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DM Neuroradiology
Neuroradiology
| Question | Answer |
|---|---|
| Indications for skull radiographs | pre-mri(rule out presence of metal), pre-surgery, metabolic diseases, multiple myeloma |
| 80% of head trauma deaths in <2yo | Child Abuse |
| Bilateral retinal hemorrhages in a child | Child abuse; shaken baby |
| Whatever is bright on X-ray is bright on | CT |
| What is brightest on a T2 | T2 fluid is bright (H20) |
| What is brightest on a T1? | Fat |
| MRI is good for | soft tissue discrimination |
| Why would you use a myelography instead of MRI? | can't fit in MRI machine, pacemaker, or other metal. Myelography: contrast injected in subarachnoid space, viewed under fluoroscopy or CT |
| CT angiogram and MR angiogram are more commonly used than | Angiography. |
| Nuclear imaging basic principle | Radiopharmaceuticals localize in tissue, emit detectable radiation |
| Nuclear imaging indications | blood flow (hypermetabolic activity), bony mets, brain activity (alzheimer disease, Parkinson, Epilepsy) |
| Caudate is located where? | Draped directly lateral to the ventricles |
| Obstructive hydrocephalus | mass causes pressure to block flow of CSF |
| Non-obstruction | impaired absorption of the CSF |
| modality of choice for a head bleed/trauma | Noncontrast CT |
| Most common cause of epidural bleed | damage to the middle meningeal artery |
| Cause of subdural hematomas | Venous; bleed will be free-flowing |
| In this type of hematoma, there is no where for the blood to go except in and out of the sulci and gyri of the brain | Subarachnoid hematoma. 2 most common causes: trauma, aneurysm hemorrhage. Acceleration/decleration injury |
| Worst headache of my life | Subarachnoid hemorrhage. Causes: trauma, ruptured aneurysm, drugs (cocaine and ecstasy can cause: sympatomimetics) |
| C1 fx | Jefferson fx |
| C2 fx | Hangman's fx |
| MOA of Hangman's fx | hyperextension; unstable, right next to the cord |
| Ligaments ripping off the spinous process | Clay Shoveler's Fx, commonly C7 |
| Spondylolysis | defect in pars interarticularis. Look for a collar/lucency around the neck of the scottie dog |
| Spondylolisthesis | slipping of vertebrae: concern of compressing the spinal cord or the caudate equina. Spondylolysis can lead to spondylolisthesis |
| Most Cerebrovascular Diseases are | Infarction (75%), Hemorrhagic (25%) |
| Suprasella Cistern should be what shape? | A star in the center of the brain |
| Floating palate, fx maxillary sinus | Le Fort I Facial Fx |
| Pyramidal fx, medial orbital and lateral maxilla | Le Fort II facial Fx |
| Craniofacial dysjunction, horizontal orbits | Le Fort III facial Fx |
| IN an orbital blowout fx, which muscle are you concerned about being entrapped? | inferior rectus muscle (causing vertical diplopia) |
| Imaging for nasal bone fx | No imaging needed!! Fingers only. DO look in the nasal cavity for hematoma |
| 5 Lines to look for on Spine Radiograph | Prevertebral soft tissue, Anterior vertebral line, Posterior Vertebral Line, Spinal Laminar line, Spinous processes |
| Pathophysiology of Cerebrovascular Disease | Cell death --> Na/K pump failure --> influx of Na --> followed by influx of water --> "cytotoxic" edema. On a T2, look for bright spots -- indicative of cytotoxic edema |
| Which vessel is stroke most common in? | The MCA has the largest territory in the brain, and thus the MCA is the most common vessel of stroke (2/3 of all cerebral infarcts) |
| A pt comes in with a stroke, which imaging modality should you use? | CT first to make sure there is not a bleed. |
| Unclear grey:white junction is an early sign of | early sign of stroke |
| Which is more sensitive to Stroke: MRI or CT? | MRI. MRI is highly sensitive and can detect stroke earlier |
| Which strokes are usually purely sensory or motor and are focal strokes from smaller vessels | lacunar stroke |
| Modality of choice for a brain neoplasm | MRI |
| ventricles, meninges and skull are considered | extra-axial. |
| 40-50% of CNS Neoplasms are | Glial tumors (graded I-IV) |
| This type of CNS neoplasm is hormonally active, see in 5th-6th decade and 90% are benign. May increase in pregnancy | Meningioma |
| Light-bulb sign on CT is associated with which neoplasm | Meningioma |
| Most common site for CNS neoplasm in kids | Posterior Fossa Tumors (brainstem, cerebellum, etc) |
| Main organisms causing acute sinusitis | H. flu, S. pneumo, M. Cat (kids). Imaging not needed |
| Do you image patients with chronic sinusitis? | NO. Unless they fail maximum tx, preoperative or neoplasm |
| Steeple sign is seen in | Croup. B/c croup is an upper airway disease; airway is thinned and peaked |
| Imaging for Croup | X-ray |
| Thumb print sign is seen in | epiglottitis; low airway sign. Need someone around who is comfortable intubating a ped. Often kids sit in "sniffing position" |
| Imaging of Choice in AIDS related CNS infections | MRI. Top OI is Toxoplasmosis. Ring enhancing lesion, which is also seen in lymphoma. Tell the difference with an abx and time |
| Imaging of choice for MS | T2 MRI |
| Axons and myelin sheaths show up as white matter on T1's b/c they are | fat |
| Dawson's fingers are typical in | MS |
| What is seen in Huntington's Imaging? | Atrophy of Caudate and Putamen and expansion of the ventricles like a butterfly |
| Normal Pressure Hydrocephalus imaging of choice | CT: Ventriculomegaly out of proportion to normal brain atrophy |
Created by:
ltm12