Imaging-CNS & Vascular Diseases Flashcards Preview

Neuro I > Imaging-CNS & Vascular Diseases > Flashcards

Flashcards in Imaging-CNS & Vascular Diseases Deck (18)
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1
Q

A 20 year old man was injured from a blast. Physical exam revealed a GCS of 12 with a penetrating neck injury. The next day his neurological function detoriated. Images from both days are shown below. What is causing his neurological function to deteriorate?

A

There is an embolus parked at the top of the basilar artery at day 1. In day 2 it moved to the posterior cerebral artery, occluded it and caused an infarction.

2
Q

What molecules are responsible for auto regulation of blood flow to the brain?

A

pH, pCO2 and a little bit of pO2.

3
Q

What artery is labeled below?

A

Opthalmic artery

4
Q

How would the structure indicated below look in the saggital view?

A

This is the flow void for the internal carotid artery. In the axial view you are seeing them in the supra cellar cistern and in the coronal view you see them in the cavernous sinus.

5
Q

What landmarks are you looking for in this image?

A

*

6
Q

Locate the Sylvian triangle in this patient. What causes this triangle to form? Locate the anterior cerebral artery, why does it take this route? Locate the posterior cerebral artery.

A

The Sylvian triangle forms a triangle because the vessels fold over the insula. The anterior cerebral artery swoops the way it does because it has to go around the corpus callosum.

7
Q

In this coronal slice, locate the lenticulate nuclei, caudate nuclei and lenticulostriate vessels. What happens if one of the lenticulostriate vessels gets occluded?

A

If a lenticulostriate vessel gets occluded, you get small lacunar infarctions because these vessels do not anastamose with one another.

8
Q

What blood vessel connects the anterior circulation to the posterior circulation?

A

The posterior communicating artery connects the internal carotid artery to the basilar artery

9
Q

What blood vessels can continue supply to the middle cerebral artery in the event that the internal carotid gets occluded?

A

Posterior cerrebral or anterior cerebral artery.

10
Q

Which blood vessels supply the regions of the brain indicated below? Why do infarcts in the arteries that supply the regions below typically not cover the entire region?

A

Blood flow is typically shunted to the nearest artery in the event of occlusion and regions of the occluded vessel are supplied with blood via anastomoses

11
Q

A 70 year old man comes to the ED with weakness on the right side of his body, slurred speech, blurred vision and difficulty walking. An angiogram was done and the results are shown below. Where is the occlusion in this patient?

A

This patient has an occlusion of the internal carotid artery. Note that the external carotid gives off branches to the face and occiput early on. The internal carotid does not give off any branches until the opthalmic artery inside of the skull.

12
Q

A 70 year old man comes to the ED with weakness on the right side of his body, slurred speech, blurred vision and difficulty walking. CT of the patient is shown below. What about this image points you towards an ischemic stroke?

A

The insular ribbon sign. Note that the insular ribbon is darker than the other side. Normal gray matter in the cortex comes out brighter than underlying white matter in the cortex on CT.

13
Q

A 53 year old man comes to the ED with left-sided hemiparalysis for the past four hours. His CT is shown below. What is your diagnosis?

A

Note the hyper dense middle cerebral artery. This patient has a clot.

14
Q

What type of images are these and what do they tell you?

A

DWI (Diffusion weighted image) and and ADC map. If the two areas of infarction line up you know there is cytotoxic edema (hallmark of cerebral ischemia that has killed the tissue)

15
Q

Is this a normal image?

A

No. There is a stump where the middle cerebral artery and its branches should be coming off, and stumps are bad.

16
Q

A 47 year old woman who had a sudden onset of head and photophobia while watching TV came to the ED. She has difficulty seeing now. Her CT angiogram is shown below.

A

This patient had a basilar tip aneurism. Note that the superior cerebellar artery and the posterior cerebral artery sandwich CN III and cause the loss of vision in this patient.

17
Q

What blood vessels are prone to causing the image seen below?

A

This is an intracerebral hematoma near the thalamus. This is typically caused by rupture of a lenticulostriate muscle as a result of muscle wall weakening from hypertension.

18
Q

What is the huge mass seen in the MRI below??

A

Arteriovenous malformation. Note that there is a huge mass without any herniation. This is a short circuit from an artery to a vein in the brain.