radcards neuroradiology
Terms
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- ddx: young patient with infarct
-
dissection
vasculitis
sickle cell
OCPs
HIV (neurosyphilis) - how is dissection diagnosed
-
MR: cresenteric high signal on T1WI surrounding the vessel
MRA: signal loss over long segment
Angio: long segment narrowing from proximal ICA to skull base - what are features of vasospasm
-
occurs around 7 days
70% prevalence by angio
30% prevalence clinically
10% have neuro deficit due to vasospasm - how is vasospasm treated
-
triple H therapy: hypertension, hypervolemia, hemodilution
vasodilators
angioplasty - what are features of temporal arteritis
-
older pts
headache
visual changes
elevated ESR
extracranial vessel irregularity
treated with steroids - what increases risk for cerebral aneurysms
-
atherosclerosis
marfan's
pseudoxanthoma elasticum
syphilis
coartation
polycystic kidney disease
FMD
persistent fetal vessels - ddx: young patient with nasal vault mass
-
encephalocele
dermoid
nasal glioma
esthesioneuroblastoma - ddx: cerebral vasculitis
-
drugs (cocaine, amphetamines)
SLE
PAN
meningitis
SAH
radiation
primary granulomatous CNS infection
HIV
syphilis - ddx: cerebral atrophy
-
HIV
ETOH
metabolic
MS
lupus
steroids
malnutrition
chemotherapy - ddx: lobar hemorrhage
-
A TIN HAT
AVM/aneurysm
trauma
infection
neoplasm
HTN
amyloid
thrombosis (venous) - ddx: mass at maxillary ostium
-
antrochoanal polyp
inverting papilloma
mucocele - ddx: pansinus disease
-
allergic polyposis
CF
wegener's - ddx: destruction of nasal septum
-
midline granuloma
wegener's
cocaine abuse
trauma - what is midiline granuloma?
-
wegener's variant
aka mutilating granuloma
worse prognosis than wegener's - ddx: mandibular lesion
-
unilocular:
-abscess
-radicular cyst
-dentigerous cyst
multilocular:
-amelobastoma
-odontogenic keratyocyst
-fibrous dysplasia - what is the approach to disease of the basal ganglia
-
bilateral symmetric: methanol (putamen), CO (globus pallidus)
bilateral asymmetric: infection
unilateral: glioma, hemorrhage, toxo, lymphoma - ddx: infrahyoid neck, visceral space mass
-
thyroglossal duct cyst
thyroid lesion
squamous cell ca - ddx: parotid space mass
-
pleomorphic adenoma
wharthin's tumor (bilateral)
adenoid cystic carcinoma
mucoepidermoid carcinoma
lymphoepithelial cyst
lymphoma
*pearl* 2/3 of parotid masses are benign; 2/3 of submandibular/sublingual gland masses are malignant - ddx: masticator space mass
-
odontogenic infection/lesion
sarcoma
lymphoma - what is a thornwald cyst
-
a notochordal remnant
cystic
superior nasopharynx, midline - ddx: pharyngeal mucosal space mass
-
squamous cell carcinoma
tonsillar abscess
pleomorphic adenoma
thornwald cyst - ddx: parapharyngeal space mass
-
tonsillar abscess
atypical 2nd branchial cleft cyst
pleomorphic adenoma
*pearl* pterygoid venous plexus may normally enhance here - ddx: carotid space mass
-
paraganglioma
schwannoma
lymphadenopathy
pseudoaneurysm - what is the most common middle ear mass?
