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DURA: 2 layers, forms faux & tentorium, normally adherant but venus sinuses formed by opening of 2 layers
PACHYMENINGES: follows periostium & dural reflections
LEPTOMENINGES: follows sulci & basal cisters, arachnoid + pia mater, MCA: ACA:
ACA: leg, cingular gyrus and superior frontal gyrus
MCA: face + arm, deep = lenticulostriates from M1 (BG) & superficial (frontal, temporal, parietal, insula)
PCA: thalamus, occipital, no PCA above level of vents
Anterior chroidal: amygdala, hippocampus, internal capsule up to ventricals
Basilar artery : posterior fossa, cerebellum, pons, also supplies PCA (PCA ischemia)
Face + arm + leg = very exensive or internal capsule (cortical spinal tract)

ANATOMY

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GLOBAL INJURY

UNCAL: usually results from temporal lobe mass effect, medial displacement of uncus w/ respect to tentorial incisura (opening of tentorium), ealy on effacement of lateral suprasellar cistern, lateral widening of ipsilateral ambient and pontine cistern, finally obliteration of cisternal spaces w/ compressed elongated midbrain and squeezing of opposite cerebral peduncle, mass effect on PCAs, anterior choroidal arteries, CN3 (occulomotor)
SUBFALCINE / CINGULATE / MIDLINE: herniation of cingulate gyrus beneath anterior free edge of falx, contralateral ventricle dilates, ipsilateral ventricle compressed
DOWNWARD / TRANSTENTORIAL: compression CN3 (blown pupil) and PCA compression / infarct
DURET HEMORRHAGE: midline brainstem hemorrhage ass w/ downward herniation

HERNIATION

Sz: pseudosubarachnoid hemorrhage (decreased brain attenuation, small pial vessels diate), pseudovenous sinus thrombosis ( venous sinuses appear hyperdense relative to the diffuse hypodensity of the edematous cerebrum)
ANOXIC BRAIN INJURY: high signal dorsolateral putamina & ventrolateral thalami, similar edemedous cerebrum w/ restrictded diffusion in globus pallidus / caudate / putamen; Cz: carbon monoxide, profound hypotension, birth trauma

DIFFUSE CEREBRAL EDEMA

Sz: focal punctate hemorrage, HIGH T2 signal, blood products at GWJ (best seen GRE), shows restricted diffusion in acute phase
Cz: shearing injury
Info: grade 1: lobar white matter, 2: corpus callosum (MC splenium), 3: dorsolateral midbrain

DIFFUSE AXONAL INJURY

Sz: abn enhancement in temporal lobes, hippocampal atrophy
Cz: disruption BBB

STATUS EPILEPTICUS

Sz: diffuse meningeal/dural enhancement, "sagging" brain w/ effacement of supracellar cisterns and tonsillar herniation, poss subdural fluid collections
Sx: postural HA

INTRACRANIAL HYPOTENSION

Tx: open depressed skull fx treated operatively if there is dural penetration, > 1 cm, frontal sinus involvemet to prevent infection
Ass: parenchymal injury
Comp: overlie dural venous sinus (sagital sinus inj), middle meningeal (epidural), "eloquent" (sensorimotor cortex), open /depressed, traverses ICA canal, temporal bone
FRONTAL SINUS FRACTURE: may lead to meningitis, CSF fistula, mucocele
SKULL BASE FRACTURE: anterior, middle (petrous bone, clivus), posterior
TEMPORAL BONE FX: classified as otic capsule violating or otic capsule sparing predicts sensorineural complications, evaluate for involvement of facial nerve canal, air in vesibule or cochlea (dizziness), disruption ossicles (hearing loss)

SKULL FRACTURE

1: 5 basic patterns: extra axial (epidural, subdural, leptomeningeal), ring enhancing, temporal lobe lesion, basal ganglia lesion, white latter lesion
2: Specific imaging (DWI key)
3: Clinical: immune status, age, chronicity, geographic

INFECTION

Sz: temporal lobe edema (can be BLm but asymetric), patchy then gyriform enhancement, gyriform signal increase (blood), may have hemorrhage, local mass effect, may have dec diffusion, spares BG (differs from mimmicker MCA infarct)
Sx: seizures, MS change
MC viral encephalitis
Tx: antiviral
Info: MC fatal encephalitis
LIMBIC ENCEPHALITIS: paraneoplastic mimic w/o enhancement or mass effect, usually BL, improves w/ tx of primary malignancy

HERPES ENCEPH ALITIS

Sz: ring enhancing lesion, uni or multifocal, vasogenic edema (cortex spared), treated = Ca+. "eccentric target" sign favors toxo over lymphoma
Tx: usually tx emperically and see if lesions resolve in 7-10 days, if no improvement bx, if not fo thallium or MR spect to differential from lymphoma
PET: Toxo (hypo to grey), Lymphoma (hyper)
THALIUM: Toxo (NO uptake), Lymphoma (uptake)

TOXO PLASMOSIS

Sz: hydroceph w/ transependymal edema (suggests inc ICP), hyperdensity along tentorium w/ enhancement, increased leptomeningeal signal & enhancement (FLAIR, postc-con), effacement sulci, use DWI to look for complications (infarct, empyema)
Comp: CVA from septic thrombosis of lenticulostriates, subdural empyema, encephalitis, brain abscess, ventriculitis (subependymal & ventricular wall enhancement, hydrocephalus, Cz: infected catheter, ruptured abscess, may appear similar to lymphoma)
Cz: Pyogenic (GBS, meningococcus, strep), cryptococcal (diffuse leptomeningeal enhancement, AIDS), TB (basilar citerns, ventriculitis, "miliary" lesions), viral

MENINGITIS

Sz: T1 hypo, T2 hyper center hypo rim, thing smooth ring enhancing lesion w/ variable edema / mass effect, daughter lesion, central necrotic center w/ dec density (inc T2), thinner wall closer to lat vent suggests, "lightbulb bright" diffusion, centrally restrict diffusion which is opposite of necrotic mets, thinner rim of enhancement, may have adjacent leptomeningeal enhancement, lactate peaks on MRS
Comp: ventriculitis (rupture into vents), subdural empyema, sinus thrombosis
Info: ring usuall thinnner vs tumor

BRAIN ABSCESS

Sz: "cyst with the dot", intracranial Ca+ (burnt out), ring enhancing cystic masses w/ marginal low signal nodule (scolex) and low intensity wall, subacrach > parenchymal > ventricles, no restricted diffusion (high on DWI & ADC) differs from abscess
Sx: Hispanic, seizures, meningitis
Info: 4 stages: vescicular (no rxn), degenerating (edema), healing (ring enhancement w/ resolving edema), Ca+
Cz: pork tapeworm
Tx: antifungal, steroids, possible excision

