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Neuro Radiology Flash
Neuro Radiology Flash
Lateral Disks
Lateral recess
Hemangioblastoma features
Syrinx
Most common intradural tumor in thoracic region
Spinal meningioma features
Most common intraspinal mass
Esthesioneuroblastoma
Three most common primary (mets by far more common)
skull base malignant tumors
Cholesteatoma
Cholesterol granuloma
Tornwaldt cysts
Most common minor salivary gland malignancy and has
propensity for perineural spread
Retinoblastoma features
Thyroglossal duct
The usual clinical presentation is that of a painless neck mass
along the anterior border of the sternocleidomastoid muscle,
presenting during the first to third decade.
Lymphangiomas
Subgaleal hematoma
Intracranial air, pneumocephalus, may be seen with what
fractures
Subdural hematomas
Subarachnoid hemorrhage
Intraventricular hemorrhage
Cortical contusions
Subfalcial herniation
Uncal herniation
Transtentorial Herniation
Leptomeningeal cyst
Duret hemorrhage
Nonaccidental trauma head findings
Moya moya disease
Differential diagnosis of supratentorial partially cystic,
partially solid mass in a child:
Le Fort I
Le Fort II
Le Fort III
Fogging effect
SCA territory
Anterior Inferior Cerebellar Arteries (AICA) arise from
Posterior Inferior Cerebellar Arteries (PICA) arise from
Involvement of the medulla in PICA infarction adds elements
of Wallenberg syndrome, which include
Lacunes
Beginning at the genu and working back, the internal capsule
carries somatotopically organized fibers
Perivascular spaces
Arteriovenous malformations
Cavernous malformations
Venous malformations
Extra-axial tumors
Significant general midline shift, if shift is greater than
Radiation necrosis
Gliomatosis cerebri
Oligodendroglioma features
Leptomeningeal carcinomatosis
Most common primary cerebellar neoplasm in adult
population.
Most reliable way to differentiate a medulloblastoma from an
astrocytoma on cross-sectional imaging studies is
Capillary hemangioblastomas
Meningioma
Central neurocytoma
Subependymoma
Colloid cyst
Pineoblastoma
Pineocytoma
Pineal cysts
Pituitary adenomas
Craniopharyngioma
Schwannoma
Most helpful imaging feature in distinguishing vestibular
schwannomas
Suprasellar Masses
Cerebellopontine Masses
Intracranial lipomas
Arachnoid cysts
Intracranial tuberculoma
Brain Coccidioidomycosis
Brain Blastomycosis
Brain Histoplasmosis
CNS Aspergillosis
CNS Mucormycosis
CNS Candidiasis
Most frequently reported CNS fungal infection.
CNS Cryptococcosis
Gelatinous pseudocyst
Cysticercosis
Echinococcosis
Amebic meningoencephalitis
Neurosyphilis
CNS Lyme disease
Creutzfeldt-Jakob disease
Meningitis forms causing thick meningeal enhancement
(pachymeningeal)
Most common AIDS CNS infections
Most common CNS AIDS tumor
HIV Encephalopathy
Most common opportunistic CNS infection in AIDS
Toxoplasmosis
Most common AIDS CNS fungal infection
Dysmyelination
Demyelination
Ependymitis granularis
Senescent periventricular hyperintensity
Marchiafava-Bignami disease
Radiation Leukoencephalitis
Radiation Necrosis
Ex Vacuo Ventriculomegaly
Parkinson disease
Huntington disease
Wilson disease
Pelizaeus-Merzbacher Disease
Hydranencephaly
Hypoxic ischemic encephalopathy occuring within 1st
trimester
Hypoxic ischemic encephalopathy occuring at less than 26
weeks of gestation
Hypoxic ischemic encephalopathy occuring at greather than
28 weeks
Alobar holoprosencephaly
Semilobar holoprosencephaly
Lobar holoprosencephaly
Hemimegalencephaly
Schizencephaly
Chiari II malformations
Chiari I malformations
Dandy-Walker Malformations
Tuberous sclerosis
Sturge-Weber Syndrome
Conjoined root: Normal variant of two roots exiting thecal sac together.
Same density of thecal sac. Tarlov cyst: Normal variant of dilated nerve root
sleeve. Same density of thecal sac.
May cause nerve root impingement causing symptoms of a superior level.
Nerve root has already exited central canal.
Facet joint degenerative change (most common). Lligamentum flavum
hypertrophy.
Facet joint degenerative change with bony encroachment.
Lumbar spine bony canals where nerve roots lie after exiting thecal sac and
before entering neuroforamen. Hypertrophy of superior articular facet is
most common cause of encroachment.
Break in bony ring of the lamina (pars interarticularis) at the mid vertebral
body level.
Bilateral spondylolysis. Facet joint degenerative change.
Scar tissue enhances. Disk material has only minimal peripheral
enhancement.
Type 2 degenerative disk disease: Low T1 disk and high T2 parallel endplate
bands. Disk space infection: High T2 disk.
Ataxia. Bowel and bladder incontinence. Babinski sign.
