Neuroradiology Flash Cards

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Title: Neuroradiology
Description: Neuroradiology flash cards from headneckbrainspine.com
Number of Cards: 378
Save Count: 6
Author: mantilo
Created: 2011-12-29
Tags: mantilo medicine neuroradiology radiology
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    • Question
    • Answer
    • Side 3
    • Disk protrusion terminology
    • Bulge: Broad-based disk bulge. Usually bulging annulus fibrosus. Protrusion: Focal disk bulge. Usually herniated nucleus pulposus.
    • Intervertebral disk high intensity zone (HIZ)
    • High T2 signal of annulus indicating annular tear.
    • Disk free fragment mimickers
    • 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.
    • Lateral Disks
    • May cause nerve root impingement causing symptoms of a superior level. Nerve root has already exited central canal.
    • Common causes of Central Canal Stenosis
    • Facet joint degenerative change (most common). Lligamentum flavum hypertrophy.
    • Most common cause of neuroforaminal stenosis
    • Facet joint degenerative change with bony encroachment.
    • Lateral recess
    • 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.
    • Spondylolysis identified on axial images
    • Break in bony ring of the lamina (pars interarticularis) at the mid vertebral body level.
    • Spondylolisthesis occurs from either
    • Bilateral spondylolysis. Facet joint degenerative change.
    • Distinguishes postop scar from disk material
    • Scar tissue enhances. Disk material has only minimal peripheral enhancement.
    • Differentiates disk infection fromdegenerative disk disease at MR
    • Type 2 degenerative disk disease: Low T1 disk and high T2 parallel endplate bands. Disk space infection: High T2 disk.
    • Myelopathy neurologic signs
    • Ataxia. Bowel and bladder incontinence. Babinski sign.
    • Radiculopathy neurologic signs
    • Muscle weakness. Decreased reflexes. Dermatomal sensory deficits.
    • Urgency for imaging acute myelopathy
    • Poor prognosis if left untreated for greater than 24 hours.
    • Common causes of myelopathy
    • Extramedullary: Epidural mass cord compression. Cervical spine stenosis. Intramedullary: Tumor. Inflammation, Arteriovenous malformation (AVM). Spinal dural arteriovenous fistula (SPAVF).
    • Definition of Intramedullary spinal canal lesion
    • Usually confined to spinal cord. May be exophytic.
    • Definition of extramedullary spinal canal lesion
    • Outside of spinal cord. May be intradural or extradural.
    • Intradural intramedullary lesions
    • Ependymoma. Astrocytoma. Hemangioblastoma. Lipoma/(Epi)dermoid. Syringohydromyelia. Intramedullary AVM. Met/abscess (rare).
    • Intradural extramedullary lesions (includes subarachnoid space)
    • Meningioma. Schwannoma/neurinoma. Neurofibroma. Hemangiopericytoma. Lipoma/(Epi)dermoid. Arachnoid cyst/adhesion. Drop/leptomeningeal metastasis. Veins (extramedullary AVM).
    • Extradural extramedullary lesions
    • Degenerative: Herniated disc. Synovial cyst. Osteophyte. Rheumatoid pannus. Nondegenerative: Metastasis. Abscess. Hematoma. Primary tumor expansion or invasion. Epidural lipomatosis
    • Most common intramedullary lesion at MRI
    • Multiple sclerosis
    • Lupus Erythematosus spinal cord involvement
    • Areas of high T2 signal with cord swelling. May involve 4 or 5 vertebral segments. Have less well-defined margins than MS plaques.
    • Atlantoaxial instability and rheumatoid arthritis
    • Inflammatory changes (pannus) destroy transverse ligament of C1. Dens may slide posteriorly and intermittently compress cord causing myelomalacia. 5% of RA patients frank atlantoaxial instability.
    • Vertebral body and disc infection findings
    • Adjacent vertebral bodies and disc usually involved. Destruction greatest at endplates. Posterior elements usually spared. Low T1 and high T2 marrow signal with normal diffusion. If pyogenic disk enhances, granulation tissue extends above and below affected vertebrae.
    • Vertebral body neoplasm findings
    • Isolated or noncontiguous involvement. Pedicles typically affected. Low T1 and high T2 signal with restricted diffusion. Disk typically spared (except prostate cancer). Enhancement may obscure metastases within fatty marrow.
    • Vertebral body osteoporosis findings
    • Several vertebral bodies with height loss. Anterior weding with posterior elements spared. Normal T1 and T2 unless fracture. Disk spared.