CYSTER CERCOSIS

Sz: extraaxial collection w/ rim dural thickening/ enhancement, signal > CSF, restrict diffusion (unlike sterile), prominent cortical veins, brain edema, AFL sinuses
Cz: Interruption of the arachnoid meningeal barrier by infection, MC frontal sinusitis or mastoiditis, also osteomyelitis / meiningitis
Comp: abscess, thrombosis (possible cavernous sinus) , ischemia, cerebral edema, meningitis, hydrocephalus
Tx: Evacuation & Abx, emergency

EPIDURAL / SUBDURAL EMPYEMA

Sz: basal ganglia hypodensity / inc sign, cryptococcomas (punctate dilated perivascular spaces) = cystic nodules (w/ possible ring enhancement) in basal ganglia, inc leptomeningeal signal & enhancement of basilar cisterns,
Sx: meningitis
Info: MC CNS mycotic infection
Ass: HIV

CRYPTO COCCUS

Sz: Diffuse enhancement of the basal cisterns, DARK T2, ring-enhancing lesions, abscess, tuberculoma, hydrocephalus
Sx: Spectrum of CNS TB: TB meningitis, cerebritis, ventriculitis, choroid plexitis, encephalitis, otomastoiditis
COCCIDIOMYCOSIS: fungal, similar appearance
INVASIVE ASPERGILLOSIS: hemorrhage, partial ring enhancement, immunocompromised

TB OF BRAIN

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WHITE MATTER DISEASE

Sz: demyelination of spinal cord &/or optic pathways w/o brain involvement

DEVICS

Sz: BL low density signal, high T2, predominantly subcortical, white > grey matter, no restricted diffusion, not always posterior, not always reversible
Info: acute encephalopathy
Ass: eclampsia, post-transplant
Sx: HA, seizures, blindness

POSTERIOR REVER SIBLE ENCEPH ALOPATHY

Sz: caudate atrophy (loss of convexity of caudate head), enlarged frontal horns

HUNTING TON'S DISEASE

Sz: Multifocal WMD, BL asymetric, spares the callososeptal interface (unlike MS)
Cz: autoimmune response to viral infect (MC chicken pox, URI), presumptive dx from hx
Sx: HA, fever >> severe neuro deficits
Tx: Steroids w/ good px

ACUTE DIS SEMINATED ENCEPHA LOMYELITIS (ADEM)

Sz: demyelinating disorder, patchy asymetric white matter lesions (subcortcal U fibers), atrophy, rare enhance, hypo T1, HIV usually iso), no mass effect
Cz: JC papovavirus,
HIV ENCEPHALITIS: periventricular (not subcortical) WMD that is usually confluent (PML patchy), atrophy. no enhance
CMV INFECTION: periventricular & subepenymal "pencil thin" enhancement enhancement, polymicrogyria

PROGRESSIVE MULTIFOCAL LEUKOENC EPHALOPATHY

Sz: Dawsons fingers (WM abn perpendicular to lateral vents), WM lesions often ovoid, enhancement and restricted diffusion suggest active demyelination, corpus collosal lesions, T1 plaques hypo, in cord lesions usually lateral (white matter) vs central lesion (grey matter) more commonly infact
Cz: inflammatory autoimm disease
Sx: weakness, parathesias, visual abn
TUMEFACTIVE MS: heterogeneous enhancing lesions w/ surrounding edema but minimal mass effect

MULTIPLE SCLEROSIS

Sz: T2 hyperintensityand restricted diffusion in basal ganglia, thalami, cortex BL
Sx: rapidly progressing dementia
Cz: abn protein priosn
WILSON'S: hyperintensity in caudate, globus pallidus, thalami from abnormal copper metabolism
DDx: hypoxic ischemic injury, carbon monoxide

CREUTZFELDT JACOB DISEASE

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VASCULAR

Sz: hemorrhage, stroke, multiple infarcts of varying ages
Cz: inflammation & necrosis of blood vessel walls
Dx: may require brain biopsy
Info: may be large vessel (involving ICA, M1, A1, P1, vertebral, basilar), medium vessel, small vessel, inflammation and necrosis of vessel walls

CNS VASCULITIS

Sz: large hyperdense sellar/suprasellar mass, suseptibility, fluid level
Sx: clinicalsyndrome w/ HA, visual change, endocrine abn
Cz: hemorrhage or infarction of pre-existing pituitary adenoma

PITUITARY APOPLEXY

Info: mimic = PCOM infundibulum, opthalmic often present large unruptured
Complication clipping PCOM: anterior choroidal artery infarct (genu of internal capsule)
Basilar tip: @ interpeduncular fossa
MYCOTIC ANEURYSM: distal MCA aneurysm, often multiple or BL, central suseptibility w/ surrounding edema, well defined periipheral low intensity, Tx: endovascular
SUBARACHNOID HEMORRHAGE: inc signal on PD and FLAIR, Basilar tip (vents, interpeduncular fossa), PICA (vents, basal cisterns), ACOM (IH fissure), PCOM (ipsilateral basal cistens), MCA trigone (sylvian fissure), traumatic SAH usually more peripheral

ANEURYSM

CAble TV
CAVERNOUS HEMANGIOMA (CAVERNOMA): sinusoidal endothelial lined space w/o interspersed parenchyma, Ca+, possible mild enhancement, heterogeneous signal, hemosiderin (LOW T2, GRE) ring, "popcorn" high T1/T2 (methemoglobin), occult angiographically usually, associated developmental venous anomalies, hemorrhage in different stages evolution, can be spinal, associated with DEVELOPMENTAL VENOUS ANOMALY, can be located in cord
AVM
TELANGIECTASIAS (CAPILLARY ANGIOMAS): "brush like enhancement", GRE suseptibility, collections capillaries interspersed w/ normal parenchyma, MC in brainstem or cord
VENOUS ANGIOMAS: clusters of dilated medullary veins drain into enlarged vein, no enhancement

CEREBRAL VASCULAR MAL FORMATIONS

Sz: tightly packed mass of vascular structures, tubular or tangled flow voids, early draining vein, enlarged anterior spinal art, large draining vein w/ early filling, IM nidus w/ cord enlargement, AVMs enhance and have characteristic serpentine "bag of worms" flow voids on MR imaging, enlarged internal cerebral & superficial veins, variable hemorrhage / Ca+
Info: risk hemorrhage 2% / yr, spinal AVMS may thrombose, replaces normal brain parenchyma w/o mass effect, sometimes adjacent atrophy, blood passes to arteries to veins w/o goig through capillaries
Grading: Spetzler Martin based on size, location (eloquent), venous drainage (superficial v deep)
Sx: multiple in pts in HHT
Tx: resection, embolization, radiosurgery
DURAL AVF (TYPE 1 AVM):aquired, fed by meningeal arteries, may be intracranial or spinal (flow voids in thecal sac & epidural space), early opacificaion of large veins w/ no nidus, aquired from inflammatory process that leads to venous thrombosis and eventually direct fistula, tx w/ surgery and/or radiation
SPINAL AVM: inborn, fed by cord arteries

