Neuroradiology Practice Questions

Q: A 79-year-old male presented to the emergency department after a facial trauma. The patient had Parkinson's disease and atrial fibrillation and was on treatment with acetylsalicylic acid for AF. The image shows? (Recent NEET Pattern 2016-17)

Pneumocephalus. ***Pneumocephalus*** - The image clearly shows **intracranial air** (dark areas within the brain parenchyma and ventricles, indicated by arrows) following facial trauma, consistent with **pneumocephalus**. - **Pneumocephalus** often results from fractures of the skull base or paranasal sinuses, especially after trauma, allowing air to enter the intracranial space. *Hydrocephalus* - **Hydrocephalus** involves enlargement of the **ventricles** due to an accumulation of cerebrospinal fluid, which would appear as dark, but *fluid-filled* spaces, not air-filled. - No signs of significantly dilated ventricles are observed; instead, distinct air pockets are visible, which look black on CT. *Intraventricular bleed* - An **intraventricular bleed** would appear as **hyperdense (bright)** material (blood) within the ventricles on a CT scan, which is not seen here. - The appearance of the abnormalities is **hypodense (black)**, indicating air, not blood. *Subarachnoid hemorrhage* - **Subarachnoid hemorrhage** is characterized by **hyperdense (bright)** blood filling the subarachnoid spaces, particularly the sulci and basal cisterns. - The image displays **hypodense** areas consistent with air within the brain, not diffuse bright areas of blood in the subarachnoid space.

Q: What intracranial complication is demonstrated by the frontal extra-axial hypodensity?

Pneumocephalus. ***Pneumocephalus*** - The image clearly shows a **dark, hypodense collection** within the subdural space, anteriorly, which is characteristic of air - This finding, combined with the presence of a metal clip, often indicates **post-surgical air entrapment** or a **breach of the dura mater** - Pneumocephalus appears hypodense (dark) on CT imaging due to the low density of air compared to brain tissue *Interventricular bleeding* - **Intraventricular bleeding** would appear as a **hyperdense (bright)** collection within the ventricles due to the presence of blood, which is not seen here - The ventricles are enlarged and dark, consistent with cerebrospinal fluid, not hemorrhage - Blood products are radiodense and would show as bright white areas on CT *Artifact* - While artifacts can occur on CT scans, the **well-defined, crescent-shaped hypodensity** with a characteristic appearance of air makes it an unlikely explanation for this specific finding - Artifacts typically present as streaks, rings, or other image distortions, rather than anatomically consistent gas collections - The systematic location and morphology of this finding is consistent with true pathology *Ventriculoperitoneal shunting* - Although a **shunt catheter** is visible within the ventricle, the primary and most striking finding is the **presence of air (pneumocephalus)** in the cranial cavity - The shunt itself is a device/procedure, not the pathological finding being demonstrated - The shunt is likely related to the cause of the pneumocephalus (post-procedural complication) rather than being the diagnosis itself

Q: A 2-year-old epileptic child with developmental delay presents to emergency with fever for the last two days. NCCT shows:

Lissencephaly. ***Lissencephaly*** - The image shows a **smooth brain surface** with **absent or reduced gyri and sulci**, which is characteristic of lissencephaly. - This condition is often associated with **developmental delay** and **epilepsy**, consistent with the child's presentation. *Subdural hemorrhage* - A subdural hemorrhage would appear as a **crescent-shaped collection of blood** between the dura mater and arachnoid mater. - The image does not demonstrate any such blood collection. *Arnold-Chiari malformation* - Arnold-Chiari malformation involves the downward displacement of the **cerebellar tonsils** into the foramen magnum. - While it can cause neurological symptoms, the primary finding in the image is a smooth cerebral cortex, not cerebellar displacement. *Schizencephaly* - Schizencephaly is characterized by **clefts or slits in the cerebral hemispheres** that extend from the pial surface to the ventricles. - The image shows a smooth brain surface rather than distinct full-thickness clefts.

Q: All are true about CNS malformation shown below except:

Large posterior fossa. ***Large posterior fossa*** - The image shown, consistent with a **Chiari II malformation**, typically features a **small posterior fossa**, not a large one. - A small posterior fossa contributes to the crowding and herniation of cerebellar structures through the foramen magnum. *Herniation of cerebellar tonsil* - **Chiari II malformation** is characterized by the **downward displacement of the cerebellar tonsils** through the foramen magnum. - This herniation can lead to obstruction of CSF flow and associated neurological symptoms. *Herniation of cerebellar vermis* - The image suggests a **Chiari II malformation**, which involves the **caudal displacement of the cerebellar vermis** and fourth ventricle into the spinal canal. - This is a hallmark feature distinguishing it from other Chiari malformations. *Association with myelomeningocele* - **Chiari II malformation** has a strong and consistent association with **myelomeningocele**, a severe form of spina bifida. - Most patients with myelomeningocele will also have a Chiari II malformation, indicating a common developmental origin.

