Neuro and Head and Neck – Autumn 2012
- Young woman involved in RTA, weakness in hands, cystic lesion next to spinal cord with cord in opposite direction – which level is the lesion:
- C4/5
- C5/6
- C6/7
- C7/T1
- Old accident with non specific arm symptoms, fluid filled spaces at C6/7 exit foramina with nerve roots not visualised and weakness in right distribution –
- Nerve root avulsion
- Torlov cyst
- MRI for brain lesion 3-4/52. Now presents with pain and itching over foot, ankle, red indurating rash, parasthesia and SOB on lying flat and upright
- NSF
- Sarcoid
- Young man, headache, supra anterior part of 3rd ventricle, hyperintense on CT- Colloid cyst
- Young woman with parotid mass, unilateral, multicystic, low on T2
- Pleomorphic adenoma
- Diabetes insipidus, which lesion can it not be ? LCH
- Midline mass mainly cystic with some Calcs closely assoc with pineal gland
- dermoid
- pineoblastoma
- germinoma
- pineocytoma
- subarachnoidhaermorrhage 2/52 ago, MRI appearances
- What is best sequence of vertebral artery dissection
- Time of flight
- 2D/3D gad enhanced
- T1 Fat sat
- T2 Fat sat
- Young man, cystic lesions in parotids bilaterally with bilateral Lymph nodes
- Sarcoid
- HIV
- TB
- Warthins
- Young man in RTA, intracranial blood at vertex crossing the midline, straddling the falx
- Intercerebralparafalcine
- Subdural
- EDH
- Combined
- 41 year old man with seizures, symmetrical high T2 hyperintensities in ext capsule, periventricular and temporal
- cadasil
- Moyamoya
- SLE
- Facial rash and seizures – SLE
- Tram track calc in optic sheath – NF2
- 80 year old man mass in corpus callosum with T2 changes in periventricular regions ?lymphoma/GBM
- 16 year old girl, confusion, low attenuation ring enhancing lesions on T2- abscess
- Arachnoid cyst – CSF density, no restriction, disappears on FLAIR
- Epidermoid at CPM – restricts on DWI
- Post trauma, which on is abnormal
- Air in Prussak
- Air in ventricle
- Air in epitympanic recess
- Fluid in cochlear
- CN6/7
- Clivalchondrosarcoma
- Cavernous sinus meningioma
- Facial nerve schwanomma
- Positive cavernoma
- Midbrain demyelination
- MS – optic neuritis, now loss parathesia? Where is the lesion in the brain?
- Calloseptal interface
- Cortical
- Bells’ palsy – which part of the facial nerve enhances?
- 80 year old man. Lytic, sclerotic and subperiosteal bone resorption. Peripheral soft mass, past medical history.
- Bisphophanate
- Ameloblastoma
- Osteonecrosis
- Dentigerous cyst
- Orbital pseudotumourvs thyroid
- Not involvement
- Involvement of lacrimal
- Single muscle
- Extraconal
- Lymph node levels –
- Above hyoid
- Tonsillar cancer
- Level II/III
- Nasopharyngeal cancer. RCA totally occluded, left carotid – 90%
- Medical
- Stenting on right
- Endarterectomy
- Surgical revasc
- Endovasc stenting
- Alobarholoprosencephaly
- Difference between benign intracranial hypertension and sagittal sinus thrombosis
- Subtle bleed in ventricle
- Prominent temp horns
- Slit like lateral ventricles
- Bilateral haemorrhages
- Pregnant pre eclampsiapt then cortical thickness where is the lesion – bilateral occipital haemorrhages
- Young man with HIV, nodular enhancement of basal ganglia
- Cypto
- Toxo
- HIV encephalopathy
- Badly controlled DM and hypertension- CSF spaces in basal ganglia, no DWI
- Perivascular
- Lacunar infarcts
- Enhancement of leptomeninges, nodular enhancement of spine – sarcoid
- Soft tissue calc in hip and calc lesion in brain and oedema – neurocystercis
- MRI/CT of sagittal sinus thrombosis
- CNIII palsy, then SAH – where is aneurysm?
- ACOM
- Ophthalmic artery
- Horner syndrome – T2 crescentic high signal
- Differential BP, collapse when playing golf, reveral of flow in left vertebral, biphasic in axillary artery, biphasic is brachial
- HIV encephalopathy
- HIV – PML
- Seizures in young man, temporal lobe lesion – DNET
- Thoracic cord lesion extramedullary, intradural mass does not affect exit foramina ?
- Neurofibroma
- Meningioma
- Dural fistula vs AVM
- Cerebellar atrophy with T2 hyperintense ring, ataxia, hameosisderin
- Anti-onconeuroantibodies in CSF – where is the primary – breast, lung, colon, thymoma
- High T2 in mesial temporal lobe and confusion – paraneoplastic syndrome
- Bronchus
- Breast
- Renal
- Thyroid
- Melanoma
- Describe mesial temporal sclerosis – small hippocampus with high T2
- B12 deficiency – signal change in dorsal columns, loss in T1 in vertebral bodies
- Thyroid, calc, positive lymph node, young woman - papillary, medullary, nothing?
- Parathyroid PTH raised, raised calc but US normal – what next? PET,CT, MRI, sestamibi
- Lymph node, Level II- normal mediastinoscopy – FNA – SCC, CT Normal, what next? PET/CT
- Something moves PPS forward – where is the lesion? Parotid, masticator, carotid, retropharayngeal
- Describe paraganglioma – pulsatile tinnitus, flow voids, avid enhancement
- CN6 palsy, retrobulabar pain and otitis media, fluid in mastoid and middle ear, ill defined change in petrous apex
- mastoiditis,
- Cholesterol granuloma
- Petrous apex apicitis
- Cholesteotoma – area least likely to be involved – semi circular canal
- HMPAO SPECT – post temporal and parietal low activity and reduced in frontal area –
- Alzheimers
- Lewy body dementia
- RTA – mass, swelling in eye – carotico cavernous fistula
- CN 7 supplies all these muscles except one – masseter
- Antrochoanal polyp
- 15 year old boy, widened pterygopalatine fossa – juvenile angiofibroma
- Cyst at base of tongue – homogenously enhancing
- Thornwaldt cyst
- Thyroglossal
- Lingular thyroid
- What structures would definitely be missing in radical neck dissection
- SCM and submandibular
- Digastric and parotid
- Medial part of clavicle
- Mandible
- Carotid