AVM

Sz; Location: BG (putamen) > thalamus > pons
HYPERTENSIVE ENCEPHALOPATHY: sulcal effacement, multifocal hemorrhage, vasogenic edema, "spot sign" in hemorrhage = enhancing focus w/i hemorrhage predicts enlargement of hematoma

ACUTE HTN HEMORRHAGE

Sz: Stenosis /occlusionsupracliniod ICA, MCA and ACA, "puff of smoke" = abnormal collateral networks adjacent to stenotic vessels, numerous collaterals w/ lenticular striate arteries prominent, white matter ischemic change, anastomosis between leptomeningeal and dural meningeal arteries, ischemia, small hemorrhage
Sx: strokes or seizures in children
DDX: atherosclerosis, radiation vasculopathy
Ass: Sickle cell disease, FMD, NF

MOYAMOYA

Sz: enlarged cortical / deep veins, hyperdensity (noncon), HIGH T1, filling defects (contrast), "empty delta" sign: triangular hypodense clot in sinus
Cz: partum, postpartum, sepsis, otomastoiditis
Tx: antithrombotic even when hemorrhage present, local thrombolysis
VENOUS INFARCTION: occurs when thrombosis extends to cortical veins, hemorrhage in white matter or GWM junction, BL parenchymal hemorrhages, hemorrhagic infarctions not in arterial distributions
DEEP CEREBRAL VENOUS THROMBOSIS: occulsion of deep cerebral veins causes infarc otr hemorrhage in BL thalamus, hippocampus, periventricular white matter (may look like basilar arty occlusion with more irregular margins)
CAVERNOUS SINUS THROMBUS: symptomssimilar to carotid cavernous fistula

VENOUS SINUS THROMBOSIS

Sz: enlargement & expansion of cavernous sinus w/ lateral wall flattening or convexity, decreased opacifiacation of cavernous sinus w/ contrast, narrowing & wall enhancement (inflammation) of internal carotid arteriesfilling defects in superior opthalmic vein, soft tissue edema
Info: venous occlusion
Sx: fever, ptosis, proptosis, opthalmoplegia
Cz: sinusitis, orbital cellulitis, oral surgery

CAVERNOUS SINUS THROMBOSIS

Sz: crescent HIGH T1 (intramural methemoglobin) around vessel (may be missed on angio), "string sign", intimal flap, can have pseudoaneurysmal (hemorrhage prone) or occlusive pattern (ischemia prone)
Cz: trauma, atherosclerosis, vasculitis, dysplasia eg Marfan / FMD
CHRONIC CAROTID DISSESCTION: collateral leptomeningeal arteries, no restricted diffusion
FIBROMUSCULAR DYSPLASIA: multifocal concentric luminal narrowing alternating with areas of mural dilitation that are wider than origional lumen, infrequent cause of stroke in young people
FENESTRATION: duplication of a portion of an artery w/ dilitation of lumen, may have linear filling defect in center of vessel 9differes from dissection: diameter increased, two lumena equal in size), MC basilar & verebral

DISSECTION

Sz: ICA extends into middle ear (hypotympanum = inf middle ear)
Sx: pulsatile tinnitus
Tx: NO TOUCH

ABERRANT ICA

Sz: lobar in location (MC frontal, parietal), may have mult subcortical GRE suseptibility, hemorrhages of different ages, multiple simultaneous hemorrhages, suseptibility on GRE, foci of hemorrhage at cortical-subcotricaljunction, subarachnoid / subdural blood possible, blood vessels with amyloid deposition.
Sx: normotensive

AMYLOID ANGIOOPATHY

Sz: crescent, tapered margins, spread along calvarium, lateral thickening of GM (isodense), cortical veins displaced from inner table (opposite SAH), btw dura & arachnoid, may cross sutures but not dural reflections (faux, tentorium), isodense if low hemocrit, do not see dura (black line) on MR as collection abuts brain, most countercoup, ominous signs: heterogeneous, convex, SAH, inc mass effect
Ass: etoh, epilepsy, coagulopathy, ("swirl" sign) indicative of active extravasation, "bridging" veins
EPIDURAL HEMATOMA: blood btw inner table and dura, almost always w/ skull fx, does not cross sutures but may cross faux, heterogeneity = active bleeding, usually only traumatic lesion that occurs at coup site
CONTUSION: contra-coup, subacute = ring enhancing, hemosiderin ring, BL, orbitofrontal, other trauma

SUBDURAL HEMATOMA

Sz: loss of GW differentiation, hypodensity, lose distinctness insular cortex" insular ribbon sign" + basal ganglia, dense artery, mismatch DWI vs perfusion = penumbra = target of treatment, subacute = gyriform enhancement
Tx: TPA window 3 hrs, (contraIx: hemorrhage or greater than 1/3 MCA territory)
Info: Flair similar to CT in stroke
WATERSHED INFARCT: "rosart of pearls" at junction of territories, cardiac output problem
EMBOLIC INFARCTION: small multifocal GW junctioninfarcts, multiple vascular territories, if BL > cardiac, if unilateral > ICA, ass w/ valve disease, if enhancing & edema consider infectious or tumoral emboli
CORTICAL LAMINAR NECROSIS: s/p infarct, laminar T1 hyperintensities, later w/ laminar calcification
CHRONIC INFARCTION: increased diffusion (reverse DWI / ADC)
Info: in trauma cases, kids more prone to infarction due to dysautoregulation

INFARCTION

GRE: exaggerates bony lesions
FSE T2: edge enhancement, best for sagital foramina, CSF flow injury
STIR: ligamentous DWI, ischemia, VB lesions

SPINE MRI

Sz: > 2 segment involvment suggestive, usualluy upper lumbar or lower thoracic,early paravertebral involvement / abscess, epidural abscesses with subligamentous spread, cauda equina compression, bone destruction rather than just edema, isolated destruction posterior elements possible, anterior wedging w/ Gibbus deformity &kyphosis
Info: MC pediatric spine infection in children worldwide
Cz: hematogenous spead

