Neuroradiology Practice Questions

Q: In which condition is the 'Eye of the Tiger' appearance typically observed?

Hallervorden-Spatz syndrome. ***Hallervorden-Spatz syndrome*** - The "Eye of the Tiger" sign is characteristic of **pantothenate kinase-associated neurodegeneration (PKAN)**, formerly known as Hallervorden-Spatz syndrome. - This imaging finding refers to a central region of **pallidal hyperintensity** surrounded by a rim of hypointensity on T2-weighted MRI scans due to **iron accumulation**. *Progressive supranuclear palsy* - This condition is characterized by midbrain atrophy, often described as the "**hummingbird sign**" or "**penguin silhouette sign**" on imaging. - It primarily affects eye movements, balance, and gait, but does not typically present with the "Eye of the Tiger" pattern. *Levodopa-responsive dystonia* - This is a rare genetic disorder, often due to mutations in the **GCH1 gene**, affecting dopamine synthesis. - Imaging findings are typically **normal**, and it is not associated with the "Eye of the Tiger" sign. *All of the options* - Since the "Eye of the Tiger" sign is pathognomonic for **Hallervorden-Spatz syndrome (PKAN)**, it is not observed in the other listed conditions. - Therefore, choosing "all of the options" would be incorrect.

Q: Hummingbird sign in brain MRI is seen in ?

Progressive supranuclear palsy. ***Progressive supranuclear palsy*** - The **hummingbird sign** is characteristic of progressive supranuclear palsy, seen as a specific pattern on MRI where the midbrain has atrophy, giving a "hummingbird" appearance. - It correlates with symptoms such as **gait instability**, **ocular dysfunction**, and **progressive neurological decline** typical of this condition. *Multiple sclerosis* - Often presents with **plaques** or **lesions in white matter** on MRI rather than a hummingbird sign. - Symptoms typically include **episodic neurological deficits** and may involve sensory, motor, or visual pathways. *Parkinson's disease* - Primarily features **substantia nigra degeneration**, which does not present a hummingbird sign on imaging. - Symptoms include **resting tremors**, and **bradykinesia**, without the distinct midbrain morphological change associated with progressive supranuclear palsy. *Alzheimer disease* - Characterized by **cortical atrophy** and does not show the hummingbird sign; instead, it features changes more related to **memory loss** and **cognitive decline**. - MRI findings may show **ventricular enlargement** and hippocampal atrophy rather than midbrain changes.

Q: Who is credited with the development of cerebral angiography?

Egas Moniz. ***Egas Moniz*** - **António Egas Moniz** (1874-1955) was a Portuguese neurologist who introduced the technique of **cerebral angiography** in 1927. - He used a **contrast medium** (initially sodium iodide, later thorium dioxide) to visualize the cerebral blood vessels, significantly advancing the diagnosis of brain tumors and other cerebrovascular diseases. - He was awarded the **Nobel Prize in Physiology or Medicine** in 1949 for his work on prefrontal leucotomy. *Sir Walter Dandy* - **Walter Dandy** (1886-1946) was an American neurosurgeon known for his pioneering work in **ventriculography** and **pneumoencephalography**, techniques used to visualize the brain's ventricular system. - While he made significant contributions to neuroimaging, he is not credited with the development of cerebral angiography. *Godfrey Hounsfield* - **Sir Godfrey Hounsfield** (1919-2004) was a British electrical engineer who developed the first **computed tomography (CT)** scanner in 1972. - He shared the **Nobel Prize in Physiology or Medicine** in 1979 with Allan Cormack for this revolutionary contribution to diagnostic imaging. - His work transformed medical imaging, but cerebral angiography predates CT by several decades. *Seldinger* - **Sven-Ivar Seldinger** (1921-1998) was a Swedish radiologist who developed the **Seldinger technique** in 1953. - This technique is a common method for safely obtaining percutaneous access to blood vessels and other hollow organs, widely used in various interventional procedures, including modern angiography. - While his technique revolutionized how angiography is performed, he did not invent cerebral angiography itself.

Q: Presence of delta sign on contrast enhanced CT scan suggests presence of?

Superior sagittal sinus thrombosis. ***Superior sagittal sinus thrombosis*** - The **delta sign** (also known as the "empty delta sign") on a contrast-enhanced CT scan is a classic radiological finding for **superior sagittal sinus thrombosis**. This sign appears as a triangular filling defect within the superior sagittal sinus, surrounded by contrast-enhancing dura, giving the appearance of a bright triangle (delta shape) with a dark center representing the thrombus. - The image demonstrates this empty delta sign specifically in the **superior sagittal sinus**, confirming thrombosis at that location. *Cholesteatoma* - A cholesteatoma is an **epidermal cyst** located in the middle ear or mastoid, visualized on CT as a **soft tissue mass**. - Its presence is typically indicated by **bone erosion** of the ossicles or mastoid, not a delta sign in the venous sinuses. *Cerebellar abscess* - A cerebellar abscess is a **collection of pus** within the cerebellar tissue, usually appearing as a **ring-enhancing lesion** on contrast CT. - It does not present with a delta sign, which is specific to venous sinus thrombosis. *Mastoiditis* - Mastoiditis is an **inflammation** or **infection of the mastoid air cells**, often appearing as **opacification of the mastoid air cells**, bone destruction, or periosteal elevation on CT. - While mastoiditis can sometimes lead to lateral sinus thrombosis, the delta sign itself is direct evidence of the **thrombosis**, not the mastoid inflammation.

