Neuro review

  1. What are the most common causes of subarachnoid hemorrhage?

    Rupture of aneurysm
  2. What is the pathophysiology of subdural hematoma?
    • Deceleration/acceleration forces
    •        Tear bridging veins
  3. What vessels are damaged in epidural hematomas?
    Damage to middle meningeal artery
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    Hemorrhage at grey-white junction

    Corpus callosum 

  5. What is the most common cause of intracerebral hemorrhage?
    Hypertensive hemorrhage
  6. What vessels are involved in hypertensive hemorrhage?
    Deep penetrating arteries
  7. Where do cerebral artery aneurysms tend to occur?
    Branch points of intracranial vessels
  8. What are structures that can be affected by acute stroke?
    Obscuration of lentiform nuclei

    Loss of insular ribbon
  9. Why are the lentiform nuclei obscured in acute stroke?
    Proximal MCA occlusion leading to limited flow to the lenticulostriate arteries
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    Concha bullosa - pneumatization of the middle turbinate
  11. What is concha bullosa associated with?
    Nasal septal deviation
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    Haller cell - Infraorbital ethmoid air cell
  13. What is the most common intracranial abnormality in battered children?
    Subdural hematoma
  14. Where do traumatic subdural hematomas tend to occur?
    Parieto-occipital region

    Interhemispheric fissure
  15. What separates the frontal and parietal lobes?
    Central (Rolandic) sulcus
  16. What regions in the brain regions affected by MS?
    • 1. Periventricular
    • 2. Spinal cord
    • 3. Juxtacortical (touching cortex)
    • 4. Infratentorial
  17. What is the difference between focal and broad based herniation?
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    Focal herniation - less than 90 degrees of disc circumference

    Broadbased herniation - anywhere between 90-180 degrees
  18. What is the difference between migration and sequestration?
    Migration - displaced disc material away from site of extrusion

    Sequestration - displaced disc material has lost connection with the parent disc
  19. What is the order of involvement of the extraocular muscles in thyroid eye disease?
    I'M SLO

    • I - inferior rectus
    • M - medial rectur
    • S - superior rectus
    • L - lateral rectus
    • O - obliques
  20. What are the most common intramedullary, intradural tumors?

  21. What are the different types of nerve sheath tumors?

  22. What findings are associated with neurofibromatosis II?
    • M - Multiple
    • I - Inherited
    • S - Schwannomas
    • M - Meningiomas
    • E - Ependymomas
  23. What syndrome is associated with multiple neurofibromas?
    Neurofibromatosis Type I
  24. What additional findings in a peripheral nerve sheath tumor that go along with Neurofibromatosis Type I?

    Ribbon ribs (rib dysplasia)

    Scalloping of the posterior vertebral body (dural ectasia)
  25. What is the most common tumor associated with chronic temporal lobe epilepsy?
  26. What is the most common central cause of precocious puberty?
    Hypothalamic hamartoma
  27. What are the most common tumors of the optic nerve?
    Glioma (most common)

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    Meningiomas grow in linear fashion along optic nerve

    "Tram track" - pattern of enhancement of sheath

    May also be extensive calcified
  29. What syndrome are optic nerve gliomas associated with?
    Neurofibromatosis Type I
  30. How can one distinguish ependymomas from astrocytomas in the spinal cord?
    Astrocytomas - longer segment of cord involvement

    More likely to be infiltrative

    LESS LIKELY - hemorrhage or tumor cyst
  31. What is the pathophysiology of Sturge Weber syndrome?
    Fetal cortical veins fail to develop normally

    Leads to chronic venous ischemia
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    Sturge Weber Syndrome

    Cortical "tram track" calcification

    Atrophy of affected side (side with port wine stain)

    Enlarged ipsilateral choroid plexus
  33. What is cranial nerves are most commonly affected by schwannomas?
    Cranial nerve VIII (eight is most common)

    Cranial nerve V
  34. What is the differential diagnosis for mass type lesions that cross midline?
    Glioblastoma Multiforme


    Tumefactive MS
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    Joubert syndrome

    Vermian hypogenesis leading to "molar tooth" appearance  of 4th ventricle and superior cerebellar peduncles
  36. What is the definition of holoprosencephaly?
    Failure of cleavage of prosencephalon into telencephalon and diencephalon
  37. What are the most and least severe forms of holoprosencephaly?
    Alobar - most severe form

    Semilobar - in between

    Lobar - least severe form
  38. What are the two major types of cholesteatomas?
    Pars flaccida (80%)

    Pars tensa (15%)
  39. What is the most common tumor of the middle ear?
    Glomus tympanicum paraganglioma
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    Vertebra plana (pancake vertebral body)

    Sparing of disc space
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  42. What are characteristic imaging and clinical findings of carotid cavernous fistula?
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    Dilation of superior opthalmic vein

  43. What is the most common tumor in the lateral ventricle of a child?
    Choroid plexus papilloma
  44. What part of the lateral ventricles are affected first in hydrocephalus?
    The atria
  45. How can one distinguish hydrancephaly versus hydrocephalus?
    Hydrocephalus - always mantle of brain parenchyma
  46. What are the TORCH infections?
    • T - toxoplasmosis
    • O - Other (varicella)
    • R - Rubella
    • C - cytomegalovirus (CMV)H - Herpes simplex
  47. What infection is suspected in the setting of a normal size head and intracranial calcifications (parenchymal, not periventricular)?
  48. What are the two types of cephaloceles?
    Meningocele - protrusion of meninges through calvarial defect

    Encephalocele - protrusion of brain tissue through calvarial defect
  49. What is the difference between a sulcus and gyrus?
    Image Upload 11

    Sulcus - depression/fissure in surface of brain

    Gyrus - gyri are surrounded by sulci (depressions)
  50. What are the stages of development of the cerebral cortex?


