Neuroradiology Cases - Flashcards Flashcards

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Cerebral Venous Thrombosis

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Thrombosis of the cerebral venous sinuses causing venous congestion, edema, and possible infarction. Imaging with MR venography or CT venography is crucial for diagnosis. Young women are commonly affected and prompt anticoagulation is the mainstay of treatment.

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Pineoblastoma

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An aggressive, primitive neuroectodermal tumor of the pineal region typically seen in children. It often causes obstructive hydrocephalus and demonstrates heterogeneous enhancement and possible calcification on imaging. Management includes surgical resection, craniospinal radiation, and chemotherapy.

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Herpes Encephalitis

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Viral infection of the brain classically involving the temporal lobes, presenting with fever, confusion, and focal deficits. MRI shows T2/FLAIR hyperintensity in the medial temporal lobes and diffusion restriction early on. Rapid diagnosis and treatment with intravenous acyclovir are critical to improve outcomes.

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Epidural Hematoma

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A biconvex, lentiform hyperdense epidural collection on CT usually associated with skull fracture and arterial bleeding. It can produce mass effect and rapid neurologic deterioration due to expanding hematoma. Emergent neurosurgical evacuation is often required.

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Chiari II Malformation

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A congenital hindbrain herniation associated with myelomeningocele, characterized by downward displacement of the cerebellar vermis and brainstem. Imaging shows small posterior fossa and aqueductal obstruction causing hydrocephalus. Management addresses hydrocephalus and associated spinal lesions.

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Wernicke Encephalopathy

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Acute neuropsychiatric syndrome due to thiamine deficiency, classically presenting with ophthalmoplegia, ataxia, and confusion. MRI shows symmetric FLAIR/T2 hyperintensity in the mammillary bodies, thalami, and periaqueductal gray. Early thiamine replacement can reverse deficits if given promptly.

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Isodense Subdural Hematoma

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A subdural collection that appears isodense to brain on CT, often seen in subacute to chronic stages or in elderly patients. This can obscure diagnosis on noncontrast CT and requires correlation with history and additional imaging modalities. Management ranges from observation to surgical drainage depending on symptoms and mass effect.

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Moyamoya Disease

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A progressive steno-occlusive disease of the terminal internal carotid arteries with development of fragile collateral 'puff of smoke' vessels on angiography. It presents with ischemic or hemorrhagic strokes, headaches, and cognitive decline. Treatment includes revascularization surgery to improve cerebral perfusion.

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Germinoma

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A midline intracranial germ cell tumor, most commonly occurring in the pineal and suprasellar regions of adolescents and young adults. Imaging often shows a solid, enhancing mass and may produce endocrine or Parinaud syndrome symptoms. Management typically involves radiotherapy and chemotherapy with excellent prognosis compared with other pineal tumors.

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Lhermitte-Duclos Disease

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A dysplastic gangliocytoma of the cerebellum presenting as a well-demarcated, striated-appearing cerebellar mass on MRI. It is associated with Cowden syndrome and can cause cerebellar symptoms and hydrocephalus. Surgical resection is considered for symptomatic relief.

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Infarcts from Meningitis

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Cerebral infarction secondary to meningeal infection due to vasculitis, vasospasm, or thrombosis of leptomeningeal vessels. MRI may show multiple infarcts and FLAIR sulcal hyperintensity suggesting meningitis. Early recognition and aggressive antimicrobial therapy are essential, though infarction can still occur despite treatment.

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Cerebral Amyloid Angiopathy

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Deposition of beta-amyloid in cortical and leptomeningeal vessel walls leading to lobar microbleeds and intracerebral hemorrhage in older adults. Gradient-echo or susceptibility-weighted imaging shows multiple cortical microhemorrhages sparing deep nuclei. There is no definitive therapy and recognition affects anticoagulation decisions.

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Ependymoma

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A tumor arising from ependymal lining cells often located in the fourth ventricle in children, causing obstructive hydrocephalus. Imaging typically shows a heterogeneous intraventricular mass with calcification and variable enhancement. Treatment involves maximal safe surgical resection and may include adjuvant radiation.

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Hypothalamic Hamartoma

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A non-neoplastic congenital lesion of the hypothalamus presenting with gelastic seizures, precocious puberty, or developmental delay. MRI shows a nonenhancing, isointense hypothalamic mass that can be sessile or pedunculated. Management includes medical therapy for endocrine symptoms and surgical or radiosurgical approaches for refractory seizures.

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Cerebral Arteriovenous Malformation

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A tangle of abnormal arteries and veins with nidus and high-flow shunting that can present with hemorrhage, seizures, or headache. Imaging demonstrates flow voids on MRI and abnormal vasculature on angiography. Treatment options include endovascular embolization, surgical resection, or radiosurgery depending on size and location.

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Heroin Leukoencephalopathy

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A toxic leukoencephalopathy associated with inhalation of heroin vapors, presenting with progressive white matter dysfunction. MRI shows confluent T2/FLAIR hyperintensity of the white matter with diffusion restriction in acute cases. Management is supportive and prognosis is variable.

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Kernicterus

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Bilirubin-induced neurologic dysfunction in neonates, causing selective neuronal injury of the globus pallidus and brainstem nuclei. MRI shows symmetric T1/T2 signal abnormalities in the globus pallidi. Early treatment with phototherapy or exchange transfusion can prevent progression.

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Dysembryoplastic Neuroepithelial Tumor

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A benign cortical tumor often presenting in children and young adults with drug-resistant focal epilepsy. Imaging characteristically shows a cortical-based, multicystic T2-hyperintense lesion that typically does not enhance. Surgical resection is usually curative and can relieve seizures.

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Dural Arteriovenous Fistula

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An acquired arteriovenous shunt between dural arteries and dural venous sinuses or cortical veins that may cause tinnitus, hemorrhage, or venous hypertension. Digital subtraction angiography demonstrates arterial feeders with early venous drainage. Endovascular embolization is the primary treatment modality.

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Progressive Multifocal Leukoencephalopathy

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A demyelinating disease caused by JC virus reactivation in immunocompromised patients, leading to multifocal white matter lesions. MRI shows asymmetric, nonenhancing T2 hyperintense lesions with little mass effect. Confirmation can be obtained via CSF PCR for JC virus and treatment focuses on immune restoration.

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Polymicrogyria

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A cortical malformation characterized by numerous small, irregular gyri giving a bumpy cortical surface, commonly affecting the perisylvian region. It is associated with epilepsy, developmental delay, and focal neurologic deficits. Management prioritizes seizure control and supportive therapies.

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Hemimegalencephaly

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A congenital overgrowth disorder of one cerebral hemisphere resulting in enlargement and cortical dysplasia. Clinical features include early-onset, often intractable seizures and developmental delay. Surgical hemispherectomy may be considered for seizure control in severe cases.

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Vein of Galen Malformation

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A congenital high-flow arteriovenous fistula involving the median prosencephalic vein that presents in neonates with high-output cardiac failure or hydrocephalus. Imaging shows a markedly dilated midline venous structure with large feeding arteries. Endovascular embolization is the primary therapeutic approach.

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Developmental Venous Anomaly

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A common, benign cerebral venous malformation characterized by radially arranged medullary veins draining into a dilated transcortical or subependymal collector vein. It is usually an incidental imaging finding and rarely symptomatic. No treatment is required unless associated pathology is present.