessels?

Arachnoid cyst. Main DDx is epidermoid tumor which encases arteries and nerves

3 MC cerebellopontine angle masses?

1. Schwannoma 2. Meningioma 3. Epidermoid cyst

MC location for intracranial lipoma?

80% are supratentorial, 50% of which occur near the splenium of the corpus callosum

term for region surrounding infarcted tissue?

penumbra

Lacunar infarcts – 15-25% of all strokes, occur where? are usually associated with what?

Small, deep cerebral infarcts, M/C located in basal ganglia, internal capsule, and thalamus, M/C multiple, usually associated with HTN

Infarction of what area results in expressive aphasia?

Broca's

how often are berry aneurysms multiple?

15-20% are multiple, with 75% have 2 aneurysms, 15% have 3, 10% >3 Female more likely to have multiple

MC location for aneurysm?

90% occur in circle of Willis, 40% of which are at anterior communicating artery

hemorrhagic infarct usually due to what?

M/C due to reperfusion after ischemia

MC location for DAI to occur?

Grey/white junction (66%), CC 20%

most lethal head injury?

SDH, up to 30% of fatal injuries

period between traumatic event and onset of coma/neuro deterioration in EDH?

lucid interval

85-95% of EDH are due to a fx that lacerates what artery?

middle meningeal artery

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