    • TB of the spine, or Pott disease
    • Causes slow collapse of one or more vertebral bodies. Gibbus deformity, acute kyphosis. Infection spreads underneath longitudinal ligaments. Can lead to cord compression. May spare disks.
    • Most common neoplasm of the spine
    • Metastases
    • Two most common primary intramedullary tumors
    • Astrocytoma. Ependymoma.
    • Spinal cord astrocytoma and ependymoma shared features
    • Expansile. Low T1 and high T2 signal with variable enhancement. Increased incidence in neurofibromatosis.
    • Spinal cord Ependymoma features
    • Most common spinal cord tumor in adults. Divided into cellular (intramedullary) and myxopapillary (filum terminale) types. Peak incidence inf ourth decade. Male predominance. These slow-growing neoplasms arise from ependymal cells lining the central canal of the cord or cell rests along the filum. Expansile. Low T1 and high T2 signal with variable enhancement. Increased incidence in neurofibromatosis.
    • Spinal cord Astrocytoma features
    • Most (75%) occur in cervical and upper to midthoracic cord. Fusiform cord widening. High T2 signal. Contrast enhancement over several vertebral body segments.
    • Hemangioblastoma features
    • 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).
    • Syrinx
    • Shorter term for syringohydromyelia. Hydromyelia, dilation of central canal and lined by ependyma. Syringomyelia, cavity outside central canal lined by glial cells. Suspect tumor as a cause of unexplained syrinx.
    • Most common intradural tumor in thoracic region
    • Meningioma
    • Spinal meningioma features
    • Most (80%) occur in women. Average age of 45. Multiple meningiomas suspicious for neurofibromatosis. Usually extramedullary/intradural. Can have extradural component. Dense calcification can occur. Dense homogenous enhancement. Broad dural tails.
    • Most common intraspinal mass
    • Schwannoma
    • Spinal schwannoma features
    • Neuroforaminal extension and expansion are common in cervical and thoracic spine with intra and extraspinal components, dumbbell shape. In lumbar spine, tend to remain within dural sac.
    • Common intrathecal drop metastases
    • Subarachnoid seeding of primary CNS tumors: Posterior fossa medulloblastomas. Ependymomas. Pineal region neoplasms.
    • Most common spine extradural neoplasm
    • Metastatses: Breast, Lung, Prostate carcinoma.
    • Very low T1 and T2 marrow signal
    • Myelofibrosis
    • Spinal AVM features
    • May be intramedullary or extramedullary. Intramedullary AVMs have a nidus of abnormal vessels that may cause hemorrhage or ischemia. Extramedullary AVMs generally are arteriovenous fistulas. Spinal dural arteriovenous fistulas (SDAVFs) cause symptoms through venous hypertension and congestion of the cord with edema.
    • Tethered Cord features
    • Low-lying conus medullaris. In a newborn conus normally at L2. Typically ascends one to two vertebral segments as child grows. May form a taut mass in posterior lumbar canal, obscuring conus/cauda junction.
    • Caudal Regression Syndrome
    • Hypoplastic or absent distal spine and sacrum. Blunted conus.
    • Spinal Arachnoid cysts and epidermoids
    • Similar to brain arachnoid cysts and epidermoids. Arachnoid cysts follow CSFsignal. Epidermoids restrict diffusion, bright on DWIs.
    • Spinal Epidural Hematoma
    • Ventral epidural space contains plexus of veins. These can tear in trauma, resulting in epidural hematoma.
    • Nerve Root Avulsion
    • Most commonly occur in cervical spine. Typically involve roots of brachial plexus and upper extremities. Birth trauma from shoulder traction is common example.
    • Acute versus chronic sinusitis findings
    • Acute sinusitis: Air-fluid levels and foamy secretions. Typically caused by viral URI. Chronic sinusitis: Mucoperiosteal thickening. Thickening of bony sinus walls.
    • Disease limited to the infundibulum of the maxillary ostium will result in
    • Isolated obstruction of maxillary sinus.
    • Lesion located at hiatus semilunaris (middle meatus) results in
    • Obstruction of ipsilateral maxillary sinus, anterior and middle ethmoid air cells, and frontal sinus. Described as ostiomeatal pattern of obstruction.
    • Sphenoid sinusitis is of great clinical concern as it may
    • Extend intracranially due to presence of valveless veins.
    • Sinus mucous retention cyst versus mucocele
    • Mucous retention cyst: Obstructed mucous glands within mucosal lining. Usually round. 1 to several cm in diameter. Mucocele: Entire sinus is obstructed. Expansion of sinus. Sinus wall bony thinning and remodeling. Mass may be present obstrucing draining ostium.
