Show:
Seizures/Epilepsy
CT Scan of the brain
Interventional neuroradiology
Movement Disorders
Dementia
100

What type of seizures is classified as generalized? 

1. Generalized tonic clonic seizure (grand mal)

2. Absence Seizure (peti Mal)

3. Myoclonic Seizure 

100

Which tissues are hyperdense and list in descending order of their hounsfield unit ?

Bone/calcification, Blood, Gray matter, White matter

100

  1. What is Digital Subtracting Angiography (DSA) commonly used for and which arteries can it evaluate? 

- Evaluation of aneurysms     

- Acute Stroke

- Vascular Leisons

Carotid and Vertebral artery 

100

What are some specific things that goes under parkinsonism?

Akinesia

Bradykinesia

Freezing

Rigidity

Postural instability 

Spasticity

Postural instability 

100

What is the prevalence of dementing disorders in the elderly? 

Alzheimer disease, lewy body disorders, frontotemporal dementias, vascular dementias and other dementias. 

200

What type of seizures are considered partial? 

1. Motor/sensory Seizure

2. Complex partial seizure 

200

What are diseases that may show calcification on the CT scan? 

1. Fahr Disease

2. Neurocysticercosis

3. Calcified meningioma

4. Metallic artifacts 

5. Bullets 

200

What is the main difference between CTA and MRA?

  • CTA → can only be performed using contrast medium. CTA has better spatial resolution than MRA. 
  • MRA → can be performed with contrast or without. Which can be used in situations where the contrast is contraindicated. 
200

Match

1. Myoclonus          a. Blood glucose

2. Oculomotor crisis  b. Ammonia, BUN, medication

3. Ballism                c. medication

4. Hemichorea         d. brain CT

1. b

2. c

3. D

4. A

200

What are the causes of dementia? 

  • Neurodegenerative dementia

  • Vascular dementia

  • Structural causes of dementia

  • Metabolic causes of dementia

  • Infectious causes of dementia

  • Dementia from endocrine dysfunction

  • Inflammatory causes of dementia

300

What are the 9 causes of seizures? 

  1. Vascular : AVM, stroke, hemorrhage, hypertension
  2. Infectious : Meningitis, encephalitis
  3. Traumatic
  4. Autoimmune : SLE, vasculitis, ADEM
  5. Metabolic/ toxic: electrolyte imbalance,tox
  6. Idiopathic : idiopathic epilepsy
  7. Neoplastic
  8. structures: cortical malformation, prior stroke, Other causes of CP
  9. syndrome : genetic disorder
300

What are some physiological structures that will have calcification?

  1. Choroid plexus (rare before 10 years)

  2. Basal ganglia (rare before 40 years) (Globi pallidi most common)

  3. Pineal gland (common after 30 years: rare before 10 years)

  4. Falx

  5. Dentate nuclei

300

  1. What are some common sites of intracranial saccular aneurysms? List from most common to least common.

Bonus: 20 points for each additional fact

including causes of aneurysms,diagnostic imaging  and treatment options. 


Ans: Anterior communicating artery, posterior communicating artery, middle cerebral artery, lateral carotid artery bifurcation, Basilar tip, pericallosal artery, posterior inferior cerebellar artery

Causes

  • Hemodynamically induced degenerative vascular injury
  • Artherosclerosis (fusiform aneuryms)
  • Vasculopathy (FMD)
  • High flow status

uncommon

trauma, infection, drug abuse, tumor

Treatment options - Clipping , embolization

Diagnosis CT, CTA, MRA, DSA



300

What are Hyperkinetic Movements? 

20 points for additional information on these different types of movements. 

