Subfalcine Downward Upward Cerebellar

herniation Transtentorial transtentorial tonsillar

herniation herniation herniation
Herniated cingulate gyrus inferomedial superior Downward
component slides underneath displacement of transtentorial displacement
the falx. the uncus through herniation of the of the
the tentorial notch cerebellar vermis cerebellar
due to posterior tonsils
fossa mass effect through
foramen
magnum
Compressed may rarely cause 1.ipsilateral CN III obstructive Compression
structure compression of the paresis hydrocephalus of medullary
anterior cerebral 2. compression of from aqueductal respiratory
artery PCA compression. centers is
Contralateral 3. Duret often fatal
hydrocephalus hemorrhages
may result from 4. compression of
foramen of Monro contralateral
obstruction cerebral peduncle

Allergic Fungal Sinusitis Acute Invasive Fugal Sinusitis

involves Opacification of multiple sinuses bilaterally Opacification of multiple
Favours ethmoid and maxillary sinuses. Stranding /
Extension into the fat around
the sinuses
Immune Normal Immune System (Asthma is common) immunocompromised
system - Neutropenic = Aspergillus
- Diabetic in DKA =
Zygomycetes / Mucor
CT Hyperdense centrally or with layers. Can Opacified Sinus with is NOT
erode and remodel sinus walls if chronic. hyperdense. Fat
stranding in the orbit,
masticator fat, pre-antral fat,
MRI Tl-T2 Dark Tl/T2 Dark. mucosa may not
Inflamed (T2 bright) mucosa which will enhance. The enhance (suggesting it is
glob of fungus snot will not enhance necrotic).
The extension of disease out of
the sinus will be
bright on STIR and enhance.
 hyperacute acute infarct early subacute late subacute chronic infarct
infarct 0-6 6-72 hours infarct infarct
hours 1.5 days - 5 5 days - 2
days weeks
DWI Hyper hyper hyper Hyper iso
ADC hypo hypo resolving Iso or normal hyper
Diffusion restricted restricted Less restricted increased increased di-
diffusivity. usivity
T2w signal Normal or Hyper in grey Hyper T2/FLAIR T2/FLAIR
subtle hyper matter involving both hyperintense hyperintense
grey and
white matter
Mass effect ---------- Increasing peaks at 3-4 reduction …….
peaks at 3-4 days in mass effect.
days
enhancement ---------- --------- gyriform ………
enhancement
6 d to 6 wks
Perfusion decreased increase in Perfusion
cerebral blood size of the imaging shows
volume of the infarct core continued
infarct core+/- with expansion of
penumbra resultant the infarct
decrease in core and
size of the further
penumbra. reduction in
penumbra
Type of cytotoxic vasogenic vasogenic resolving resolving
edema edema
Traumatic pseudoaneurysm:Arteries close to bony structures (such as the basilar and vertebral
artery) are prone to dissecting aneurysms.

Saccular Fusiform Mycotic Oncotic Traumatic

aneurysm aneurysm aneurysm aneurysm pseudoaneurysm

cause combination Atherosclerosis Bacterial neoplasm trauma

of chronic endocarditis
hemodynamic dissection
stress and
acquired
degeneration
of the vessel
wall.
location arising at a Posterior distal arterial distal arterial
branch point circulation circulation, circulation
in the circle of beyond the
Willis circle of Willis
Other can be do not occur at A benign left Arteries close to
classified as branch point atrial bony structures
small (<1 cm), myxoma may (such as the
medium (>1 peripherally basilar and
cm and <2.5 embolize and vertebral artery)
cm), and giant cause a distal are prone to
(>2.5 cm). oncotic dissecting
aneurysm aneurysms.
 Rhomboencephalosynapsis joubert syndrome
vermis absent Absent or small
cerebellum abnormal fusion of the cerebellum Small Cerebellum
Classic imaging Transversely oriented single lobed "Molar Tooth" appearance
appearance cerebellum
4th ventricle small Large 4th Ventricle
"Batwing Shaped"
Fastigial point and primary Rounded Fastigial Point, Absent Fastigial Point,
fissure Absent Primary Fissure Absent Primary Fissure
association Holoprosencephaly Spectrum Retinal dysplasia (50%),
Multicystic dysplastic
kidneys (30%).
Liver Fibrosis ("COACH"
Syndrome)

Chiari type I II III

features Tonsillar descend more here is relatively less features of of Chiari 2
that 5 mm from BO tonsillar herniation, plus
line but more cerebellar Occipital
vermian Encephalocele
displacement

Imaging features Clival Hypoplasia Encephalocele

Low Lying Torcula containing cerebellum
Thinned Corpus and/ or the brainstem,
Callosum occipital lobe, and
Tectal Beak sometimes even
Interdigitated Cerebral the fourth ventricle
Gyri
association Syrinx Lumbar • Syrinx ( cervical)
Klippel-Feil Syndrome. myelomeningocele / • Tethered cord
 NOT associated with a Spina Bifida • Hydrocephalus
neural tube defect Only seen in patients • Agenesis of the
with a neural tube corpus
defect callosum

pseudotumor Thyroid ophthalmopathy

unilateral bilateral
painful painless
Involves the myotendinous insertion Spares the myotendinous insertion
most commonly involves the lateral rectus I aM SlOw
Inferior, Middle, Superior, Lateral, Oblique