Several vertebral bodies with height loss. Anterior weding with posterior
elements spared. Normal T1 and T2 unless fracture. Disk spared.
Most (75%) occur in cervical and upper to midthoracic cord. Fusiform cord
widening. High T2 signal. Contrast enhancement over several vertebral
body segments.
Occur in spinal cord and posterior fossa. High association with Von Hippel-
Lindau syndrome. Densely enhancing nidus with related cyst and or cord
expansion. May be extramedullary and multiple. May be mistaken for
arteriovenous malformation (AVM).
(1) Superficial mucosal. (2) Parapharyngeal. (3) Carotid. (4) Parotid. (5)
Masticator. (6) Retropharyngeal. (7) Prevertebral.
Squamous mucosa. Lymphoid tissue (adenoids, lingual tonsils). Minor
salivary glands.
the carotid space posteriorly, the parotid space laterally, the masticator
space anteriorly, and the superficial mucosal space medially. Therefore, the
parapharyngeal space will be compressed on its medial surface by masses
originating from the mucosal surface, displaced anteriorly by carotid sheath
masses, displaced medially by parotid masses, and displaced posteriorly
and medially by masses within the masticator space.
Vascular tumors arising from neural crest cell derivatives. Names given
according to location: Carotid body tumor (at carotid bifurcation). Glomus
vagale tumor (vagus nerve). Glomus jugulare tumor (jugular ganglion of
vagus nerve). Glomus tympanicum tumor (Arnold and Jacobson nerves of
middle ear).
Grow in a linear fashion along optic nerve. Tram track pattern of linear
enhancement. May invade through dura. May be extensively calcified.
Usually arterial in origin. Often result from skull fracture disrupting middle
meningeal artery.Strips dura from inner table of the skull. Forms an ovoid
mass. Generally does not cross suture lines.
Less common than arterial epidurals. Tend to occur at the vertex, posterior
fossa, or anterior aspect of middle cranial fossa. Usually result from
disrupted dural venous sinuses. Vertex epidurals can cross sagittal suture.
Typically result from tearing of cortical veins that traverse the subdural
space. Will not cross falx cerebri or tentorium. Can cross sutural margins.
Frequently layer along hemispheric convexity from anterior falx to posterior
falx. Crescent-shaped in axial plane. Biconvex in coronal plane.
Focal brain injury involving superficial gray matter. Occur near bony
protuberances: Temporal lobes above petrous bone or posterior to greater
sphenoid wing. Frontal lobes above cribriform plate, planum sphenoidale,
and lesser sphenoid wing.
Both follow CSF T1 and T2 signal. Epidermoids restrict diffusion, are bright
at DWI. Arachnoid cysts do not restrict diffusion. Epidermoids are
composed of epithelial cells that grow in layers. Arachnoid cysts contains
CSF.
Pachymeningeal enhancement is characteristically thick, smooth, and
uninterrupted.
Colloid cyst. Generally are hyperdense to brain parenchyma. Do not
enhance.
CT finding occuring during 2nd week after infarction. Cerebral edema and
mass effect subside while proteins accumulate from cell lysis. Injurred brain
morphology and density appear normal at CT.
Commonly seen in infarct during the first week. May be due to slow flow or
vasodilation in arteries and veins. May be detected within minutes of vessel
occlusion. Seen in a majority of cortical infarcts at 1 to 3 days. Resolves by
10 days.
3 to 7 days postinfarction.
30 to 90 days (1 to 3 months) postinfarction.
Medial lenticulostriate branches: Rostral portions of basal ganglia.
Pericallosal branches: Corpus callosum. Hemispheric branches: Medial
frontal and parietal lobes.
Lateral lenticulostriate branches: Supply most of basal ganglia. Hemispheric
branches: Lateral cerebral surface.
Midbrain and thalamic perforating branches. Posterior choroidal arteries.
Cortical branches to medial temporal and occipital lobes.
ACA/Medial lenticulostriates/Left
MCA/Hemispheric branch/Left
MCA/Hemispheric branch/Left
MCA/Hemispheric branch/Left
MCA/Hemispheric branch/Right
PCA/Hemispheric branch/Either
PCA/Hemispheric branch/Both
PCA/Hemispheric branch/Both
PCA/Thalamoperforators/Either
PCA/Thalamoperforators/Either
Watershed/ACA,MCA,PCA/Bilateral
SAP: Superior cerebellar artery. Anterior inferior cerebellar artery. Posterior
inferior cerebellar artery.
Superior vermis. Middle and superior cerebellar peduncles. Superolateral
aspects of cerebellar hemispheres.
Proximal basilar artery.
Distal vertebral artery, 1 to 2 cm below basilar origin.
Virtually all infarcts will be smaller in size by 3 weeks. If lesion is same size
or larger at 3 weeks, a neoplasm should be favored.
Everything outside the brain: Arachnoid. Meninges. Dural sinuses. Skull.
Ventricles.
Granulation tissue generally forms 72 hours after surgery. Early (less than
72 hours) postop enhancement likely reflects residual tumor rather than
granulation tumor.
Oligodendroglioma.