- glomus tympanicum
- where do middle ear acquired cholesteatomas live
- prussak's space (between ossicles and scutum)
- ddx: petrous apex mass
-
cholesterol cyst (granuloma)
congenital cholesteatoma
mucocele
metastasis
chondrosarcoma
chordoma (atypical) - what is the difference between vasogenic and cytotoxic edema
-
vasogenic:
-most common
-spreads along white matter tracts
-BBB breakdown
cytotoxic:
-inflammation or ischemia
-gray matter and white matter
-due to cell death - ddx: hyperdense sinus
-
fungal sinusitis
inspissated secretion
hemorrhage - most common osseous tumor of sinuses
- osteoma
- what are the findings in chiari 2
-
small posterior fossa
cervico-medullary kink
vermian peg
beaked tectum
elongated 4th ventricle
agenesis of corpus callosum
stenogyria
myelomeningocele - what are the findings in dandy-walker
-
large posterior fossa
agenesis of vermis
torcular inversion
migrational abnormalities
agenesis of corpus callosum - most common cause of solitary lesion in AIDS
- lymphoma
- most common infection of brain in AIDS
- HIV
- second most common infection of brain in AIDS
- toxoplasmosis
- ddx: pulsatile tinnitus
-
dehiscent jugular bulb
aberrant carotid artery
glomus tumor
dural AVM/F
petrous aneurysm
meningioma - what are the types of carotid-cavernous fistula
-
direct:
-large hole
-trauma or cavernous aneurysm
-severe symptoms
-any age
indirect:
-dural AVF
-many small holes
-mild progressive symptoms
-older females - ddx: chronic sinus disease
-
cystic fibrosis
osteomeatal complex obstruction
fungal sinusitis
allergic sinusitis
obstructing neoplasm
wegener's
midline granuloma
cocaine - ddx: subarachnoid hemorrhage
-
aneurysm
truama
dural AVF?M
dissection - what are typical injection rates in cerebral angio
-
arch: 20-25 cc/total of 40-50
CCA: 7-8/9-10
ICA: 5-6/7-8
ECA: 4/6
vert: 4-5/6-10 - how does the signal of parenchymal blood change over time on T1 and T2 WIs
-
hyperacute: iso and hyper
acute: iso and hypo
early subacute: hyper and hypo
late subacute: hyper and hyper
chronic: hypo and hypo
ItBe IdDy BiDy BaBy DooDoo - ddx: intradural, extramedullary lesion
-
nerve sheath tumor
meningioma
CNS 'drop mets'
extra-CNS mets
ependymoma
dermoid/epidermoid
sarcoid - what primaries like to spread to leptomeninges
-
lung
breast
melanoma
leukemia/lymphoma - name the CNS primaries that can give 'drop mets'
-
medulloblastoma
ependymoma
germinoma
pineoloblastoma
choroid plexus papilloma
GBM - ddx: lateral intraventricular mass
-
astrocytoma
choroid plexus papilloma
ependymoma
meningioma
PNET
mets
subependymal giant cell astrocytoma
central neurocytoma
dermoid/epidermoid - which CNS tumors hemorrhage
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GBM
oligodendroglioma
PNET
ependymoma
mets - which mets hemorrhage
-
MRICT
melanoma
renal cell ca
islet cell tumors
choriocarcinoma
thryoid cancer - which mets spread to the dura
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breast
lymphoma
prostate
neuroblastoma - describe a giant intracranial aneursym
-
aneurysm > 25 mm
2-5% of all aneurysms
F>M
40% involve cavernous ICA - compare CT and MR evaluation for infarction
-
CT:
acute: early insular ribbon sign, hyperdense vessels
late: gray-white differentiation lost, hypodensity
subacute: sulcal effacement
chronic: encephalomalacia
*pearl* may see fogging subacute (infarct is isointense and unseen)
MRI:
hyperacute: abnormal diffusion/perfusion; intravascular enhancement
acute: lost grey-white differentiation, T2 high signal; meningeal enhancement
subacute: mass effect, sulcal effacement, gyral enhancement
chronic: encephalocmalcia, gyral enhancement
*pearl* gyral enhancement may persist for months - ddx: spinal intramedullary lesion
-
astrocytoma
ependymoma
mets
hemangioblastoma
syringohydromyelia
demyelination
viral mets
sarcoid
infarct
vascular malformation - ddx: sellar/parasellar mass
-
SATCHMOE
-suprasellar germinoma/sarcoid
-adenoma/aneurysm
-TB
-crangiopharyngioma/rathke cleft cyst
-hypothalamic glioma/hamartoma
-meningioma/mets
-optic nerve glioma
-eosinophilic glioma - ddx: pineal lesion
-
Baby Germs Make Some People Cough
pineoBlastoma
germ cell tumor
meningioma
spelenium glioma
pineocytoma
cyst (pineal) - what's too large for a pineal cyst
- > 8.5 mm
- what sign on CT may differentiate an intra- from an extra-pineal lesion
- exploded pineal - intrapineal lesions push normal calcs outside them, extrapineal lesions engulf normal calcs