Q: Identify the condition based on the provided image.

Callosal dysgenesis. ***Callosal dysgenesis*** - The image shows **colpocephaly**, characterized by **dilatation of the posterior horns** of the lateral ventricles and narrowing of the anterior horns. This is a classic MRI finding in callosal dysgenesis. - The absence or partial formation of the **corpus callosum** leads to a high-riding third ventricle and parallel lateral ventricles, which are often visualized alongside colpocephaly. *Dandy-Walker syndrome* - Characterized by a **cystic dilatation of the fourth ventricle** that fills the posterior fossa, leading to an upward displacement of the tentorium. - This condition involves agenesis or hypoplasia of the **cerebellar vermis**, which is not depicted in this image. *Aicardi syndrome* - Aicardi syndrome is characterized by the triad of **agenesis of the corpus callosum**, **chorioretinal lacunae**, and **infantile spasms**. - While it includes agenesis of the corpus callosum, the image alone does not provide evidence of the ocular or seizure components of Aicardi syndrome. *Septo-optic dysplasia* - This condition is defined by the **triad of optic nerve hypoplasia**, **pituitary hormone abnormalities**, and **midline brain defects**, specifically hypoplasia or absence of the septum pellucidum. - The image does not show features specific to optic nerve hypoplasia or the typical midline cysts or absent septum pellucidum characteristic of septo-optic dysplasia.

Q: Identify the condition in the image below?

Lacunar infarct. ***Lacunar infarct*** - The image displays a small, well-demarcated **hypodensity** (darker area) in the basal ganglia region, characteristic of a lacunar infarct. - Lacunar infarcts are typically caused by **occlusion of small perforating arteries** and result in small, deep infarcts, often appearing as precise, round or ovoid lesions on CT. *Embolic infarct* - Embolic infarcts tend to be **larger**, wedge-shaped, and often extend to the cortical surface, unlike the deep, small lesion seen. - They are commonly associated with a **cardiac source** or large artery atherosclerosis leading to distal embolization. *Thrombotic infarct* - Thrombotic infarcts are usually **larger** areas of infarction due to occlusion of a major artery, often preceded by symptoms like TIAs. - While they also appear hypodense, they are typically **more extensive** and less precisely defined than a lacunar infarct in the early stages. *Intracerebral hemorrhage* - Intracerebral hemorrhage would appear as a **hyperdense** (bright white) area on a non-contrast CT scan due to the presence of acute blood. - The image clearly shows a **hypodense lesion**, ruling out acute hemorrhage.

Q: Identify the condition shown in the MRI image.

Dandy-Walker malformation. ***Dandy-Walker malformation*** - The image shows an enlarged posterior fossa with **cystic dilation of the fourth ventricle** and **absence/hypoplasia of the cerebellar vermis**, which are classic features of Dandy-Walker malformation. - The elevated tentorium is also characteristic, contributing to the distinct appearance. *Cerebellar vermis hypoplasia* - While cerebellar vermis hypoplasia is a component of Dandy-Walker malformation, it is not the sole, defining feature. - Dandy-Walker also includes cystic dilation of the fourth ventricle and an enlarged posterior fossa, which are evident in the image and go beyond isolated vermis hypoplasia. *Mega cisterna magna* - A **mega cisterna magna** is a benign enlargement of the cisterna magna, which is the space between the cerebellum and the medulla oblongata. - Unlike in Dandy-Walker malformation, a mega cisterna magna usually does not involve displacement of the tentorium or hypoplasia of the cerebellar vermis, and the fourth ventricle is typically normal in shape and size. *None of the options* - The image clearly displays the diagnostic hallmarks of Dandy-Walker malformation, making this option incorrect.

Q: Which of the following abnormalities is most commonly detected as a vascular malformation on skull MRI?

Vein of Galen abnormalities. ***Vein of Galen abnormalities*** - **Vein of Galen malformations (VOGM)** are the **most common symptomatic cerebral vascular malformations in neonates and infants**, accounting for approximately **30% of pediatric cerebral vascular malformations**. - They often present with **high-output cardiac failure**, hydrocephalus, or seizures in early life. - On **MRI**, they appear as a large, abnormal midline venous pouch in the quadrigeminal cistern with characteristic **flow voids** on T2-weighted images. - VOGM represents an **arteriovenous shunt** to a persistent embryonic vein (median prosencephalic vein of Markowski). *Dandy Walker malformation* - This is a **congenital brain malformation** involving the cerebellum and fourth ventricle, characterized by hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, and an enlarged posterior fossa. - While readily seen on MRI, it is a **structural developmental anomaly**, not a vascular malformation. *Pneumocephalus presence* - **Pneumocephalus** refers to the presence of **air within the intracranial cavity**, usually resulting from trauma, neurosurgery, or skull base fractures. - It is an **acquired condition**, not a congenital vascular malformation, and appears as dark signal (air) on all MRI sequences. *Crouzon syndrome features* - **Crouzon syndrome** is a genetic disorder (FGFR2 mutation) characterized by **craniosynostosis** with premature fusion of coronal and sagittal sutures, leading to brachycephaly and midface hypoplasia. - It is a **craniofacial skeletal disorder**, not a vascular malformation.