Q: The image given below shows presence of:

Ventricular CSF shunt. ***Ventricular CSF shunt*** - The image clearly shows a **thin, radiopaque tube** extending from the cranial vault (indicated by the top arrow) down through the neck (indicated by the bottom arrow), consistent with the path of a ventricular CSF shunt. - A ventricular CSF shunt is surgically placed to **drain excess cerebrospinal fluid** from the brain's ventricles, commonly used in cases of hydrocephalus. *Enlarged sella turcica* - An enlarged sella turcica would appear as an expanded bony structure housing the pituitary gland, which is **not visible** or indicated in this image. - This finding is usually associated with **pituitary tumors** or other conditions causing increased intracranial pressure, but not identifiable here. *Craniosynostosis* - Craniosynostosis involves the **premature fusion of cranial sutures**, leading to an abnormally shaped skull. - While it can cause abnormal skull contour, there are **no clear signs of fused sutures** or specific deformation indicative of craniosynostosis in this lateral skull radiograph. *Pneumocephalus* - Pneumocephalus refers to the presence of **air within the cranial cavity**. - This would appear as **radiolucent (dark) areas** within the skull, which are not observed in the image; instead, a radiopaque structure is clearly visible.

Q: The NCCT head scan of a 45-year-old head injury patient shows:

Intraventricular bleed. ***Intraventricular bleed*** - There is readily apparent hyperdensity within the **ventricles**, confirming an intraventricular hemorrhage. *Subarachnoid bleed* - The image does not demonstrate clear hyperdensity within the sulci to confirm blood in the subarachnoid space. *Intraparenchymal bleed* - The image does not show clear evidence of hyperdense blood within the brain parenchyma consistent with an isolated intraparenchymal hemorrhage. *All of the above* - This option is incorrect as the scan does not support concurrent intraparenchymal and subarachnoid hemorrhages in addition to the intraventricular hemorrhage.

Q: The given NCCT shows the presence of:

Left intraparenchymal hemorrhage. ***Left intraparenchymal hemorrhage*** - This **NCCT image** demonstrates a **hyperdense lesion** (bright white area) within the **frontal lobe** of the brain. - The location is clearly within the **brain parenchyma** and on the **right side of the image**; however, in standard axial CT orientation, the right side of the image represents the patient's left side, indicating a left intraparenchymal hemorrhage. *Left intraventricular hemorrhage* - This would appear as hyperdensity **within the ventricles**, which are the fluid-filled spaces of the brain. - The hemorrhage in the image is located in the brain tissue, not within a ventricular cavity. *Right intraventricular hemorrhage* - A right intraventricular hemorrhage would be seen as hyperdensity **within the right ventricle**. - The lesion shown is within the brain parenchyma, not in the ventricular system. *Right intraparenchymal hemorrhage* - This would appear as a hyperdense lesion **within the brain parenchyma on the patient's right side**. - In standard axial CT orientation, the right side of the image represents the patient's left side, so the hemorrhage visible in the image is on the **left side**, ruling out a right-sided hemorrhage.

Q: The MRI head of this infant with macrocephaly shows which of the following?

Dandy-Walker syndrome. ***Dandy-Walker syndrome*** - The MRI image clearly shows a **large posterior fossa cyst** (dilated fourth ventricle, indicated by the black arrow) communicating with the fourth ventricle and **agenesis/hypoplasia of the cerebellar vermis** (indicated by the white arrowhead). The white arrow on top indicates **dilated supratentorial ventricles (hydrocephalus)**. These are the classic features of Dandy-Walker syndrome. - The presence of **macrocephaly** in the infant is consistent with the obstructive hydrocephalus often associated with Dandy-Walker malformation, due to impaired CSF flow from the dilated fourth ventricle. *Aqueductal stenosis* - Aqueductal stenosis would primarily cause **dilatation of the lateral and third ventricles**, with a normal-sized fourth ventricle. - It would not typically present with a large posterior fossa cyst or cerebellar vermis hypoplasia/agenesis. *Tubercular meningitis* - Tubercular meningitis usually presents with **basilar meningeal enhancement** and sometimes hydrocephalus, but not with severe structural malformations of the cerebellum and fourth ventricle as seen here. - Imaging findings would include basal exudates, infarctions, and occasionally tuberculomas. *Neurocysticercosis* - Neurocysticercosis causes **cysts within the brain parenchyma** (often with an eccentric scolex) or within the ventricular system, typically in older children or adults from endemic areas. - It does not cause the characteristic posterior fossa malformation with vermian agenesis and communication with the fourth ventricle seen in the image.

