Vascular neuroroadiology Flashcards
(24 cards)
Classically where is SAH in trauma vs. aneurysm
Trauma - vertex Aneurysm - basilary/dependent
Where do these aneurysms bleed?
Acom
Pcom
MCA
Basilar tip
PICA
Acom - interhemispheric fissure
Pcom - Ipsilateral basal cistern
MCA - Sylvian fissure
Basilar Tip - Interpeduncular cistern
PICA - Posterior fossa
Aneurysms are associated with what diseases? (3 diseases/catagories)
PCKD
collagen vascular diseases
coarctations
SAH
Ealry sideffects
mid - side effects
late side effects
Early; hydrocephalus
mid; vasospasm (4-14 days after)
late; Superficial siderosis
Things other than SAH that also cause vasospasm
Meningitis
PRES
RCVS (reversible cerebral vasospasm syndrome) (a/w pregnancy and a thurnderclap headache)
Migraine
What is superficial siderosis?
(clinical history, classic imaging).
What is next step?
Sideffect of repeated episodes of SAH.
Classic presentation is sensorineural hearing loss and ataxia.
“Staining the surface of brain w/ hemosidern.’ classic look is curvilinear low signal on GRADIENT which is coating the surface of the brain.
Next step is CTA or MRA
pseudo SAH
Edema make the cisterns look relatively more bright.
The tricks to tell it is Pseudo SAH are that there will be no sulcal density, its just in basal cisterns. and the hounsfield units will not be high enough.
Hypertensive hemorrhage classic findings
Basal ganglia, Pons, Cerebellum.
Putamen is very commonlocation.
Intraventricular extension is common.
Ddx for lobar hemorrhage
Amyloid hemorrhage, hypertensive hemorrhage, hemorrhage from a mass
3 classic findings with susceptibility sequencews
Amyloid
Cavernoma
Bleeding
Old person w/ multiple head bleeds
Amyloid angiopathy
Old, multiple bleeds in multiple lobes of different ages. Subcortical microhemorrhages. Lobar bleed with normal blood pressure
What does Flair look like on hyperacute stroke?
Normal. It only begins to intensify after the first 6 hours.
Infarct that involves bilateral thalami
Artery of percheron infarct.
Classically involves Bilateral paramedian thalamus w/ or w/o midbrain involvement. Artery of Percheron comes off of PCA.
The artery of Percheron is a rare variant of the posterior cerebral circulationcharacterised by a solitary arterial trunk that supplies blood to the paramedian thalamiand the rostral midbrain bilaterally.
Infarct of caudate head
Recurrent artery of hubener infarct.
Originates from proximal ACA
Classic history - s/p acom aneurysm clipping.
Ddx hypdense lesion in thalami
Artery of percheron infarct
Wernicke’s encephalopathy
internal cerebral vein thrombosis.
Which types of people/strokes are likely to have hemorrhagic conversion of stroke?
people with anticoagulation
large territory bleed, proximal MCA stroke
multiple strokes
venous infarcts
T1 Curvilinear/gyriform hyperintense signal
Cortical laminar necrosis.
Occurs after a stroke. Starts after 2 weeks. Peaks at 1-3 monts. Then it fades.
Accumilation of dead cells/protein creates T1 hyperintensity. No blood.
What do Brain MRI sequences look like in peds patients.
On T1, you don’t look like you’re an adult until you’re 1
On T2, you don’t look like an adult unti you’re 2. (before that, your white matter is still bright on T2, cause it hasn’t yet myelinated)
2 types of watershed territories
External watersheds
- between cortical branches
- isolated infarcts, hemodynamic compromise, decreased distal perfusion pressures with less embolism washout
- better prognosis
Internal watersheds
- between cortical branches and perforators.
- systemic hypodynamic compromise
- Poorer prognosis (deep perforators have less collaterals)
ICA stenosis with puff of smoke appearance on angiographyl in a Sickle cell patient.
Difference in how this can present for kids vs. adults.
MoyaMoya
Stenosis of supraclinoid ICA - develops lots of collaterals
In a kid - watershed stroke
in Adult - bleed
What is classic association with DVA
Cavernoma
Low flow lesion with a dilated capillary bed. Name, classic imaging, classic association.
Cavernoma
Can be single or familial
“popcorn-like” with peripheral rim of hemosidern
typically do not have catastrophic bleeds
a/w nearby DVA
Venous malformation in the PONS.
Classic pattern
What is an iatrogenic way they can develop
Capillary telengiectasia
has intervening normal brain tissue
Incidental findings
Brush-like or stipple pattern
can develop as a complication of radiation therapy.
Middle age person with bad white matter disease centeredon temporal lobes
CADASIL
Temporal lobes heavily involved
Normal vasculature.
Classic hx is 40 year old w/ migraine headaches and eventual dementia. There will be severe white matter disease with multiple vascular territories. Temporals involved, occipitals usually spared.
