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Neuroradiology

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