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Neuro Review

2nd Branchial Cleft Cyst: Between submandibular salivary gland and SCM, lateral to carotid, deep to the platysma. Displaces submandibular gland anteromedially, SCM posterolaterally and carotis posteromedially. R/O necrotic squamous ca LN > 30yo

Anterior vertebral line,
spinolaminar line,
posterior spinous line,

predental space (3mm, kids 4-5mm - RA, AS, DS, trauma)
Bones: Jefferson fx
S: ST swelling above C4 < 50% width of vertebral body; below C4 width of vertebral body

facet joints,
spinous process,
pars interarticularis - lateral mass, pedicle, transverse foramen (vertebral artery)
Spinal canal: posterior vertebral body to spinolaminar line

Classifications of C-spine injuries
Stable: vertebral compression > 25%, anterolisthesis, widened or narrowed disc space, widened interspinous spaces, widened apophyseal
3 columns: anterior, middle, posterior

Flexion injuries:
Wedge compression fx: MRI T2 w/ fat sat, anterior wedging > 3mm
Flexion teardrop: C6, C7, ligamentous injury, unstable, permanent quadruplegia, vertebral artery injury
Bilateral facet locks, dislocation: >50% anterior dislocation, all ligaments injured: anterior, posterior, flavum, interspinous, ..., unstable
Clay shoveler fx: C7 spinous process fx; stable injury
Unilateral facet dislocation: < 50% of anterior dislocation, simultaneous flexion and rotation, stable, perched, bow-ties, bat-wing

Extension injuries:
Hangman fx: pars interarticularis fx of C2; hyperextension, chin on dashboard w/o seat belt
Extension teardrop: stable, hyperextension,

Jefferson fx: lateral masses of C1 lateral displacement > 2mm, transverse ligament tears,
Burst fx: C3-C7, fx fragments into canal (retropulsion), stable unless >25% of compression

Atlanto-Occipital dislocation: Down Sy; distance from basion (tip of clivus) to the posterior ring of C1, opisthion, unstable
Dens fx: type 1 - high (unstable), type 2 neck , type 3 below neck
C1 fx other than Jefferson: rare, isolated

congenital nonunion, Mach line (looks like type 2), os odontoideum,
degenerative changes, DISH, AS

Calcified glial tumors
Old Elephant Ages Gracefully: Oligodendroglioma, Ependymoma, Astrocytoma, GBM

Cyst and Mural Nodule
Pilocytic Astrocytoma: posterior fossa in children, if supratentorial may appear solid
PNET: supratentorial, 80% in children < 5, more common in neonates, very aggresive w/ edema
Ganglioglioma: temporal lobe
Hemangioblastoma: posterior fossa in adults, assoc. w/ VHL, age 30-80, nodule on pial surface. If seen in children, always assoc. w/ VHL. May be isolated lesion in adults
Pleomorphic Xanthoastrocytoma (PXA): temporal lobe, big cyst, enhancing big nodule in children