Neuroradiology and Brain Tumours Flashcards Preview

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Flashcards in Neuroradiology and Brain Tumours Deck (66):
1

what can cause a headache due to raised ICP

mass, bleed, hydrocephalus, venous thrombosis, infection, oedema

2

what is CT good for

bony detail
spatial resolution
good with emergency/ ICU equipment
fast

3

what is CT bad for

soft tissue
detail
contrast not as good as MRI
high radiation

4

what is dark and light on CT

white things more dense
darkest thing is air

5

what is MRI good for

contrast
soft tissue resolution
depiction of anatomy
marrow and cord pathologies

6

what is MRI bad for

less bony detail
less spatial resolution
not compatible with equipment/ implants
not as quick- need patient cooperation

7

what are the different types of MRI

T1 and T2

T1
-fat, methemoglobin (subacute haematoma), mineral deposition, melanin, contrast material = bright/ hyperintense
-water, air= dark/ hypointense
GREY MATTER WILL BE DARK

T2
(two W's= water white)
-water, air= bright
-fat and 4 m's= dark
GREY MATTER WILL BE LIGHT

T2 flare
form of T2 (grey matter bright) that removes brightness of CSF in the image to look for oedema in the brain
GREY MATTER BRIGHT, CSF DARK

8

does white or grey matter have more myelin

white matter- will be dark in T2, bright in T1 MRI

9

what scan if you suspect an infarct in the brain

MRI (if blood vessel not flowing will show up white)

10

what scan for a brain haemorrhage

CT sensitive for acute haemorrhage but sensitivity lessens with time

time doesn't matter in MRI

if haemorrhage look for aneurysm with CT angiography

11

what vascular abnormality has a popcorn appearance on imaging

cavernoma (cluster of abnormal blood vessels)

12

what scan is used in acute stroke

CT- shows loss of distinction between grey and white matter

13

what imaging is used in all strokes

diffusion weight image

14

what is the hallmark for trauma imaging

CT

15

what can a haematoma in the brain cause

mid line shift, herniation

16

what type of dural haematoma will affect the shape of brain more

extra dural- sub dural can spread further across the brain, extra will create a convex shape

17

when will a tumour enhance with contrast

if vascular in brain only when high grade or if arises from dura (BBB)

18

what does low density around hydrocephalus on imagine mean

oedema in brain

19

what does demyelination look like on CT (T2 and flare)

predominantly affects white mater, inflammation around small venules and veins, lesions on the white matter. CT T2 and flare

20

what is an example of an non infective imflammatory brain condition

demyelination- MS

21

what are intrinsic or extrinsic brain tumours

within our outside of brain parenchyma

22

what are the most common presentations of brain tumours

progressive neurological deficit
motor weakness
headache
seizures

23

how can a tumour increase ICP

mass
oedema mass effect
blockage of CSF flow
haemorrhage

24

what symptoms does raised ICP cause

headache, vomiting, mental changes, seizures
if uncal herniation can cause blown pupil if compresses on oculomotor nerve

25

what are the types of brain herniations

cingulate (subflacine)
central (trans tentorial)
transcalvarial
uncal
upward cerebellar/ transtentorial
downward cerebellar (tonsillar)

26

what type of headache should make you think of brain tumour

worse in morning- wakes them up
increased with coughing/ leaning forward
may be associated with vomiting or symptoms similar to tension headaches/ migraines

27

what do you do if there is scary headache symptoms

always do fundoscopyto look for papilloedema

28

why do tumours cause headaches

raised ICP
invasion/ compression of dural/ blood vessels/ periosteum
double vision
difficulty focusing
extreme hypertension (cushings triad of raised ICP)
psychogenic

29

what does the parietal lobe do

processes sensory input
sensory discrimination
body orientation
primary somatic area
secondary somatic area