TB OF SPINE AKA POTT'S DISEASE

Sz: disk w/ diffusely high T2 signal (degenerated disks T2 dark), endplate erosion and edema (endplates can also be T2 bright w/ enhancement in Modic 1 degen), disks and endplates enhance, Gallium scan brighter than bone scan
Sx: immunocompromised w/ GU infect, IVDU, S Aurus
EPIDURAL ABSCESS: rim enhancing, restricted diffusion, anterior from discitis and posterior from hematogenous, Ass: IDVU, DM, Etoh, dialysis (DDx epidural hematoma, mets)
EPIDURAL HEMORRHAGE: can have peripheral enhancement, DWI can help differentiate form abscess

VERTEBRAL OSTEO MYELITIS / DISCITIS

Sx: can > severe spinal stenosis w/ cord/root compression

OSSIFIED PLL

Sz: expansile dral sac causes remodeling of spinal canal and posterior scalloping
Cz: NF1, Marfan, Ehler Danlos, Tumor (posterior scalloping add tumor and congenital dysplasia)

DURAL ECTASIA

Sz: enhancement of conus, cauda equina, and nerve rootlets (primarily anter), thickening nerve roots
Sx: progressive lower extremity weakness
Cz: preceded by bacterial or viral infection

GUILLAIN BARRE SYNDROME

Sz: epidural fat > 6mm and extending for long segments, MC dorsally in thoracic and circumferentially in lumbar,
Cz: idiopathic, steroids, obesity

EPIDURAL LIPOMATOSIS

Sz: cystic intraspinal mass, usually in anterior epidural space, 50% w/ vertebral anomalies or spinal dysraphism

NEURENTERIC CYSTS

Sz: myelogram w/ filling defect in contrast column displacing dural sac, oval shaped lesion arising near facet, occupy lateral recess, , can contain fluid preotein air or blood, CSF signal, displaces nerve roots,
MC lumbar spine
Cz: chronic degen change in facets w/ herniation of synovium thru joint capsule
Tx: steroid injection
TARLOV CYST: extradural, CSF filled
contain neural elements

FACET SYNOVIAL CYST

Sz: intramedullary central high lesion in cord, 3-4 segments in length, cord expansionno intracranial lesion, variable enhancement, > 2/3 cross section area
Info\: dx of exclusion
SPINAL CORD ISCHIMIA / INFARCT: usually anteriro
SPINAL MS: < 2 segments, peripheral, < 1/2 croos sectgion area
SUBACUTE COMBINED DEGENERATION: T2 signal in posterior columns initially, later into lateral spinal tracts, usually cervical/upper thoracic, Tx w/ B12

TRANSVERSE MYELITIS

Sz: spectrum 14cutaneous ectoderm
LIPOMYELOCELE and LIPOMYELOMENINGOCELE: large subQ lipomas extend through wide spina bifida, all w/ tethered cord, 50% w/ skin anomaly, LM: placode lipoma inferface is inside canal, LMM: outside
INTRADURAL LIPOMA
MYELOMENINGOCELE: less extensive spinal dysraphism, not covered w/ skin, not always tethered cord
MENINGOCELE: herniation of CSF in sac lined w/ dura / arachnoid , covered with skin

LIPO MYELOSCHISIS

Sz: high "snake eyes" (axial) T2 signal in central cord, will show solid enhancement in subacute phase, cord enlargement
Info: superiorly supply is two vertebrals + several radicular arteries (protective), inferirly supply is from single artery of Adamkiewicz
CORD CONTUSION: s/p disk herniation, more severe in pts w/ degenerative changes

CORD INFARCTION

Sz: closed dystraphic state with spinal cord divided into 2 hemicords by sagital cleft, fibrous or bone spur in 50%
Ass: Chiari 2, tethered cord, hydromyelia, myelomeningocele, scoliosis
Tx: remove spur
DIPLOMYELIA: true duplication of the spinal cord, mythical

DIASTEMATO MYELIA

PSEUDOMENINGOCELE Sz: absence of exiting nerve root with CSF cystic structure in its expected location
Cz: traction injury of arm causing nerve root avulsion, tear of arachnoid & dura

MENINGOCELE

EXTRADURAL located outside thecal sac
INTRADURAL EXTRAMEDULLARY: located inside thecal sac, outside cord
INTRAMEDULLARY: w/i cord; expansile (neoplasm) vs nonexpansile (inlafmmatory, traumatic, demyelinating, infarct)

SPINAL LOCATION

Sz: expansile cystic mass, fusiform, no enhancement, can be septated, well defined central area of fluid w/i cord, tapers near conus, cord expansion
DDx: cystic neoplasm (astrocystoma), myelomalacia, ventricularis terminalis
Ass: chiari 1 or 2, spinal dysrphysim, atrophic neuroarthropathy shoulder
VENTRICULUS TERMINALIS: nonenhancing ovoid nonseptate cystic structure localized to a normally positionad conus

SYRINX

Sz: abnormal clumping nerve roots, diffuse pial enhancement of thecal sac, conus, cauda equina

ARACHNOIDITIS

BULGING ANNULUS:diffuse
DISC HERNIATION: localized displacement of disc material
DISC EXTRUSION:
DISC SEQUESTRATION: "free fragment", +/- migration
DISC PROTRUSION: base> height
T1: marrow should be brighter than disc
MODIC 1: "acute", edema, dark / bright
MODIC 2: "subacute", fatty, bright / bright
MODIC 3: "chronic",sclerosis, dark / dark

DISC DISEASE

Sz: small dense globe, mixed signal in globe from hemorrhage of differring ages, abnormal lens, triangular retrolental soft tissue w/ "martini glass" shape, no Ca+ (distinguish from retinoblastoma)
Sx: white papillary reflex, poor vison, nystagmus

PERSISTENT HYPERPLASTIC PRIMARY VITROUS

Sz: IMSLO, fusiform enlargment EOM that spares tendons, usually BL, spares lateral rectus
Sx: proptosis

THYROID OPTHALM OPATHY

Sz: EOM or nerve thickening (involves tendons unlike thyroid), Enhancing uveal-scleral thickening and peripheral globe soft tissue, fat stranding, ill-defined border w/ adj fat, proposis, LOW T2 (opposite mets)
Info: Nonspecific inflam condition w/o identifiable cause
MC intraorbital adult mass
Sx: acute pain
Tx: good response to steroids
TOLOSA-HUNT SYNDROME: identical, involvement orbital apex, cavernous sinus

ORBITAL PSEUDO TUMOR

Sz: EOM thickening + enhancement, pre and post-septal enhancement, ehancing abscess
Sx: visual loss, proptosis & EOM restriction (not w/ preseptal)
Complications: cavernous sinus thrombus, meningitis, brain abscess
Cz: MC is sinusitis, 2MC penetrating injury
Tx: steroids
ORBIAL ABSCESS

