Neuroradiology Practice Questions

Q: What is the primary use of T2-weighted imaging in MRI?

Excellent for detecting pathology. ***Excellent for detecting pathology*** - T2-weighted imaging highlights areas with **increased water content**, which is characteristic of many pathological processes like **inflammation, edema, and tumors**. - Pathological tissues often appear **bright** (hyperintense) on T2-weighted images due to their higher water content, making them distinguishable from normal tissues. *Useful for both pathology and anatomy* - While T2-weighted imaging is excellent for pathology, its primary strength lies in its **sensitivity to water**, which makes it less ideal for detailed anatomical bone or fatty tissue differentiation compared to T1-weighted images. - T1-weighted images are generally superior for visualizing **normal anatomy** due to good contrast between fat (bright) and water (dark). *Not useful for either* - This statement is incorrect as T2-weighted imaging is a fundamental sequence in MRI, providing crucial information about **fluid and pathology**. - It plays a vital role in the diagnosis and characterization of a wide range of diseases. *Good for visualizing normal anatomy* - T2-weighted imaging is less optimal for visualizing normal anatomy compared to T1-weighted imaging due to the **bright signal from free water** (e.g., CSF), which can obscure fine anatomical details. - While some anatomical structures are visible, its main utility is in **pathological detection** rather than fine anatomical delineation.

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: What is the most sensitive investigation for diffuse axonal injury?

MRI. ***MRI*** - **Magnetic Resonance Imaging (MRI)** is the most sensitive imaging modality for detecting **diffuse axonal injury (DAI)** due to its ability to visualize microscopic changes in white matter integrity. - **Susceptibility Weighted Imaging (SWI)** is particularly sensitive for detecting **microhemorrhages** (petechial hemorrhages) at gray-white matter junctions, corpus callosum, and brainstem—characteristic locations for DAI. - **Diffusion Weighted Imaging (DWI)** and **Diffusion Tensor Imaging (DTI)** can demonstrate disruption of axonal tracts by showing restricted diffusion and measuring changes in fractional anisotropy. - Conventional sequences like **T2*-weighted gradient-recalled echo (GRE)** and **FLAIR** also help detect edema and blood products associated with DAI. *CT* - **Computed Tomography (CT) scans** are often the initial imaging modality in acute head injury due to their speed and ability to detect gross abnormalities like **hemorrhages** or **fractures**. - However, CT is **insensitive** to the microscopic axonal shearing and tears characteristic of DAI, typically appearing normal even in severe cases. *X ray* - **X-rays** are primarily used to evaluate **bone structures** and detect **skull fractures**. - They provide no information about soft tissue injury to the brain parenchyma, making them completely insensitive for detecting DAI. *PET scan* - A **Positron Emission Tomography (PET) scan** measures metabolic activity in the brain and can show changes in glucose metabolism or neurotransmitter function. - While PET may reveal **functional deficits** or **metabolic abnormalities** in chronic stages of brain injury, it is not used in the acute setting to diagnose DAI and does not directly visualize axonal damage.

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?

Lateral sinus thrombophlebitis. ***Lateral sinus thrombophlebitis*** - The **delta sign** (also known as the "empty delta sign") on a contrast-enhanced CT scan is a classic radiological finding for **venous sinus thrombosis**. This sign is due to the thrombus filling the sinus, surrounded by contrast-enhanced dura. - While the image specifically mentions the sagittal sinus, the principle of a filling defect in a venous sinus due to thrombosis and the resulting "delta sign" applies to other dural venous thromboses, including **lateral sinus thrombophlebitis**. *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: Tigroid pattern on MRI is seen in -