    Cortical organization
  51. What disorders result from abnormalities of neuronal cell proliferation?
    Too many cells - hemimegancephaly

    Too few cells - microlissencephaly/microcephaly
  52. How can one distinguish epidermoid cysts from arachnoid cysts on diffusion weighted imaging?
    Epidermoid cysts - keratin material restricts free diffusion of water

    Arachnoid cysts - no restriction of diffusion of water
  53. What are the parts of the corpus callosum?
    Genu - anterior


    Splenium - posterior
  54. How does CSF flow from the ventricular system?
    Lateral ventricles > Foramen of Monro > Third ventricle > Cerebral aqueduct (Aqueduct of sylvius) > Fourth ventricle > Foramen of Magendie/Luschka
  55. How do brain metastases present in children versus adults?
    Children - leptomeningeal spread

    Adults - gray-white junction
  56. What is the expected spectroscopy profile of glioblastoma?
    Image Upload 12

    • High choline
    • Low NAA
  57. What is the one pathologic condition that does not manifest in low NAA (and high choline)?
    Canavan disease- markedly elevated NAA level

    Often megalocephaly
  58. What is a cholesterol granuloma?
    Granulation tissue in the middle ear
  59. What is a cholesteatoma histologically?
    Epidermoid cyst
  60. What are the major types of cholesteatomas and how often do they occur?
    Acquired (98%)

    Congenital (2%)
  61. What is choanal atresia?
    Block of back of nasal passage due to bone or membrane
  62. What syndrome are angiomyolipomas associated with?
    Tuberous sclerosis
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    Enhancing cribiform plate mass with cysts at tumor/brain margin
  64. What is the white matter above the ventricles called?
    • Corona radiata
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  65. Image Upload 15
    Creutzfeldt Jacob disease

    • T2 hyperintensity/restricted diffusion
    • - Caudate
    • - Putamen
    • - Thalamus (hockey stick)
    • - Cortex
  66. What space is used to determine the location of masses in the suprahyoid space?
    Parapharyngeal space
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    Balo concentric sclerosis

    Variant of MS - alternating bands of demyelinated white matter
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    • Image Upload 18
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    • Bilateral thalamic infarcts - internal cerebral vein thrombosis (straight sinus, vein of Galen)

    Venous infarcts - often bilateral, midline and hemorrhagic
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    Bilateral thalamic and midbrain infarcts -

    Artery of Percheron infarct

    • Single arterial trunk coming off PCA supplying portion of thalamus and midbrain
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  70. 3 year old boy with seizures
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    Neonatal hypoglycemia
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    Neurocysticercosis -

    Most common location in subarachnoid space
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    • Atlanto-occipital dissociation - basion dens interval is greater than 12 mm
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  73. What are the two most common odontogenic tumors?
    Odontoma ("tooth hamartomas")

  74. Young male presenting with muscle spasms and seizures
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    X-linked adrenoleukodystrophy - genetic defect in paroxysmal oxidation of fatty acids

    Posterior periventricular white matter changes

    Can get areas of enhancement (not seen in metachromatic leukodystrophy)
  75. What is the MOST common hereditary leukodystrophy?
    Metachromatic leukodystrophy
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    Indentation of the frontal bones (typically seen before 24 weeks)

    • Associated with:
    • Spina bifida
    • Chiari II Malformation
  77. 11 year old with history of dystonia
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    Pantothenate kinase degeneration (previously known as Hallervorden-Spatz syndrome) - excess iron accumulation in globus pallidi

    Low signal intensity of globus pallidi surrounding central small hyperintense area
  78. Differential diagnosis?
    Image Upload 30
    Dysmelinating disease - "Tigroid" appearance of white matter

    Metachromatic Leukodystrophy

    Pelizaeus-Merzbacher disease
  79. Diagnosis on the left and diagnosis on the right?
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    Left - thyroid opthalmopathy (spares tendinous insertion)

    Right - orbital pseudotumor (can involve tendinous insertion)

    Orbital pseudotumor is associated with a more acute onset involving decreased motion and pain
  80. What syndrome is this lesion commonly associated with?
    Image Upload 32
    Lhermitte Duclos  lesion - likely hamartomatous malformation

    Associated with Cowden disease
  81. How to differentiate mega cisterna magna from an arachnoid cyst?
    Arachnoid cyst - has mass effect
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Neuro review
Neuro review