Grade II tumor. Commonly located in the frontal lobes. Often extends to
cortex and may erode calvarium. 70% calcify.
Old Elephants Age Gracefully: Oligodendroglioma. Ependymoma.
Astrocytoma. Glioblastoma multiforme.
Hemangioblastoma.
Noncontrast CT scan. Astrocytoma will usually be hypodense.
Medulloblastoma will almost never be hypodense.
Pilocytic astrocytoma.
Subependymoma.
Meningioma. Metastasis.
Seen in 10% of patients with tuberous sclerosis (look for subependymal and
cortical hamartomas). WHO grade I. Commonly calcifies. and slow-growing,
with calcification a common feature. Almost always produces some degree
of hydrocephalus.
1 cm.
Most commonly seen in adults (women more than men). Usually well
demarcated, noninvasive, and slow growing. Often calcified. Rarely
metastasizes. At imaging, can't be differentiated from pineal germinoma or
pineoblastoma.
Are common. Signal similar to or slightly higher than CSF, likely due to lack
of CSF puslation. No enhancement.
Occur within all age groups. Most common locations: Interhemispheric falx
(often associated with agenesis of corpus callosum). Quadrigeminal plate.
Suprasellar regions. Chemical shift artifact or fat suppression. Presence of
flow void or traversing cranial nerve favors lipoma and excludes dermoid.
Are intra-arachnoidal. 50% occur in middle cranial fossa. Other sites: Frontal
convexity. Suprasellar and quadrigeminal cisterns. Posterior fossa. Follow
CSF signal and density. May remodel adjacent bone. Do not restrict
diffusion. Enlarged cisterna magna fills immediately at cisternography;
whereas, arachnoid cyst may not fill or slowly fill.
Caused by dog tapeworm. More commonly involves liver and lungs, but
brain can rarely be involved. Cysts are usually solitary, unilocular, large,
round, and smoothly marginated. Most often supratentorial, in the middle
cerebral artery territory.
Herpes zoster facial neuritis. Ear pain, facial paralysis, vesicular eruption
about the ear. MR may reveal increased enhancement of facial nerve.
Multiple high T2 signal and enhancing mass lesions (1-4 cm) with
surrounding vasogenic edema. Larger lesions usually exhibit ring
enhancement. Unlike bacterial abscesses, toxoplasmosis lesions are not
high in signal on DWI. Preferred sites: Basal ganglia. White matter. Cortex.
Main differential consideration is primary CNS lymphoma.
Cryptococcosis.
Multiple CNS lesions separated in time and space. Typical lesions are high
T2 signal and round or ovoid in a periventricular (perpendicular to ventricle)
or subcortical location. Enhancement reflects new lesions. Dark T1 lesions
are due to acutal neuronal tissue loss. Other sites affected: Cerebellar and
cerebral peduncles. Corpus callosum. Medulla. Spinal cord. Conglomerate
large lesions may be mistake for a neoplasm (tumefactive).
MS.
Proton-density and FLAIR sequences. PD: CSF has similar signal intensity as
white matter. Perivascular space is isointense to brain. Ischemic lesions are
bright due to gliosis. FLAIR: Parenchymal lesions with gliosis have abnormal
signal.
Normal head size. Infantile form 1-2 yo. Juvenile form 5-7 yo. Diffuse white
matter involvement. No gray matter invovlement. Most common
Leukodystrophy. Deficiency of the enzyme arylsulfatase A.
Normal head size. 5-10 yo. Symmetric occiptal and splenium of corpus
callossom white matter invovlement. No gray matter involvement. Sex-
linked recessive condition (peroxisomal enzyme deficiency) occurring only
in boys.
Normal head size. Less than 5 yo. Focal areas of subcortical white matter.
Basal ganglia and periaquaductal gray matter involvement. Also called
subacute necrotizing encephalomyelopathy. Mitochondrial enzyme defect.
Normal to large head size. Less than 1 yo. Frontal white matter
involvement. No gray matter involvement.
Normal to large head size. less than 1 yo. Diffuse white matter involvement.
Vacuolization of cortical gray matter. deficiency of aspartoacylase, leads to
the buildup of NAA (MRS).
28 weeks .
26 weeks.
Deep gray matter: Isodense to white matter. Mottled high T1 and low T1
signal. White matter: Normal. May see blurred gray-white junction on
protein density images.
Deep gray matter: Variable T1 and T2 signal. White matter: High T1 and low
T2 perirolandic cortex.
Deep gray matter: High T2 signal. White matter: High T2 perirolandic cortex.
Thinned gyri, atrophy.
Large posterior fossa with high tentorial insertion. Dilated cystic 4th
ventricle fills posterior fossa. Cerebellar vermis and hemispheres may be
hypoplastic or absent.
Altered signal in white matter and basal ganglia. Dural ectasia. Optic and
other gliomas. Sphenoid dysplasia. Thinning long bone cortex (ribbon ribs).
Plexiform neurofibromas. Caf au lait spots. Iris hamartomas (Lisch
nodules). Vascular stenoses.
Vestibular schwannomas. Meningiomas. Spinal glial tumors. Optic and
other gliomas.