Neuroddx – docslide.com.br brain anoxia

NEURO DDX

Neuro ddx

EC

Persistent embyronic ICA to vertebrobasilar connections: trigeminal (#1), hypoglossal, otic, proatlantic artery

Intraaxial hemorrhage: HTN (#1), tumor, trauma, AVM, aneurysm, coagulopathy, amyloid angiopathy, emboli, hemorrhagic infarction, vasculitis, HTN encephalopathy (eclampsia, cyclosporine)

Aneurysm: saccular â degenerative, trauma, mycotic, vasculopathies; fusiform â atherosclerotic; dissecting â trauma vasculopathy spontaneous

SAH: aneurysm (#1), trauma, AVM, coagulopathy, extension of intraparenchymal bleed, idiopathic, spinal AVM

Vascular malformations: AVM, capillary telangiectasia, cavernous malformation, venous anomaly, vein of galen AVM or varix


Stroke: atherosclerosis, cardiac emboli, arterial dissection, vasculopathy, IVDA, venous thrombosis, blood dyscrasias

brain anoxia

Venous sinus thrombosis: pregnancy, dehydration, infection, tumor, hypercoagulable state, trauma

Primary brain injury: epidural hematoma, SDH, subdural hygroma, DAI, cortical contusion

Secondary brain injury: cerebral herniation, diffuse cerebral edema, arterial dissection (spontaneous, trauma, HTN, vasculopathy, migraine, IVDA), CCF

Extraaxial masses: hemisphere â meningioma, mets, lymphoma, arachnoid cyst, dermoid/epidermoid, hemorrhagic or infectious fluid collections, hemangiopericytoma; clivus/prepontine cistern â meningioma, mets, chordoma, chondrosarcoma; CPA mass â acoustic neuroma, meningioma, mets, epidermoid, petrous apex cholesterol granuloma, paraganglioma, aneurysm, arachnoid cyst

brain anoxia

Intraaxial masses: hemisphere â astrocytoma, GBM, oligodendroglioma, lymphoma, mets, PNET, ganglioglioma, DNET; sella â adenoma, craniopharyngioma, rathkeâs cyst, mets, abscess, sarcoid, EG stalk; brainstem â astrocytoma, GBM; pineal region â germinoma, teratoma, pineocytoma, pineoblastoma; cerebellum â astrocytoma, medulloblastoma, hemangioblastoma, mets, ependymoma, choroid plexus papilloma; temporal lobe in young patient â ganglioglioma, DNET, JPA, PXA

Multiple lesions: tumor â mets, GBM, lymphoma; infection â abscess, fungus, cysticercosis, toxoplasmosis; vascular â embolic infarctions, multifocal hemorrhage, DAI, contusions, cavernous hemangiomas, vasculitis

Corpus callosum lesions: tumors â GBM, lymphoma, lipoma, mets (rare); demyelinating â MS, ADEM, PML; infarct â always also involves cingulate gyrus; trauma – DAI

brain anoxia

Intrasellar masses: pituitary adenoma, apoplexy, craniopharyngioma, rathkeâs cyst, mets, aneurysm, abscess

Suprasellar masses: SATCHMOE â sellar lesion extending superiorly, sarcoid, aneurysm, arachnoid cyst, teratoma, craniopharyngioma, hypothalamic glioma, mets, meningioma, optic nerve glioma, EG, epidermoid/dermoid; adults â macroadenoma (#1), meningioma, glioma, craniopharyngioma, aneurysm; children â craniopharyngioma (#1), glioma, germinoma, hypothalamic hamartoma, EG

Posterior fossa tumors: adults â mets, hemangioblastoma, astrocytoma, choroid plexus papilloma, meningioma, epidermoid, dysplastic gangliocytoma; children -âjpa, medulloblastoma, brainstem glioma, ependymoma

Brain tumor in infant: teratoma (#1), PNET, choroid plexus papilloma, astrocytoma

brain anoxia

Intraventricular tumors: adults â astrocytoma, subependymoma, meningioma, mets, cysticercosis; children â choroid plexus papilloma, ependymoma, medulloblastoma, teratoma, astrocytoma; lateral ventricle â PNET, choroid plexus papilloma, glioma, JPA, subependymoma, astrocytoma, mets, oligodendroglioma, meningioma, central neurocytoma; 3rd ventricle â astrocytoma, EG stalk, germinoma, extrinsic craniopharyngioma, colloid cyst, glioma, mets, pituitary or pineal mass, aneurysm, sarcoid; 4th ventricle â ependymoma, medulloblastoma, choroid plexus papilloma, mets, hemangioblastoma, subependymoma

CPA mass: acoustic neuroma (#1), meningioma, epidermoid, arachnoid cyst, mets, ependymoma through luschka, lipoma

brain anoxia

Cystic mass: tumor â cystic astrocytoma/GBM, hemangioblastoma, mets, necrotic pituitary adenoma, craniopharyngioma; benign â epidermoid/dermoid, arachnoid cyst, porencephalic cyst, colloid cyst, cavum variants, rathkeâs cyst, thrombosed aneurysm

Diffuse infiltrative: lymphoma, gliomatosis cerebri, white matter disease

Restricted diffusion: infarct, infection, possibly subacute hemorrhage

Metastasis: intraaxial â lung, breast, colon, melanoma; extraaxial â breast, lymphoma, prostate, neuroblastoma; hemorrhagic â melanoma, renal, chorioca, thyroid

Tumors with CSF seeding: choroid plexus papilloma, ependymoma, PNET (medulloblastoma), piineoblastoma, germinoma, GBM