ORBITAL CELLULITIS

Sz: enlarged enhancing optic chiasm, enlarged optic nerve w/ decreased surrounding CSF, may be BL, spares nerve sheath
Cz: MC is MS, viral, sarcoid, lyme, SLE
Sx: acute visual loss and pain w/ globe movement
Ddx: sarcoidosis

OPTIC NEURITIS

Sz: fusiform optic nerve mass w/ variable enhancement uncommon Ca+
Info: low grade pilocytic astrocytoma
Ass: NF1
OPTIC NERVE MENINGIOMA: "tram track" enhancement or Ca+

OPTIC GLIOMA

Sz: well marginated orbital mass w/ intense enhancement, CT hyperdense
Info: MC orbital tumor adults, non neoplastic w/ dilated vascular channels
ORBITAL CAPILLARY HEMANGIOMA: poorly marginated uniformly enhancing mass anywhere in orbit (usually extraconal), most spontaneously regress (may tx w/ steroids)

ORBITAL CAVERNOUS HEMANGIOMA

Tx: usually radiation
Sx: enophthalmos (inward retraction of globe ala skin in breast) seen in metastatic scirrhous breast carcinoma.

ORBITAL LYMPHOMA

GLOBE RUPTURE: misshappen globe w/ blood/ air, vitreous hemorrhage,
RUPTURE POSTERIOR SCLERA: enlarged anterior chamber and retraction of lens
LENS DISLOCATION: (also in marfans ehler danlos)

ORBITAL TRAUMA

Info: What space is mass in? What are contents of space?, Superficial mid & deep cerival fascia divide spaces areound pharynx, rarely lesions do not conform to spaces (congenital or aggressive lesions), all spaces can abut skull base > look for brain extension, neck abscesses often not rim enhancing, on lateral xray cant distinguish retropharyngeal from prevertebral swelling, peds MC neck tumor rhabdomyosarcoma
PHARYNX: tube from constrictor muscles, contains mucosa (SCC) and lymphoid tissue (lingual tonsils - base of tongue, palatine tonsils - lateral walls, nasopharyngeal tonsils in nasopharynx), demarcations: nasopharynx (beind nasal cavity), oropharynx (behind oral cavity), oral cavity, hypopharynx (hyoid to esophogus), larynx (hyoid to trachea)
4 ANTERIOR SPACES:
MASTICATOR: contents: teeth, mandible, muscles (medial and lateral ptergoids, massetor, temporalis); pathology: dental infect MC (tooth removal MC),
PAROTID: contents: salivary tissue, lymph nodes, CN 7, pathology: 90% parotid tumors pleomorphic adenomas
CAROTID: contents: carotid artery, jugular vein, CN9 through 12; pathology: carotid body tumor, neurofibroma,
PARAPHARYNGEAL: contents: triangular layer of fat anterior to carotid space, if triangle is displaced, you can localize a mass to the parotid, masticator, carotid, or pharynx
3 POSTERIOR SPACES:
PERIVERTEBRAL: contents: vertebral bodies/disks, paraspinal & prevertebral muscles, nerves including brachial plexus
RETROPHARYNGEAL; between middle and deep cervical fascia, higher up it is difficult to see & only a potential space, contents: nodes & fat
POSTERIOR CERVICAL: fatty space btw SCM and paraspinus muscles, contents: nodes, fat CN 11

NECK / ENT

Sz: symmetric enlargement of adenoids + palatine tonsils (Waldeyer's ring)
DDx: lymphoid hyperplasia

NON HODGKIN LYMPHOMA

Sz: hypervascular, ptergopalatine fossa with anterior bowing maxillary sinus, possible extension to middle cranial fossa
Sx: males, teens, benign but locally aggressive, rarely transform to sarcoma
Tx: Biopsy contraindicated, can embolize prior to debulking
Angio: Supplied by dilated internal maxillary artery (ECA), rapid filling of reticulated vessels in arterial phase, homogeneous vascular blush in venous phase

JUVENILLE ANGIO FIBROMA

Sz: normal thyroid in abnormal location
Cz: failure of thyroglossal duct to migrate

LINGUAL THYROID

Sz: lobulated circumscribed HIGH T2 mass, heterogeneously enhancing
Inf: benign tumor of salivary glands

PLEOMORPHIC ADENOMA

AKA ESTHESIONEUROBLASTOMA
Sz: large heterogeneous dumbell shaped mass (intracranial and nasal cavity w/ waist at cribiform plate), peripheral tumor cysts, bony remodeling
Info: Peak age 20, 10 % extend intracraniallly, neuralcrest origin

OLFACTORY NEURO BLASTOMA

Sz: SCC arising from nasopharyngeal mucosa
Ass: EBV, diet

NASO PHARYNGEAL CARCINOMA

Sz: smoothly expansile lytic lesion of petrous apex, high T1 & T2, can erode into clivus, inner ear, CPA
Cz: obstrustion PA air cells, chronic otitis media, surgery, cholestiatoma
Tx: drainage vs resection

CHOLESTEROL GRANULOMA

Sz: diffuse cellulitis of tongue, sublingual & submandibular space w/ phlegmon & abscess
Cz: dental

LUDWIG'S ANGINA

sz: enlarged patotids w/ multiple small cysts
Ass: HIV
WARTHIN'S TUMOR: Sz: BL multiple round ISO/HIGH T2 lesions in parotid (looks similar to lymphoepithelial cysts), supress on FLAIR, represent heterotopic salivary tissue w/ rare degeneragtion to cancer
SJOGREN'S: parotid enlargement w/ diffuse BL cysts, dy eys, dry mouth, lymphocytic invasion of exocrine glands, small inc risk salivary gland malignancy

LYMPHO EPITHELIAL CYSTS

Sz: dilitation pyriform apex, asym thickening aeryepiglottic fold, displacement vocal cord

VOCAL CORD PARALYSIS

Sz: soft tissue, osseus destruction
Cz: immunocompromised MC aspergillus,
Comp: cavernous sinus, ICA thrombosis

FUNGAL SINUS INFECTION

Sz: cochlear abnormalities with 1.5 turns versus normal 2.75 turns. enlarged vestibule. can be BL
LARGE VESTIBULAR AQUEDUCT SYNDROME: large vestibular aqueduct and bony canal of endolymphatic sac, cochlea abnormal

MONDINI DEFORMITY

Sz: purulent infection in mastoid, middle ear, can extend to outer ear, possible extension to TMJ, dural spaces, cerebellum (thru mastoid), temporal lobe (thru termen tympani), petrous apex, cranial nerves
Comp: venous thrombosis / infarction