    • Inverting Papilloma
    • Neoplastic epithelium inverts and grows into underlying mucosa of lateral nasal wall. Surgically resected due to association with squamous cell carcinoma.
    • Juvenile nasopharyngeal angiofibromas
    • Male adolescents with epistaxis. Benign tumor but can be locally aggressive. Fills nasopharynx and bows posterior wall of maxillary sinus forward. Retromaxillary pterygopalatine fossa location is a hallmark feature. Avidly enhance.
    • Malignancies of paranasal sinuses and nasal cavity.
    • Squamous cell carcinoma. Lymphoma. Minor salivary tumors.
    • Most common salivary malignancies include
    • Adenoid cystic carcinoma. Adenocarcinoma. Mucoepidermoid carcinoma.
    • Esthesioneuroblastoma
    • Arises from neurosensory receptor cells of olfactory nerve and mucosa. Occurs anywhere from cribriform plate to turbinates. Often quite destructive by time of diagnosis. Usually found high within nasal vault.
    • Three most common primary (mets by far more common) skull base malignant tumors
    • Chordoma (destructive midline mass). Chondrosarcoma. Osteogenic sarcoma (from radiation or Paget's degeneration).
    • Cholesteatoma
    • Soft tissue mass (epidermoid cyst of desquamating stratified squamous epithelium) within middle ear cavity. Typically associated with bone erosion. Superior tympanic membrane (pars flaccida) is the most common site. CT images extent of disease.
    • Opacified petrous apex differential
    • Retained fluid secretions: Dark T1, bright T2, no enhancement. Petrous apicitis: Dark T1, bright T2, and ring enhancement. Nonaerated petrous apex: Bone marrow, bright T1, dark T2, and no enhancement. Cholesterol granuloma: Hemorrhagic component, bright T1 and T2.
    • Cholesterol granuloma
    • Granulation tissue within partially obsructed petrous air cells. Have cholesterol and hemorrhagic component (high T1 and T2 signal).
    • Deep anatomy of the head and neck is subdivided by layers of deep cervical fascia into the following spaces:
    • (1) Superficial mucosal. (2) Parapharyngeal. (3) Carotid. (4) Parotid. (5) Masticator. (6) Retropharyngeal. (7) Prevertebral.
    • Mucosal head and neck compartment contents
    • Squamous mucosa. Lymphoid tissue (adenoids, lingual tonsils). Minor salivary glands.
    • Mucosal head and neck compartment pathology
    • Nasopharyngeal carcinoma. Squamous cell carcinoma. Lymphoma. Minor salivary gland tumors. Juvenile angiofibroma. Rhabdomyosarcoma.
    • Parapharyngeal head and neck compartment contents
    • Fat. Trigeminal nerve (V3). Internal maxillary artery. Ascending pharyngeal artery.
    • Parapharyngeal head and neck compartment pathology
    • Minor salivary gland tumor. Lipoma. Cellulitis/abscess. Schwannoma.
    • Parotid head and neck compartment contents
    • Parotid gland. Intraparotid lymph nodes. Facial nerve (VII). External carotid artery. Retromandibular vein.
    • Parotid head and neck compartment pathology
    • Salivary gland tumors. Metastatic adenopathy. Lymphoma. Parotid cysts.
    • Carotid head and neck compartment contents
    • Cranial nerves IX–XII. Sympathetic nerves. Jugular chain nodes. Carotid artery. Jugular vein.
    • Carotid head and neck compartment pathology
    • Schwannoma. Neurofibroma. Paraganglionoma. Metastatic adenopathy. Lymphoma. Cellulitis/abscess. Meningioma.
    • Masticator head and neck compartment contents
    • Muscles of mastication. Ramus and body of mandible. Inferior alveolar nerve.
    • Masticator head and neck compartment pathology
    • Odontogenic abscess. Osteomyelitis. Direct spread of squamous cell carcinoma. Lymphoma. Minor salivary tumor. Sarcoma of muscle or bone.
    • Retropharyngeal head and neck compartment contents
    • Lymph nodes (lateral and medial retropharyngeal). Fat.
    • Retropharyngeal head and neck compartment pathology
    • Metastatic adenopathy. Lymphoma.
    • Prevertebral head and neck compartment contents
    • Cervical vertebrae. Prevertebral muscles. Paraspinal muscles. Phrenic nerve.