Hyperdense lesion on CT: lymphoma, medulloblastoma/PNET, ependymoma, germinoma, GBM, hemorrhagic mets, mucinous mets, osteogenic tumor, hemorrhage, meningioma, colloid cyst, aneurysm

brain anoxia

Calcified intraparenchymal lesions: oligodendroglioma, ependymoma, mucinous adenoca, osteogenic sarcoma, toxoplasmosis, CMV, cysticercosis, TB, AVM, aneurysm, TS, sturge-weber, hematoma; sellar lesions â meningioma, craniopharyngioma, germ cell tumor, aneurysm

T2 hypointense lesions: ferritin, hemosiderin, deoxyhemoglobin, intracellular methemoglobin, melanin, calcification, lymphoma, myeloma, neuroblastoma, fibrous tissue (meningioma), high protein concentration, flow void

T1 hyperintense lesions: gd, methemoglobin, melanin, certain states of calcium, fat (dermoid), high protein concentration (colloid cyst), slow flow

Lesions with no enhancement: cysts, tumors with intact BBB (low-grade gliomas)

brain anoxia

Lesions with strong enhancement: meningioma, medulloblastoma/PNET, AVM, paraganglioma, aneurysm, HIV-associated lymphoma, GBM

Ring enhancement: mets, abscess, GBM, infarct, contusion, AIDS, lymphoma, demyelinating, resolving hematoma, radiation

Diffuse meningeal enhancement: meningitis, carcinomatosis (lymphoma, mets), post-op, SAH, intracranial hypotension, CSF leak

Basilar meningeal enhancement: infection – TB (#1), fungal, pyogenic (more common on convexity), cysticercosis; tumor â lymphoma, leukemia, carcinomatosis; inflammatory â sarcoid, rheumatoid pachymeningitis, drugs, pantopaque, ruptured dermoid

Ependymal enhancement: tumor â lymphoma, mets, CSF seeding (PNET, GBM); infection â spread of meningitis, CMV (rare); inflammatory ventriculitis â postshunt or after instrumentation, posthemorrhage

brain anoxia

T2 hypointense basal ganglia lesions: old age, any chronic degenerative disease (MS, parkinsonâs), childhood hypoxia

T2 hyperintense basal ganglia lesions: tumor â lymphoma, NF; ischemia â hypoxic encephalopathy, venous infarction; neurodegenerative diseases (uncommon), leighâs dz; toxin â CO, CN, H2S poisoning, hypoglycemia, methanol; infection â cryptococcus, parasites

T1 hyperintense basal ganglia lesions: dystrophic calcifications (any cause), hepatic failure, NF, manganese

Basal ganglia calcification: physiologic (#1), hypoparathyroid, HPT, TORCH, AIDS, TB, toxoplasmosis, cysticercosis (common), lead, CO, radiation, chemotherapy, fahrâs disease, mitochondrial (common), ischemic-hypoxic injury

brain anoxia

White matter disease: demyelinating (MS, ADEM, CPM), dysmyelinating (leukodystrophies), tumor (lymphoma, mets) vasculopathies (small vessel ischemic dz, vasculitis, HTN, eclampsia, migraines, radiation, chemotherapy, cyclosporine, IVDA), inflammatory (lyme, sarcoid, HIV, PML, CMV)

Wallerian degeneration: infarction, trauma, demyelinating, radiation, neurodegenerative, tumor

Neurodegenerative disorders: WM â demyelinating, dysmyelinating; GM â alzheimerâs, pickâs, multiinfarct dementia, parkinsonâs, lysosomal storage disorders, wernickeâs, creutzfeldt-jakob, mesial temporal sclerosis; BG â huntingtonâs, wilsonâs, fahrâs, leighâs, ALS

Cerebellar atrophy: oligopontocerebellar degeneration, alcohol, dilantin, hemosiderin deposition

brain anoxia

Noncommunicating hydrocephalus: foramen of monro obstruction â 3rd ventricle tumors, colloid cyst, oligodendroglioma, central neurocytoma, giant cell astrocytoma in TS, ependymoma, suprasellar tumors; aqueduct obstruction â congenital aqueductal stenosis, ventriculitis, IVH, tumor (mesencephalic, pineal, posterior 3rd ventricle region); 4th ventricle obstruction â DW malformation, IVH, infection, subependymoma, exophytic brainstem glioma, posterior fossa tumors

Communicating hydrocephalus: meningitis (infectious, carcinomatous), SAH, surgery, venous thrombosis; NPH

Cystic supratentorial congenital anomalies: holoprosencephaly, hydrancephaly, aqueductal stenosis, callosal dysgenesis, porencephaly, arachnoid cyst, cystic teratoma, epidermoid/dermoid, vein of galen AVM

brain anoxia

Posterior fossa cystic abnormalities: DW malformation (vermian hypoplasia/aplasia and large posterior fossa), DW variant (normal size posterior fossa and vermian hypoplasia), megacisterna magna (normal vermis), retrocerebellar arachnoid cyst (must show mass effect), chiari 4 (near complete absence of cerebellum), epidermoid/dermoid, cystic tumor, joubertâs syndrome (superior vermian hypoplasia/aplasia), rhomboencephalosynapsis (vermian hypoplasia/aplasia + fusion)

Absent septum pellucidum: holoprosencephaly, ACC, septooptic dysplasia, chiari 2

Migration and sulcation anomalies: lissencephaly, schizencephaly, polymicrogyria, pachygyria, cortical heterotopia (focal, diffuse, subependymal), hemimegalencephaly

brain anoxia

Phakomatoses: NF, TS, VHL, sturge-weber

Diffuse marrow involvement: mets, myeloma, lymphoma, leukemia, anemia, pagetâs, FD

Spine ddx

Spinal cord compression: criteria â no CSF seen around cord, narrowed AP diameter of cord (