EAR INFECTION

Sz: soft tissue, in middle ear, expanding epitympanum & aditus, erosion of scutum & ossicles, thinning tegmen tympani
Info: path identical to epidermoid
Cz: healing of perforated TM
Tx: mastoidectomy & ossicle reconstruction

CHOLEST EATOMA

OVAL WINDOW ATRESIA: thick bone at oval window
EXTERNAL AUDITORY CANAL ATRESIA: stenosis of EAC w/ auricle deformity, malformations of ossicles, may be ass w/ congenital cholestiatoma

EAR ATRESIA

Sz: middle meatus, expansile bony changes
Ass: SCC which may be indistinguishable

INVERTING PAPILLOMA

Sz: high jugular bulb, enlarged jugular bulb w/ dehiscent border, small diverticulum, abscense of sigmoid plate w/ bud from superolateral bulb entering middle ear
Sx: pulsatile tinnitus
Normal variant

DEHISCENT JUGULAR BULB

Sz: exension of left air or fluid filled vallecula laterally into infrahyoid soft tissues,
Sx: glassblower
Comp: infected

LARYNGOCELE

Sz: water density cystic mass, conforms to medial mandible, displace submandibular duct
Sx: blue domed cystic swelling at floor of mouth
Cz: retention cyst from submandibular or minor gland duct obstruction
DIVING RANULA: simple ranula enlarges and extends beyond sublingual space into submandibular space

RANULA

Cz: ductal calculus (sialithiasis) or stenosis
Info: acute > enlarged gland, chronic > gland atrophy
Tx: posterior duct stones require resection

SIALADENITIS

Sz: opacification petrous apex, middle ear, mastoid air cells, possible dural extension
Cz: complication infection of otitis media or mastoiditis
Comp: extradural abscess, osteomyelitis, cavernous sinus thrombosis
PETROUS APEX EFFUSION: sterile residula collection from remote otomastoiditis, non-expansile non-enhansing can f/u in 3 yrs to exclude transformation to cholesterol granuloma

PETROUS APICITIS

Sz: circumscribed lobulated sinus mass, AFL in large expansile skull lesion related to sinus, expansion and thinning sinus (accumulated musus behind an obstructed sinus ostium)
Sx: Proptosis, vision alteration
Ass: CF

SINUS MUCOCELE

PYRIFORM APETURE = nasal inlet (anterior)
CHOANA = nasal outlet (posterior)
Sx: respiratory difficulty, difficulty passing NGT

NASAL STENOSIS

Sz: vasogenic edema w/o great mass effect, irregular parenchymal enhancement, often temporal lobes (chordoma, nasopharyngeal)
Info: distinction between recurrent tumor & radiation injury may be difficult as both present as necrotic masses. Often, patients have both
PET: Hypometabolic

RADIATION NECROSIS

Sz: expanded hemisphere, w/ mass effect, inhomogeneous high T2 mainly involving white matter, usually no enhancement
Info: Infiltrative rather a distinct mass diffusely infiltrating glial tumor involving 2 or more lobes, often BL

GLIO MATOSIS CEREBRI

Sz: nodular dural or leptomeningeal thickening & enhancement (esp. basal cisterns, can be in cord), white matter lesions, cerebral masses (granulomas), CN & infundibular hypothalamic involvement, hydrocephalus, spinal cord masses, dural thickening w/ plaques T1 hypo
Sx: chronic meningitis
Info: spread along dura & leptomeninges, positive on PET & Gallium
Tx: steroids, immunosuppressives

NEUROSARCOID

Sz: dilation of lateral and third ventricles, normal fourth ventricle, upward upward convexity / bowing of the corpus callosum due to lateral ventricular dilation, inferior bowing of the anterior recesses of the third ventricle, depression of the optic chiasm,
Cz: congenital or previous subarachnoid hemorrhage, meningitis or ventriculitis, extrinsic compression from mass

AQUEDUCTAL STENOSIS

Sz: circumscribed suprasellar HIGH (variable) T1 and T2, can have fluid level or thin rim
Sx: may compress optic chiasm (headache and visual disturbances) or pituitary gland (diabetes insipidus or hypopituitarism)
Info: benign epithelial lined cyst

RATHKE CLEFT CYST

Sz: disproportionate enlargement central ventricles, normal hippocampus (distinguishes from atrophy), transependymal flow,
COMMUNICATING: obstructing of arachnoid villi, eg meningitis, tx w/ shunting
NONCOMMUNICATION: neoplasm, surgery
NORMAL PRESSURE: T1 sag aqueductal "flow void" from increased CSF velocity, from remote hemorrhage or infection, tx w/ shunting

HYDRO CEPHALUS

Sz: isointense to CSF on all pulse
sequences (differ from non cystic-degneration lacunars), often BL & symmetric, located along the anterior commissure (lacunar infarcts usually superior putamen, perivascular spaces usually inferior), lacunars may have a thin rim on T2 representing gliosis.

VIRCHO ROBIN PERI VASCULAR SPACES

Sz: cystic mass in ant / sup 3rd vent near Monro, no enhancement, may be hyperdense w/ possible blood products, variable MRI often iso to grey matter
Comp: positional headaches from intermittent hydrocephalus, may enlarge rapidly causing coma
Info: must exclude aneurysm
Tx: shunt, resect, cyst drainage

COLLOID CYST

Sz: T2 hyperintensity & restricted diffusion in central pons (cytotoxic edema)
Cz: rapid correction of low Na, Etoh, sepsis
Sx: spastic quadraparesis, CN palsies
Px: variable, can > coma

CENTRAL PONTINE MYELINOLYSIS

Sz: radiolucent and sclerotic lesions, skull base and sphenoid wings w/ inc sclerosis, outward osseus expansion
Info: Skull and face involved in 1/4 (mono) to 1/2 (poly)

FIBROUS DYSPLASIA

Sz: small sella turcica, small pituitary, atresiastalk, ectopic post pit bright spot
Sx: traumatic delivery w/ rupture pit infundibulum

PRIMARY PANHYPO PITUITARISM

Sz: varius types hemorrhage

ECLAMPSIA

Sz: hydrocephalus w/ kinked brainstem + compressed 4th vent, flat skull base

BASILAR INVAGINAITON

Sz: defect of cranium / dura w/ extracranial extension of intracranial structures
ENCEPHALOCELE: brain elements
MENINGOCELE: only CSF elements, can protrude from NF and mimic neurofibroma (but is cystic)

CEPHALOCELE

Sz: low T2 signal coats surface of brain, brainstem, CNs, spinal cord, corresponding hyperdensity on CT
Cz: chronic subarachnoid hemorrhage

SUPERFICIAL SIDEROSIS

Sz: atrophy and high T2 signal in hippocampus, ex vaculo dilitation temporal horn
Sx: epilepsy (partial complex seizures)
Tx: usually surgical as refractory to meds

