Neuro Notes

Talk about Scoliosis if the Cobb Angle is >10
Spine Red Flags:
  1. Recent significant trauma, or milder trauma, age >50
  2. Unexplained weight loss
  3. Unexplained fever
  4. Immunosuppression
  5. History of cancer
  6. IV drug use
  7. Prolonged use of corticosteroids, osteoporosis
  8. Age >70
  9. Focal neurologic deficit progressive or disabling symptoms
  10. Duration greater than 6 weeks
(W.G. Bradley, Jr. for the Expert Panel on Neurologic Imaging. Low Back Pain.
AJNR Am. J. Neuroradiol 2007; 28: 990 – 992 )

Flexion-extension radiography is widely used in the imaging diagnosis of lumbar intervertebral instability. 

Modic Type 1 changes are more associated with LBP and instability then other types.

Diskitis (infection) can be confused for Modic Type 1 DDD.  However, for Modic Type 1 the discs typically normal/hypointense, the endplates are preserved, normal CRP, and no adjacent soft tissue inflammation.

T1 Enhancement of annular tears (and T2 hyperintensities) do not correlate with acuity.

Pleomorphic adenoma, look for recurrence on T2 sequences.  Hyperintensities 

For squamous glottic cancers, intermediate t2 in cartilage is more predictive of local failure vs high t2 which is more likely to be infectious/inflammatory 

When tumor that encompasses more than 270 degrees of the carotid artery, it  cannot be surgically removed from the artery.  

Absence of ethmoidal invasion can differentiate between antrochoanal polyp from inverted papilloma and Juvenile angiofibroma.  

Suspicious nasal masses have intermediate T2 signal, show invasion of other structures, and heterogenous signal intensity.  

Esthesioneuroblastoma from olfactory epithelium, Juvenile angiofibroma from sphenopalatine foramen, inverted papiloma from lateral nasal wall, chordoma from clivus

Fungal sinusitus has very low T2 
(SM Allbery, G Chaljub, NL Cho, CH Rassekh, SD John, and FC Guinto MR imaging of nasal masses RadioGraphics 1995; 15: 1311-1327. )

READING PARATHYROID CT: Parathyroid adenoma has contrast enhancement in the arterial phase, rapid washout of contrast material on delayed phase, and lower attenuation compared with thyroid gland in the nonenhanced phase. Peak enhancement between 25 and 60 seconds.  (Mimics - lymph nodes and thyroid tissue.  1) Lymph nodes show increasing enhancement after contrast, with peak enhancement at in the delayed phase. 2) Thyroid tissue enhances in the arterial phase and has increasing contrast enhancement between the arterial and the delayed phases; thyroid tissue has high attenuation on the non contrast CT) 

Clivus lesions-  Chordoma (bright T2 midline)  Chondrosarcoma (off midline bright T2 with rings and arcs on CT), Pituitary macroadenoma (low T2), fibrous dysplasia (low T2, plus enhancement, younger patient), Giant Cell (rare, large, expansile, soft tissue). 

Common intradural extramedullary lesions- meningioma and schwanoma.  Get CT to check for Calcification: Meningioma

Multiple intramedullary lesions- mets, hemangioblastomas, sarcoid

cryptococcus: Dilated Vircow Robin Spaces and  enhancing masses  (similar to TB)

Complications of Sinusits:  Preseptal cellulitis, postseptal cellulitis, subperiostial abscess,  orbital abscess, cavernous thrombosis.     Intracranial Complications:  Meningitis, Epidural/Subdural abscess, cerebritis, vascular infarction

Macdonald criteria Revised 2010 
DIS (dissemination of lesions in space )can be demonstrated with at least 1 T2 lesion in at least 2 of 4 locations considered characteristic for MS and as specified in the original McDonald Criteria (juxtacortical, periventricular, infratentorial, and spinal cord),

 DIT can be demonstrated by a scan containing both enhancing and nonenhancing lesions in regions of the CNS a diagnosis of MS can be made in some CIS patients based on a single MRI. Anew clinical event or serial imaging to show a new enhancing or T2 lesion will still be required to establish DIT in those patients who do not have both gadolinium-enhancing and nonenhancing lesions on their baseline MRI.

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