Q: The CT head of this infant with macrocephaly shows:

Dandy-Walker syndrome. ***Dandy-Walker syndrome*** - The image shows a **markedly enlarged posterior fossa** with a **cystic dilatation** that communicates with the fourth ventricle (indicated by arrows on the axial scan). There is also **hypoplasia of the cerebellar vermis** and **hydrocephalus**, characteristic features of Dandy-Walker syndrome. - This condition is a congenital brain malformation affecting the cerebellum and the fluid-filled spaces around it, leading to symptoms like macrocephaly due to hydrocephalus. *Aqueductal stenosis* - Aqueductal stenosis would primarily cause **dilatation of the lateral and third ventricles**, with a normal-sized fourth ventricle due to the blockage. - It would not typically present with the characteristic large posterior fossa cyst and cerebellar vermian hypoplasia seen here. *Tubercular meningitis* - Tubercular meningitis on imaging typically shows **basal meningeal enhancement**, hydrocephalus, and sometimes infarctions or tuberculomas. - It does not present with a primary cerebellum malformation or a large posterior fossa cyst as demonstrated in the image. *Neurocysticercosis* - Neurocysticercosis involves parasitic cysts (larval stage of *Taenia solium*) in the brain parenchyma, subarachnoid space, or ventricles, often seen as **cystic lesions with a scolex**. - While it can cause hydrocephalus if cysts block CSF flow, it does not involve the specific malformations of the posterior fossa and cerebellum seen in Dandy-Walker syndrome.

Question 1

A 79-year-old male presented to the emergency department after a facial trauma. The patient had Parkinson's disease and atrial fibrillation and was on treatment with acetylsalicylic acid for AF. The image shows? (Recent NEET Pattern 2016-17)

Accepted Answer

Pneumocephalus

Answer

Hydrocephalus

Answer

Intraventricular bleed

Answer

Subarachnoid hemorrhage

Question 2

What intracranial complication is demonstrated by the frontal extra-axial hypodensity?

Accepted Answer

Pneumocephalus

Answer

Interventricular bleeding

Answer

Artifact

Answer

Ventriculoperitoneal shunting

Question 3

A 2-year-old epileptic child with developmental delay presents to emergency with fever for the last two days. NCCT shows:

Accepted Answer

Lissencephaly

Answer

Subdural hemorrhage

Answer

Arnold-Chiari malformation

Answer

Schizencephaly

Question 4

All are true about CNS malformation shown below except:

Accepted Answer

Large posterior fossa

Answer

Herniation of cerebellar tonsil

Answer

Herniation of cerebellar vermis

Answer

Association with myelomeningocele

Question 5

The image given below shows presence of:

Accepted Answer

Ventricular CSF shunt

Answer

Enlarged sella turcica

Answer

Craniosynostosis

Answer

Pneumocephalus

Question 6

The NCCT head scan of a 45-year-old head injury patient shows:

Accepted Answer

Intraventricular bleed

Answer

Subarachnoid bleed

Answer

All of the above

Answer

Intraparenchymal bleed

Question 7

The given NCCT shows the presence of:

Accepted Answer

Left intraparenchymal hemorrhage

Answer

Right intraventricular hemorrhage

Answer

Left intraventricular hemorrhage

Answer

Right intraparenchymal hemorrhage

Question 8

Which of the following is correct about the NCCT shown below? (Recent NEET Pattern 2016-17)

Accepted Answer

Acute ischemic stroke

Answer

Acute hemorrhagic stroke

Answer

Subarachnoid hemorrhage

Answer

Intraparenchymal hemorrhage

Question 9

The MRI head of this infant with macrocephaly shows which of the following?

Accepted Answer

Dandy-Walker syndrome

Answer

Aqueductal stenosis

Answer

Tubercular meningitis

Answer

Neurocysticercosis

Question 10

The CT head of this infant with macrocephaly shows:

Accepted Answer

Dandy-Walker syndrome

Answer

Aqueductal stenosis

Answer

Tubercular meningitis

Answer

Neurocysticercosis

Neuroradiology — MCQs

Neuroradiology — MCQs

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