Metachromatic leukodystrophy. ***Metachromatic leukodystrophy*** - The **tigroid pattern** on MRI, characterized by **perivascular sparing** within demyelinated white matter, is highly characteristic of metachromatic leukodystrophy. - This pattern results from the accumulation of **sulfatides** in oligodendrocytes and macrophages, leading to central demyelination with spared U-fibers and white matter adjacent to vessels. *Wilson's disease* - Wilson's disease involves **copper accumulation** and typically presents with abnormalities in the **basal ganglia**, thalami, and brainstem. - While it causes neurodegeneration, it does not produce a characteristic tigroid demyelination pattern. *Parkinsonism* - Parkinsonism refers to a group of neurological disorders characterized by motor symptoms like **bradykinesia, rigidity, tremor, and postural instability**. - MRI findings in Parkinsonism often show **nigral degeneration** but do not typically involve a tigroid pattern of leukodystrophy. *GB syndrome* - **Guillain-Barré syndrome (GBS)** is an acute autoimmune peripheral neuropathy affecting the **peripheral nerves and nerve roots**. - It does not involve central nervous system demyelination or display a tigroid pattern on brain MRI.

Q: Epidural hematoma on CT scan shows which of the following?

Biconvex hyperdense lesion. ***Biconvex hyperdense lesion*** - An epidural hematoma is characterized by a **biconvex** (lens-shaped) collection of blood between the dura mater and the skull. - Since it is an acute hemorrhage, the blood appears **hyperdense** (bright white) on a CT scan. *Crescent-shaped hyperdense lesion* - A **crescent shape** is characteristic of an **acute subdural hematoma**, not an epidural hematoma. - While acute subdural hematomas are also hyperdense, their crescent shape (following the contour of the brain) distinguishes them from the biconvex epidural hematomas. - Epidural hematomas are limited by suture lines and appear lens-shaped, while subdural hematomas can cross suture lines. *Biconcave hypodense lesion* - A **biconcave** shape is not a standard description in neuroradiology and does not represent epidural hematoma. - **Hypodense** would indicate an older lesion or other pathology, not acute hemorrhage. *Ring-enhancing hypodense lesion* - **Ring-enhancing lesions** are typically associated with abscesses, glioblastoma, or metastatic tumors, not an acute hematoma. - A **hypodense** (darker) center with enhancement would indicate an abscess or necrotic tumor, not a fresh extravasation of blood.

Question 1

What is the primary use of T2-weighted imaging in MRI?

Accepted Answer

Excellent for detecting pathology

Answer

Useful for both pathology and anatomy

Answer

Not useful for either

Answer

Good for visualizing normal anatomy

Question 2

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 3

Hummingbird sign in brain MRI is seen in ?

Accepted Answer

Progressive supranuclear palsy

Answer

Multiple sclerosis

Answer

Parkinson's disease

Answer

Alzheimer disease

Question 4

What is the most sensitive investigation for diffuse axonal injury?

Accepted Answer

MRI

Answer

CT

Answer

X ray

Answer

PET scan

Question 5

Who is credited with the development of cerebral angiography?

Accepted Answer

Egas Moniz

Answer

Sir Walter Dandy

Answer

Godfrey Hounsfield

Answer

Seldinger

Question 6

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

Accepted Answer

Lateral sinus thrombophlebitis

Answer

Cerebellar abscess

Answer

Cholesteatoma

Answer

Mastoiditis

Question 7

Identify the condition based on the provided image.

Accepted Answer

Callosal dysgenesis

Answer

Dandy-Walker syndrome

Answer

Aicardi syndrome

Answer

Septo-optic dysplasia

Question 8

Identify the condition in the image below?

Accepted Answer

Lacunar infarct

Answer

Embolic infarct

Answer

Thrombotic infarct

Answer

Intracerebral hemorrhage

Question 9

Tigroid pattern on MRI is seen in -

Accepted Answer

Metachromatic leukodystrophy

Answer

Wilson's disease

Answer

Parkinsonism

Answer

GB syndrome

Question 10

Epidural hematoma on CT scan shows which of the following?

Accepted Answer

Biconvex hyperdense lesion

Answer

Crescent-shaped hyperdense lesion

Answer

Biconcave hypodense lesion

Answer

Ring-enhancing hypodense lesion

Neuroradiology — MCQs

Neuroradiology — MCQs

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