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Neuro and Head and Neck – Autumn 2012Young woman involved in RTA, weakness in hands, cystic lesion next to spinal cord with cord in opposite direction – which level is the lesion: C4/5C5/6C6/7C7/T1Old 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 avulsionTorlov cystMRI 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 uprightNSFSarcoidYoung man, headache, supra anterior part of 3rd ventricle, hyperintense on CT- Colloid cystYoung woman with parotid mass, unilateral, multicystic, low on T2Pleomorphic adenomaDiabetes insipidus, which lesion can it not be ? LCHMidline mass mainly cystic with some Calcs closely assoc with pineal glanddermoid pineoblastomagerminomapineocytomasubarachnoid haermorrhage 2/52 ago, MRI appearancesWhat is best sequence of vertebral artery dissectionTime of flight2D/3D gad enhancedT1 Fat satT2 Fat satYoung man, cystic lesions in parotids bilaterally with bilateral Lymph nodesSarcoidHIVTBWarthinsYoung man in RTA, intracranial blood at vertex crossing the midline, straddling the falxIntercerebral parafalcineSubduralEDHCombined41 year old man with seizures, symmetrical high T2 hyperintensities in ext capsule, periventricular and temporalcadasil MoyamoyaSLEFacial rash and seizures – SLETram track calc in optic sheath – NF280 year old man mass in corpus callosum with T2 changes in periventricular regions ?lymphoma/GBM16 year old girl, confusion, low attenuation ring enhancing lesions on T2- abscessArachnoid cyst – CSF density, no restriction, disappears on FLAIREpidermoid at CPM – restricts on DWIPost trauma, which on is abnormal Air in Prussak Air in ventricleAir in epitympanic recessFluid in cochlearCN6/7 Clival chondrosarcomaCavernous sinus meningiomaFacial nerve schwanommaPositive cavernoma Midbrain demyelinationMS – optic neuritis, now loss parathesia? Where is the lesion in the brain? Calloseptal interfaceCorticalBells’ palsy – which part of the facial nerve enhances?80 year old man. Lytic, sclerotic and subperiosteal bone resorption . Peripheral soft mass, past medical history.BisphophanateAmeloblastomaOsteonecrosisDentigerous cystOrbital pseudotumour vs thyroidNot involvementInvolvement of lacrimal Single muscle ExtraconalLymph node levels –Above hyoidTonsillar cancerLevel II/IIINasopharyngeal cancer. RCA totally occluded, left carotid – 90%MedicalStenting on rightEndarterectomySurgical revascEndovasc stentingAlobar holoprosencephalyDifference between benign intracranial hypertension and sagittal sinus thrombosisSubtle bleed in ventricleProminent temp hornsSlit like lateral ventriclesBilateral haemorrhagesPregnant pre eclampsia pt then cortical thickness where is the lesion – bilateral occipital haemorrhagesYoung man with HIV, nodular enhancement of basal ganglia CyptoToxoHIV encephalopathy Badly controlled DM and hypertension- CSF spaces in basal ganglia, no DWIPerivascular Lacunar infarctsEnhancement of leptomeninges, nodular enhancement of spine – sarcoidSoft tissue calc in hip and calc lesion in brain and oedema – neurocystercisMRI/CT of sagittal sinus thrombosisCNIII palsy, then SAH – where is aneurysm? ACOM Ophthalmic arteryHorner syndrome – T2 crescentic high signalDifferential BP, collapse when playing golf, reveral of flow in left vertebral, biphasic in axillary artery, biphasic is brachialHIV encephalopathyHIV – PMLSeizures in young man, temporal lobe lesion – DNETThoracic cord lesion extramedullary, intradural mass does not affect exit foramina ? NeurofibromaMeningiomaDural fistula vs AVMCerebellar atrophy with T2 hyperintense ring, ataxia, hameosisderinAnti-onconeuroantibodies in CSF – where is the primary – breast, lung, colon, thymomaHigh T2 in mesial temporal lobe and confusion – paraneoplastic syndromeBronchusBreastRenalThyroidMelanomaDescribe mesial temporal sclerosis – small hippocampus with high T2B12 deficiency – signal change in dorsal columns, loss in T1 in vertebral bodiesThyroid, calc, positive lymph node, young woman - papillary, medullary, nothing?Parathyroid PTH raised, raised calc but US normal – what next? PET,CT, MRI, sestamibiLymph node, Level II- normal mediastinoscopy – FNA – SCC, CT Normal, what next? PET/CTSomething moves PPS forward – where is the lesion? Parotid, masticator, carotid, retropharayngealDescribe paraganglioma – pulsatile tinnitus, flow voids, avid enhancementCN6 palsy, retrobulabar pain and otitis media, fluid in mastoid and middle ear, ill defined change in petrous apex mastoiditis, Cholesterol granulomaPetrous apex apicitisCholesteotoma – area least likely to be involved – semi circular canalHMPAO SPECT – post temporal and parietal low activity and reduced in frontal area – AlzheimersLewy body dementiaRTA – mass, swelling in eye – carotico cavernous fistulaCN 7 supplies all these muscles except one – masseterAntrochoanal polyp15 year old boy, widened pterygopalatine fossa – juvenile angiofibroma Cyst at base of tongue – homogenously enhancingThornwaldt cystThyroglossalLingular thyroidWhat structures would definitely be missing in radical neck dissectionSCM and submandibularDigastric and parotidMedial part of clavicleMandibleCarotid ................
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