MESIAL TEMPORAL SCLEOSIS

Sz: symmetric high T2 lesions of mamillary bodies medial thalami and periaq GM, often nonenhancing, late = mamillary body atrophy
Sx: opthalmoplegia, ataxia, AMS
Cz: Etoh
Tx: thalamine IV

WERNICKE'S ENCEPHALO PATHY

CATEGORIES:
BRAIN PARENCHYMA: glioma
BRAIN COVERING: meningioma
NEURONAL CELLS:neurocytoma
PRIMITIVE CELLS: meduloblastoma, PNET
METS
Comp: 3H hydrocephalus, hemorrrhage, herniation
Imaging char: enhancement , T2 signal (not as bright as cst = cellular), cyst, hemorrhage, Ca+ necrosis, multiplicity
Info: >80% pts w/ brain tumor present w/ seizure, rare w/ stroke

NEOPLASM

Sz: cystic cerebellar mass w/ enhancing mural nodule, well circumscribed, usually cerebellar, Ca+ and hemorrhage uncommon
Tx: surg w/ good prognosis
Info: Grade 1 astrocytoma, MC intracranial tumors children

JUVENILLE PILOCYTIC ASTROCYTOMA

Sz: microdenoma < 1 cm, macro > 1cm, T1 HYPO, T2 Variable, hypoenhancement early, late wash-IN, possible internal hemorrhage, plasitc tumor that narrows as it crosses diaphragmatic sella = " snowman", cavernous extension common
Info: MC tumor sella turcica
Sx: micro > endocrine abn, macro > mass effect

PITUITARY ADENOMA

Sz: posterior fossa mass (often 4th vent or CPA), expand ventricle, heterogeneous, possible Ca+ & cystic components, subarachnoid seeding, obstructive hydrocephalus, "tongue of tumor squeezes" out of 4th ventricle foramina on lateral
Info: supratentorial: interparenchymal, infratentorial: intraventricular, spine imaging for drop mets, ependymoma usually intracranial in peds and spinal in adults
Tx: difficult surgical resection, poor progosis
associated hydrocephalus

BRAIN EPENDYMOMA

Sz: avid enhancement, expansion of IAC, start in IAC & extend to CPA, lack of dural tail, acute angulation with underlying petrous ridge (differ from meningioma)
Info: BL in NF2, IAC MC Location

BRAIN SCHWANNOMA

Sz: extends from spinal canal, can encase vertebral artery, expands and infiltrates nerve, can be seen in extremities ("target appearance on T2")
Info: benign
Ass: NF1
PLEXIFORM NF: large soft tissue mass w/ T2 bright serpiginous tube like structures, T2 "target sign", along course of nerve, associated skin lesions, benign
PERIPHERAL NERVE SHEATH TUMORS: fusiform, rind of "split" fat around mass, homorgeneous signal & enhancement

NEUROFIBROMA

Sz: pedunculated mass, inferior to hypothalamus, posterior to optic chiasm / infundibulum, anterior to mamillary bodies, usually iso to GM w/ no enhancement
Sx: gelastic (laughing) seizures, precocous puberty, developmental delay
Info: Hamartoma of tuber cinereum or hypothalamus containing ectopic neural tissue

HYPO THALAMIC HAMARTOMA

Sx: isointense to CSF on all sequences, smooth remodeling of inner table, displace surrounding structures, hypogenesis of surroundging brain parenchyma

ARACHNOID CYST

Sz: intensely enhancing, "salt & pepper" flow voids, bony erosion if large
GLOMUS JUGULARE: arise jugular fossa
GLOMUS TYMPANICUM: arise middle ear near cochlear promontory, abut (or mildly erode) tympanic membrane, need to ID ass w/ ICA & jugular vein
CAROTID BODY TUMOR: splays int / ext carotid arteries
GLOMUS VAGALE: nasopharyngeal carotid space, displace ICA anteromedially
Sx: GT ad GJ w/ pulsatile tinnitus, hearing loss
Ass: pheochromocytoma
Tx: excision or radiation

PARAGANGLIOMA

Sz: T1 ISO, T2 MILD HYPER, can encase vessels, angio: "mother in law sign" = early homogeneous enhancement with prolonged vascular stain, avid enhancement, dural tail, Ca+ in 25%, homogeneous enhancement, surrounding edema, hyperdense, hyperostosis, cortical thickening & inner table invasion
Sx: rare < 20 unless NF,
Spinal: Intradural, extramedullary
Angio: supplied by ECA
HEMANGIOPERICYTOMA: similar appearing with no hyperostosis or Ca+, vessels w/i tumor

MENINGIOMA

Sx: T2 dark/iso (hypercellular), usually mildly restrictedm diffusion, hyperdense CT, ring with AIDS marked enhancement, homogeneous,MC deep grey matter (basal ganglia, thalamus, hypothalamus), white matter, corpus callosum, homogeneous enhancement, mujltiple lesions frequent
Tx: chemo + XRT, responds dramatically to steroids but may render bx nondiagnostic, if immunocompromised often tx for Toxo iniatially
Info: parenchymal + dural = mets or lymphoma
METASTATIC LYMPHOMA: dural based or
leptomeningeal

LYMPHOMA

Sz: HIGH T2 infliltrating mass, may involve corpus callosum, may have subependymal or ependymal nodular enhancement/ spread (ddx TB, sarcoid), central necrosis
Info: Grade 4 astrocytoma
FIBRILLARY ASTROCYSTOMA: less aggressive , Grade 2-4

GLIO BLASTOMA MULTIFORME

Sz: usually midline, basal surface of brain, High T1 fat (ddx lipoma, teratoma), Ca+, no enhancement, extra-axial
Comp: rupture > chemical meningitis & vasospasm / stroke, chemical meningitis = intraventricular and subarachnoid rupture + enhancement
Info: ectodermal in origin, differentiated epithelial components (hair, sweat gland), lipid debres
Ass: dermal sinus tract, arachnoiditis (ruptured), tethered cord

DERMOID

Sz: suprasellar, Ca+, solid (enhancing) and multicystic components, may cause hydrocephalus, extra axial
Info: often peds, slow growing, squamous epithelial, arise from remnants of Rathke's cleft.