30

what does werknickes area do

language comprehension

31

what does the occipital lobe to

visual reception area
visual interpretation

32

what does the cerebellum do

coordination and control of voluntary movement

33

what does the brainstem do

breathing, digestion, heart control, blood vessel control, alertness

34

what does the temporal lobe do

auditory reception area
expressed behaviour
receptive speech
memory/ information retrieval

35

what does the frontal lobe do

premotor cortex- storage of motor patterns

prefrontal area- concentration, elaboration of though, judgement, inhibition, personality, emotional traits

brocas area language production

motor cortex- voluntary motor activity

36

what symptoms should make you urgently refer a patient on suspicion of a brain tumour

adults- progressive sub acute loss of central neurological function
children- newly abnormal cerebellar or other central neurological function

new onset seizures
headaches
mental changes
cranial nerve palsy
unilateral sensioneural deafness

headaches with symptoms of raised ICP
-vomiting
-drowsiness
-posture relates
-pulse synchronous tinnitus

37

what investigations for suspected brain tumour

CT
MRI
LP
PET
lesion biopsy
EEG
evoked potentials
angiograms
radionucleotide studies

38

is papilloedema a late or early sign of a brain tumour

late

39

what is the commonest brain tumour

mets from other areas

40

what type of cells do gliomas arise from

astrocytes

41

what are grade 1 astrocytomas

benign, slow growing- affects children and young adults

42

what are grade 2 astrocytoma like

not benign
vascular
tend to be in parietal or frontal lobes
present with seizures

43

what are the poor prognostic factors for

over 50
focal deficit
short duration of symptoms
raised ICP
altered consciousness
enhancement on contrast studies

44

what is the treatment for a grade 2 astrocytoma

want to do surgery as can become malignant
or depending on tumour:
serial imaging +/- chemo, radio/ no Tx

45

what are grade 3 astrocytomas like

bad- median survival 2 years

46

what are grade 4 astrocytomas like

really bad- median survival 14 months

47

what is the most common pituitary tumour

astrocytoma

48

what is the treatment for grade 4 astrocytomas

Tx not curative unless present v early with a cyst, surgery- cytoreduction, reduce mass effect, post op radiotherapy

49

can you drive if you have a brain tumour operation

no if seizure risk (all glioblastomas) or if significant visual defect

50

what are the types of chemotherapy

temozolomide, PCV, carmustine wafers

51

what are oligodendrogial

tumour of oligodendrocytes (myelin making cells)
affects frontal lobes, may present with seizures - chem sensitive

52

what does tiptoeing, ataxia and vomiting with headaches in children suggest

BRAIN TUMOUR

53

what are meningiomas like

extra axial
commoner in females
majority asymptomatic
90% benign

54

what are the aggressive types of meningiomas

clear cell, choroid, rhabdoid, papillary, radiation induced

55

what is the Tx for meningiomas

small- leave, pre op embolisation
surgery, radiotherapy

56

what does recurrence of meningiomas depend on

extent of resection and grade

57

what are the types of nerve sheath tumours

schwanomas, neurofibromas, malignant peripheral nerve sheath tumours

58

what are the symptoms of a vestibular schwannoma

hearing loss (unilateral), tinnitus, dysequilibrium

59

what is the treatment of a vestibular schwannoma

'expectant'
hydrocephalus management
radiotherpay
surgery
audiological assessment

60

are vestibular schannomas malignant

1% are

61

what are pineal tumours like

present with parinad syndrome, lots of them hormone secreting, often curable with chemo and radio (germ cell tumours)

62

what do you test in any child with a midline tumour

tumour markers- ALP, HCG, LDH
to see if germ tumour and whether it will be chemo/ radio sensitive

63

what procedure treats hydrocephalus

VP shunt

64

what are the symptoms of a pituitary tumour

bitemporal hemianopia, HA, endocrine abnormality

65

what tests for a pituitary tumour

morning cortisol and prolactin

66

which pituitary tumours do you surgically remove

in patients with cushings, acromegaly or if going blind (unless prolactinoma)