1. Athetosis- Slow, involuntary, convuluted, writhing movements of fingers, hands, toes, and feet.  Piano playing fingers

2. Ballism- also called hemiballismus, Flailing, ballistic, undesired movements of the limbs, subthalamus ICH

3. Chorea- Dance like movements, often occur with athetosis, huntington disease , chorea gravidarum(a complication of pregnancy) 

Hemichorea- blood glucose 

4. Dystonia - sustained muscle contractions cause twisting and repetitive movements or abnormal postures

5. Myoclonus - brief involuntary twitching of muscles, hypnic jerk, positive myoclonus and negative myoclonus

6. Tremor- rhythmic, muscle contraction and relaxation involving to and from movements. 

enhanced, physiology tremor, essential tremor and parkinsonian tremor 

7. Tics - sudden repetitive, non rhythmic motor movement or vocalization involving discrete muscle groups. motor tics or verbal tics 

300

What are some MRI manifestations of cerebral small vessel disease? 

1. Recent small subcortical infarct

2. White matter hyperintensity

3. Lacune

4. Perivascular Space

5. Cerebral microbleeds

400

What kind of symptoms present when the seizures originate from 

1. frontal lobe

2. Temporal lobe

3. Parietal lobe

4. Occipital lobe 

  • the frontal lobe?
    • Jacksonian seizure( tingling feeling in hand or arm)
    • Adversive seizures (eyes or head both turn to one side)
  • the temporal lobe?
    • strange smell or taste
    • Altered behavior
    • Feeling as if ‘I’ve been there before’ or I’ve seen that before. Deja vu
    • Lip smacking or chewing movements
  • the parietal lobe?
    • Tingling in or jerking of leg, arm and face
  • the occipital lobe?
    • flashing lights
    • Spots, Vomiting
400

What are some things that are hypodense on CT and what condition may these be associated With? 

Air- Pneumocephalus, air emboli

Fat- Lipoma, dermoid, fat containing tumor

Fluid - edema from infarction, infection, tumor, cystic lesion, effusion, abscess 

400

  1. What are the goals of acute stroke imaging? What is the characteristic feature of a penumbra?

- detection of IntraCranial Hemorrhage

    - Differentiation btw infarcted tissue from salvageable tissue

    - identification of intravascular thrombi

    - selection of appropriate therapy

    - prediction of clinical outcome

b. central irreversibly infarcted core surrounded by a peripheral region of stunned cells

400

What is a movement disorder vs. seizure?

Oculomotor crisis – Preserved consciousness 

Positive myoclonus – Consult Neurologist 

Seizure persisted during sleep but movement disorders do not

400

What are the two most common structural causes of dementia? Explain what they are. 

1. Chronic subdural hematoma- Typically presents as a progressive deterioration in cognition and gait over days to weeks

2. hydrocephalus - causes compressive dysfunction of descending cortical pathways and cortex itself. The symptoms classically involve gait disorder, urinary incontinence and dementia

500

what are some red flags of syncope? 

  • Exertional or resting syncope
  • Dyspnea or cardiac function deteriorating 
  • Known structure heart disease or arrhythmia
  • Family history of sudden cardiac death
  • Frequent attacks
  • Other focal neurologic signs presented
500

match each image to the type of hemorrhage it is. 

Bonus 100 points to list 5 causes of hemorrhage

20 points bonus for any additional correct facts that can be given regarding hemorrhage

Image 1- ICH

Image 2- Subdural - 

Image 3- Epidural - 

Image 4- Subarachnoid

Image 5 - Intraventricular 

1. ruptured aneurysm

2. Falls

3. arteriovenous malformation

4. shear and tear of bridging veins 

5. hitting the head with force 

6. cerebral atrophy

500

To manage head and neck active bleeding what procedures could be utilized?

Embolizer → NCBA - PVA - Gelform - Onyx 

Manual decompression

surgery 

coil

cover stent

balloon temporary occlusion 

500

How to approach a movement disorders? 

Check the involved limb

the duration

consciousness 

disappearing in sleep

medication

500

What are some diagnostic testing that can be carried out when evaluating dementia?

1. Neuropsychological testing

2. Laboratory blood testing- CBC, serum chemistry, serum BUN, creatinine, Liver function test, thyroid function test, B12 level, serologic test for syphilis and HIV

3. Laboratory CSF testing- checks for infectious or inflammatory etiologies

4. Neurophysiologic testing- EEG, can see the possibility of subclinical paroxysmal disorders being responsible 

5. Neuroimaging- CT, MRI, Biomarker imaging (functional and molecular imaging