CRANIO PHARYNGIOMA

Sz: sl irregular contour, extra-axial but can extend into ventricles, no enhancement, similar to arachnoid cyst , usually slightly higher than CSF signal on T2 but restricted diffusionheterogen on FLAIR and PD, variable location (MC posterior fossa, CPA, QP cistern), encases vessels/ nerves, insinuating lesion (vs compressive arachnoid cysts), MC location is CPA
Info: AKA PRIMARY CHOLESTEATOMA, Ectodermal in origin
Tx: Resection
Ass: dermal sinus tract, arachnoiditis (ruptured), tethered cord

EPIDERMOID

Sz: partially calcified cortical/subcortical mass (astrocytoma cortex usually spared), slow growing, infiltrative w/ poorly defined borders, often frontal, expands overlying cortexedema & enhancement uncommon

OLIGO DENDROGLIOMA

Sz: Hyperdense 4th ventricle mass cerebellum, LOW ADC (dec diffusion), enhancement, roof of 4th ventricle, osurrounding edema
Info: Malignant neuroepithelial tumor (PNET), eval spine for drop mets (earlier than ependymoma), arise from vermis
Sx: HA, ataxia
BASAL CELL NEVUS SYNDROME: meduloblastoma, faux Ca+, jaw keratocysts
PNET: "supratentorial meduloblastoma", similar imaging and histology, different genetics, can be located in pineal

MEDULO BLASTOMA

Sz: Focal or diffuse non-enhancing white matter mass, increased choline:NAA
WHO 3 subtypes: astrocytoma, anaplastic astrocytoma, GBM
ANAPLASTIC ASTROCYTOMA: may be indistinguishable

ASTROCYTOMA

Sz: mass that "engulfs" the pineal gland or suprasellar mass w/ diabetes insipitus (involve infundibulum), midline, hperdense, strong enhancement, hydrocephalus
Info: check spine for drop mets (not encapsulated), arise from primitive germ cells

GERMINOMA

Sz: bone destruction w/ soft tissue mass, 50% Ca+, MC location clivus or sacrum
Info: benign but malignant behavior w/ locally agressive and possible mets
CHONDROSARCOMA: clivus

CHORDOMA

Sz: nonenhancing HIGH T2 mass, rim on flair, may appear cystic, "bubbly" intracortical mass, often temporal, no vasogenic edema
Sx: cortical tumor (ass w/ seizures)
DDx: CVA, low grade glioma

DNET

Sz: solid and cystic mass arising from midbrain
Info: subtypes include JPA, tectal glioma, fibrillary astrocytoma
Info: astrocytoma

BRAIN STEM GLIOMA

Sz: Adult posterior fossa cystic mass and enhancing mural nodule, prolonged blush on angio
Info: benign, MC primary infratentorial neoplasm in adults, Ass w/ VHL

HEMANGIO BLASTOMA BRAIN

Sz: large heterogeneous pineal mass w/ "exploded" pineal Ca+, enhancement, cystic, subarachnoid spread, hydrocephalus (compression of the cerebral aqueduct), c
Sx: Parinaud's syndrome (inability to gaze upward due to compression of tectal plate)
Info: MC in children and young adults, PNET = check spine for mets

PINEOBLASTOMA

Sz: enhancing intraventricular mass, (abuts or attached to septum pellucidum), well circumscribed, lobulated, "bubbly" intratumoral cysts, hydrocephalus, isodense to brain w/ Ca+ & cystic change, possible flow voids
Info: very vascular, need to know preop
SUBEPENDYMOMA: nonenhancing intraventricular mass, often attached to septum, also often in 4th vent, tx: resect

CENTRAL NEUROCYTOMA

Sz: more circumscribed vs pineoblastoma, enlarged, calcified pineal gland, homogeneous enhancement, hyperdense on CT, may be ISO to CSF but has trabeculatsions (differ pineal cyst), slow growing, unencapsulated
Info: mature pineal parenchymal cells

PINEOCYTOMA

Sz: marked enhancement, lobulated intraventricular mass, dilated choroidal arteries feed tumor (angio), hydrocephalus, lateral ventricle in kids and 4th vent in adults (may extend through foramen of Lushka to CP angle)
Info: spine imaging for drop mets

CHOROID PLEXUS PAPILLOMA

Sz: "sugarcoating" and nodular enhancement of nerve roots, dural / leptomeningeal thickening & enhancement
Cz: mets from CNS or other tumor (lung, breast, lymphoma, drop mets)
DDx: meningitis, sarcoidosis

MENINGEAL CARCINO MATOSIS

Sz: MC intradural extramedullary mass, high T2, rim enhancement, extend & enlarge neuroforamina, cystic change and hemorrhage common, extradural "dumbell" component", bony remodeling, usually anterior & lateral (meningioms usually posterior), "target sign" = low central signal w/ peripheral enhancement), extend to neural foramina (unlike meningiomas)
Info: if single, impossible to differentiae from neurofibromas

SCHWANNOMA SPINE

Sz: intramedullary cyst w/ cyst w/ enhancing nodule
Ass: intamedulary edema & syrinx
Tx: resection

ASTROCYTOMA SPINE

Sz: extramedullary intradural, T1 ISO and T2 ISO/Hyper, intensely enhancing, usually posterior (schwannomas usually anterior & lateral)
IMED: mening, schwan, paraganglioma, epidermoid, arachnoid cyst, mets, lymphoma

MENINGIOMA SPINE

Sz: Intramedullary mass w/ highT2, marked enhancement, sharply marginated (vs. astrocytomas= infiltrating), "cap sign" = rim of chronic blood products, possible necrosis, cystic degeneration, widened IP distance, MC cervical
Info: multiple ass w/ NF2
Tx: microsurgical resection, XRT for incomplete resection
MYXOPAPILLARY EPENDYMOMA: Sausage shaped intradural enhancing mass in conus, cauda equina, filum terminale

EPENDYMOMA SPINE

Sz: 60% intramedullary, intramedullary cysts with enhancing nodule(s) and dilated dosal veins (flow voids), enlarged (and sl irrgular) cord (usually dorsal), located dorsally in cord (less syrinx b/c eccentric location vs astrocytoma & ependymoma) surrounding edema
Info: 1/3 with VHL
Ass: syrinx

HEMANGIO BLASTOMA SPINE

Sz: thickened cortex, abnormal T2 signal, MC temporal lobe, blurring grey-white junction
Sx: seizure
Info: abnormal focl arrangement cortical neurons, PET can help localize focus

FOCAL CORTICAL DEFECT

Sz: peripheral, MC temporal, cyst w/ mural nodule, "dural tail"
Info: Grade 1 astrocytoma

PLEOMORPHIC XANTHOASTROCYTOMA

Sz: MC temporal, variable w/ possible cystic mass, solid nodule, Ca+, can indent inner table of skull, no edema, cortically based
Sx: children, young adults
Info: mixed neuronal & glial tumor

GANGLIO GLIOMA

Info: mets involveing dura MC breast in women and prostate in men

METASTATIC DISEASE, BRAIN

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