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 C-Spine Alignment: Anterior vertebral line, posterior, spinolaminar line, posterior spinous line, predental space (3mm, kids 4-5mm - RA, AS, DS, trauma) Bones: Jefferson fx Cartilage: S: ST swelling above C4 < 50% width of vertebral body; below C4 width of vertebral body Anatomy: facet joints, lamina, 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 Unstable 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, Compression: 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 Other: 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