Differences

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--- neuro [2019/04/22 08:23] – nfasano
+++ neuro [2022/07/18 14:17] (current) – [Terminology] nfasano
@@ Line 1: / Line 1: @@
+====== Perfusion CT ======
+===== Core vs Penumbra =====
+^ ^MTT^CBF^CBV^
+|Core|↑|↓↓|↓↓|
+|Penumbra|↑|↓|nl or ↓|
+===== Rapid AI =====
+  * CBF - cooler = worse
+    * CBF < 30% criteria
+  * MTT - hotter = worse
+    * Tmax > 6.0 seconds
+  * Report:
+    * Mismatch volume
+    * Mismatch ratio
+==== Interpretation ====
+  * Start with TTP and delay images to spot abnormality
+  * MTT & CBF
+  * Then CBV to determine core vs penumbra
+==== Reporting ====
+  * Sample
+    * Acute R MCA territory infarct with MCA/PCA penumbra.
+    * CBF < 30% of 17 mL, Tmax > 6 sec of 155 mL, and mismatch volume of 127 mL (ratio 8.5).
+==== Terminology ====
+  * AIF = Arterial In-flow
+  * VOF = Venous Out-flow
+  * CBF = Cerebral Blood Flow (core infarct/overestimates infarct)
+  * CBV = Cerebral Blood Volume (core infarct/good for visual estimate)
+  * Tmax = Arterial in-flow to capillary time (ischemia)
+  * MTT = Mean Transit Time = Capillary transit time (ischemia/least sensitive)
+  * TTP = Time to Peak = Arterial in-flow to capillary time AND capillary transit time (ischemia)
+==== Microbleeds on MRI ====
+  * <5 - tPA safe
+  * >5 - safety unknown
+====== Vascular Supply ======
+  * Recurrent artery of Heubner (aka medial lenticulostriate)
+    * branch of ACA
+    * caudate head, ant limb of internal capsule, septum pellucidum
+  * Lateral lenticulostriate
+    * branch of MCA
+    * lentiform nucleus, caudate capsule, internal capsule
+  * Thalamic and midbrain perforators
+    * branch of PCA
+  * SCA
+    * superior cerebellum
+  * AICA
+    * inferolateral pons
+    * middle cerebellar peduncle
+    * anterior cerebellum
+  * PICA
+    * medulla
+    * posterior and inferior cerebellum
+{{brainvascterritories.jpg|Brain Vascular Territories}}
+{{:aspects-score.png|Aspects Score}}
+  * Areas with hemorrhage count as abnormal in aspects scoring.
+  * Dense MCA does not count.
+==== Vertebral Artery Anatomy ====
+{{:verta.jpg|:verta.jpg}}
+  * Part one is from the origin to the point at which it enters the transverse foramina of either the fifth or sixth cervical vertebra.
+  * The second part courses within the intervertebral foramina
+  * The third part exits behind the atlas and heads towards the foramen magnum.
+  * The fourth part (intracranial) begins as it pierces thedura and arachnoid mater at the base of the skull, and ends as it meets its opposite vertebral artery to form the midline basilar artery at the level of the medullopontine junction.
 ====== White Matter Dz ======
 ===== Multiple Sclerosis Criteria =====
@@ Line 221: / Line 284: @@
   * causes hoarsness and dysphagia
-====== Vascular Supply ======
-  * Recurrent artery of Heubner (aka medial lenticulostriate)
-    * branch of ACA
-    * caudate head, ant limb of internal capsule, septum pellucidum
-  * Lateral lenticulostriate
-    * branch of MCA
-    * lentiform nucleus, caudate capsule, internal capsule
-  * Thalamic and midbrain perforators
-    * branch of PCA
-  * SCA
-    * superior cerebellum
-  * AICA
-    * inferolateral pons
-    * middle cerebellar peduncle
-    * anterior cerebellum
-  * PICA
-    * medulla
-    * posterior and inferior cerebellum
-{{:aspects-score.png|}}
 ====== Brainstem and Cranial Nerves ======
-{{brainstem.jpg}}
+{{brainstem.jpg|Brainstem and Cranial Nerves}}
 ===== Facial Nerve Segments =====
@@ Line 525: / Line 571: @@
 Sjogren's can look like fatty replaced salivary glands
-===== Vertebral Artery Anatomy =====
-{{:verta.jpg|:verta.jpg}}
 ===== Lymph Node Levels =====
 {{:lymphzones.gif|:lymphzones.gif}}
@@ Line 650: / Line 695: @@
     * Matched DWI/FLAIR abnormality
     * Vascular territory
+===== Dark spots on GRE =====
+  * Amyloid angiopathy
+  * Hypertensive microbleeds
+  * Cavernomas (familial)
+  * DAI
+  * Calcifications
+  * Hemorrhagic mets
 ===== Ring-enhancing lesion =====
   * Metastasis