Q: Investigation of choice to evaluate intracranial hemorrhage of less than 48 hours is -

CT scan. ***CT scan*** - **Non-contrast CT** is the most sensitive and rapid imaging modality for detecting acute intracranial hemorrhage, appearing as a **hyperdense** (bright) area within the brain parenchyma or subarachnoid space. - It is readily available in emergency settings and is crucial for immediate diagnosis to guide management, especially within the first **48 hours**. *MRI* - While MRI can detect hemorrhage, its sensitivity for **acute hemorrhage** (especially within the first few hours) is less than CT, and it is more time-consuming. - MRI is superior for detecting older hemorrhage or subtle lesions, but it is not the **first-line investigation** for acute bleeding. *PET* - **Positron Emission Tomography** (PET) scans are primarily used to assess metabolic activity and blood flow in the brain, often for conditions like cancer, epilepsy, or dementia. - It does not directly visualize fresh blood and therefore is not used for the diagnosis of **acute intracranial hemorrhage**. *SPECT* - **Single-Photon Emission Computed Tomography** (SPECT) is used to evaluate cerebral blood flow and neuronal activity, similar to PET but with different tracers and resolution. - It is not indicated for the rapid assessment of **acute intracranial hemorrhage** as it does not directly image blood.

Q: Investigation of choice for acute intracerebral hemorrhage is -

NCCT. ***NCCT*** - **Non-contrast Computed Tomography (NCCT)** is the investigation of choice for acute intracerebral hemorrhage because it can **rapidly and reliably detect acute blood** within the brain parenchyma. - Acute hemorrhage appears as a **hyperdense (bright) lesion** on NCCT, allowing for quick diagnosis and management vital in emergency settings. *MRI* - While MRI can detect hemorrhage, its sensitivity for **acute hemorrhage** can be variable, and it is **less readily available** and takes longer to perform than NCCT. - MRI is generally preferred for subacute or chronic hemorrhage, or to investigate the **underlying cause** of the bleed (e.g., tumor, vascular malformation). *PET scan* - **Positron Emission Tomography (PET) scan** primarily measures **metabolic activity** and blood flow within the brain. - It is **not suitable for detecting acute bleeding** and is typically used for diagnosing conditions like tumors, epilepsy, or neurodegenerative diseases. *None of the options* - This option is incorrect because **NCCT** is indeed the gold standard for diagnosing acute intracerebral hemorrhage.

Question 1

In which condition is the 'Eye of the Tiger' appearance typically observed?

Accepted Answer

Hallervorden-Spatz syndrome

Answer

Progressive supranuclear palsy

Answer

Levodopa-responsive dystonia

Answer

All of the options

Question 2

Hummingbird sign in brain MRI is seen in ?

Accepted Answer

Progressive supranuclear palsy

Answer

Multiple sclerosis

Answer

Parkinson's disease

Answer

Alzheimer disease

Question 3

Who is credited with the development of cerebral angiography?

Accepted Answer

Egas Moniz

Answer

Sir Walter Dandy

Answer

Godfrey Hounsfield

Answer

Seldinger

Question 4

Presence of delta sign on contrast enhanced CT scan suggests presence of?

Accepted Answer

Superior sagittal sinus thrombosis

Answer

Mastoiditis

Answer

Cholesteatoma

Answer

Cerebellar abscess

Question 5

Identify the condition based on the provided image.

Accepted Answer

Callosal dysgenesis

Answer

Dandy-Walker syndrome

Answer

Aicardi syndrome

Answer

Septo-optic dysplasia

Question 6

Identify the condition in the image below?

Accepted Answer

Lacunar infarct

Answer

Embolic infarct

Answer

Thrombotic infarct

Answer

Intracerebral hemorrhage

Question 7

Identify the condition shown in the MRI image.

Accepted Answer

Dandy-Walker malformation

Answer

None of the options

Answer

Cerebellar vermis hypoplasia

Answer

Mega cisterna magna

Question 8

Which of the following abnormalities is most commonly detected as a vascular malformation on skull MRI?

Accepted Answer

Vein of Galen abnormalities

Answer

Dandy Walker malformation

Answer

Pneumocephalus presence

Answer

Crouzon syndrome features

Question 9

Investigation of choice to evaluate intracranial hemorrhage of less than 48 hours is -

Accepted Answer

CT scan

Answer

MRI

Answer

PET

Answer

SPECT

Question 10

Investigation of choice for acute intracerebral hemorrhage is -

Accepted Answer

NCCT

Answer

MRI

Answer

PET scan

Answer

None of the options

Neuroradiology — MCQs

Neuroradiology — MCQs

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