Cns Tumors And Infections Part1
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Extraaxial
Where is the lesion
Extra-axial (external to the pia)
Intra-axial (beneath the pia)
Supratentorial
Infratentorial
Scwhannoma Meningioma Epidermoid Metastases
EXTRA-AXIAL TUMORS:Meningioma Pituitary adenoma
How old is the patient
Child
Adult
Craniopharyngioma Schwannoma
INTRA-AXIAL VS EXTRA-AXIAL INTRA-AXIAL • • •
Narrows CSF space Displaces cortex toward periphery Gray matter stretched over lesion
EXTRA-AXIAL • •
Widens CSF space Displaces brain; deeper lesion has a broad base toward dura
•
Gray-white “buckling”
matter
INTRA-AXIAL Location • • • •
Cortex Gray-white junction Deep white matter intraventricular
1. MENINGIOMA • Common locations convexity, interhemispheric, tent. Classically iso to GM on all sequences. •
Most common extraaxial neoplasm of adults
•
15 % of primary intracranial neoplasms,
•
Peak 50-60 y.o., F 2:1 intracranial, 4:1 intraspinal
•
CT
Differential Diagnosis • • • •
Glioma Medulloblastoma Hemangioblastoma Metastases
EXTRA-AXIAL Location • • • • • •
Subarachnoid Subdural Epidural Calvarium Subgaleal Scalp (soft-tissues)
Differential Diagnosis • • • • • • •
Meningioma Pituitary adenoma Craniopharyngioma Schwanomma Chordoma Dermoid/epidermoid, cyst, lipoma Metastasis
BRAIN TUMORS IN CHILDREN Supratentorial (52%) • •
Low grade astrocytoma Craniopharyngiomas
Hyperdense
Variable edema (possibly extensive),
Intense enhancement
Dural tail (60%) – nonspecific,
+/- cysts, +/- fat
Vascular supply: ECA 85%, ICA 63%- “mother in law sign”- comes early, stays late •
MRI
Distinguishing features: lens shaped/ plaque-like appearance, hypo T2
Meningiomas typically hypo T2 due to fibrous content or calcification,
Strongly enhance, iso noncom T1. Broad dural base, extraaxial, +/- dural tail
Infratentorial (48%) • • • •
Cerebellar astrocytoma Brainstem gliomas Medulloblastomas Ependymomas
BRAIN TUMORS IN ADULTS Supratentorial (80-85%) Intraaxial Astrocytoma Oligodendroglioma Extraaxial Meningioma Pituitary adenoma Infratentorial (uncommon)
***A 63 y.o. M with mild dementia and decreased vision left eye
Meningioma
On MRI: T1 – similar to brain parenchyma, min. CSF cleft, buckling cortex, homogenous enhancement, dural tail
•
Extraaxial
Where is the lesion
Extra-axial (external to the pia)
Intra-axial (beneath the pia)
Supratentorial
Infratentorial
Scwhannoma Meningioma Epidermoid Metastases
EXTRA-AXIAL TUMORS:Meningioma Pituitary adenoma
How old is the patient
Child
Adult
Craniopharyngioma Schwannoma
INTRA-AXIAL VS EXTRA-AXIAL INTRA-AXIAL • • •
Narrows CSF space Displaces cortex toward periphery Gray matter stretched over lesion
EXTRA-AXIAL • •
Widens CSF space Displaces brain; deeper lesion has a broad base toward dura
•
Gray-white “buckling”
matter
INTRA-AXIAL Location • • • •
Cortex Gray-white junction Deep white matter intraventricular
1. MENINGIOMA • Common locations convexity, interhemispheric, tent. Classically iso to GM on all sequences. •
Most common extraaxial neoplasm of adults
•
15 % of primary intracranial neoplasms,
•
Peak 50-60 y.o., F 2:1 intracranial, 4:1 intraspinal
•
CT
Differential Diagnosis • • • •
Glioma Medulloblastoma Hemangioblastoma Metastases
EXTRA-AXIAL Location • • • • • •
Subarachnoid Subdural Epidural Calvarium Subgaleal Scalp (soft-tissues)
Differential Diagnosis • • • • • • •
Meningioma Pituitary adenoma Craniopharyngioma Schwanomma Chordoma Dermoid/epidermoid, cyst, lipoma Metastasis
BRAIN TUMORS IN CHILDREN Supratentorial (52%) • •
Low grade astrocytoma Craniopharyngiomas
Hyperdense
Variable edema (possibly extensive),
Intense enhancement
Dural tail (60%) – nonspecific,
+/- cysts, +/- fat
Vascular supply: ECA 85%, ICA 63%- “mother in law sign”- comes early, stays late •
MRI
Distinguishing features: lens shaped/ plaque-like appearance, hypo T2
Meningiomas typically hypo T2 due to fibrous content or calcification,
Strongly enhance, iso noncom T1. Broad dural base, extraaxial, +/- dural tail
Infratentorial (48%) • • • •
Cerebellar astrocytoma Brainstem gliomas Medulloblastomas Ependymomas
BRAIN TUMORS IN ADULTS Supratentorial (80-85%) Intraaxial Astrocytoma Oligodendroglioma Extraaxial Meningioma Pituitary adenoma Infratentorial (uncommon)
***A 63 y.o. M with mild dementia and decreased vision left eye
Meningioma
On MRI: T1 – similar to brain parenchyma, min. CSF cleft, buckling cortex, homogenous enhancement, dural tail
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