Neuroradiology Practice Questions

Q: Which of the following conditions is most commonly associated with the "doughnut" sign seen on a brain scan?

Brain abscess. ***Brain abscess*** - The **doughnut sign**, characterized by a **ring-enhancing lesion** with a central hypodense core, is highly suggestive of a brain abscess due to central necrosis and peripheral inflammation. - The ring enhancement often appears **thinner and smoother** in abscesses compared to tumors, and there is usually significant surrounding edema. - This sign is most **characteristically and commonly associated** with pyogenic brain abscesses. *Brain metastases* - While brain metastases can also present as **ring-enhancing lesions**, they tend to have a **thicker and more irregular wall** compared to a brain abscess. - They often present with **multiple lesions** and a known primary malignancy, which differentiates them from a solitary abscess. *Glioblastoma multiforme* - **Glioblastoma multiforme (GBM)** typically shows a **thick, irregular, and often nodular ring enhancement** due to areas of necrosis, hypervascularity, and active tumor growth. - Its enhancing rim is generally **thicker and more variable** than that of a typical abscess, and it often invades surrounding brain parenchyma. *Toxoplasmosis* - **Cerebral toxoplasmosis** can present with ring-enhancing lesions, particularly in immunocompromised patients (HIV/AIDS). - Typically shows **multiple lesions** with predilection for basal ganglia and corticomedullary junction. - The "**eccentric target sign**" (eccentric dot within the ring) is more characteristic of toxoplasmosis than the smooth doughnut sign of pyogenic abscess.

Q: A patient with suspected subarachnoid haemorrhage presents with blood isolated in the fourth ventricle on a CT scan. Aneurysmal rupture is likely to have resulted from which of the following?

Basilar Artery Tip Aneurysm. ***Basilar Artery Tip Aneurysm*** - Aneurysmal rupture at the **basilar artery tip** can directly lead to bleeding into the **fourth ventricle** due to its anatomical proximity to the brainstem and ventricular system. - The basilar artery bifurcates at the tip into the posterior cerebral arteries, lying anterior to the pons and close to the floor of the fourth ventricle. *Posterior Inferior Cerebellar Artery Aneurysm* - Rupture of a **PICA aneurysm** typically causes bleeding in the cerebellopontine angle cistern or directly into the fourth ventricle, but is less common for isolated intraventricular hemorrhage compared to basilar tip. - PICA supplies the posterior inferior cerebellum and lower brainstem, and its rupture is more often associated with posterior fossa hemorrhage. *Anterior Communicating Artery Aneurysm* - Rupture of an **anterior communicating artery (ACOM) aneurysm** commonly results in **interhemispheric hemorrhage** and often causes blood in the lateral ventricles. - Due to its anterior location, it is anatomically unlikely to cause isolated bleeding in the **fourth ventricle**. *Posterior Communicating Artery Aneurysm* - Rupture of a **posterior communicating artery (PCOM) aneurysm** typically leads to subarachnoid hemorrhage around the **chiasmatic cisterns** and sylvian fissures. - While it is part of the posterior circulation, its rupture is less likely to result in isolated fourth ventricular hemorrhage compared to a basilar tip aneurysm.

Q: A middle-aged person is rushed to the emergency department with a history of loss of motor power in the left upper and lower limb since the last 30 minutes. The imaging modality of choice to plan appropriate treatment would be

CT scan of the head. ***CT scan of the head*** - A **non-contrast CT scan of the head** is the immediate imaging modality of choice in acute stroke symptoms to quickly rule out a **hemorrhagic stroke**. - This rapid assessment guides treatment decisions; if hemorrhage is absent, **thrombolytic therapy (tPA)** can be considered within the critical time window. *MRI of the brain* - While **MRI** offers superior detail for detecting ischemic stroke, it is **unsuitable for initial emergency assessment** due to longer acquisition times and limited availability. - The delay in obtaining an MRI could critically hinder the initiation of time-sensitive therapies like **thrombolysis**. *Carotid doppler study* - A **carotid Doppler study** is useful for identifying **carotid artery stenosis**, which can be a cause of ischemic stroke but is not an acute diagnostic tool for stroke itself. - It does not provide information about the presence of hemorrhage or acute ischemic changes within the brain parenchyma. *EEG* - An **EEG (electroencephalogram)** measures electrical activity in the brain and is primarily used to diagnose conditions like **seizures** or evaluate altered mental status. - It provides no structural information and is not indicated for the initial evaluation of acute motor deficits indicative of a stroke.

Q: CT scan of a child with intellectual disability who has recurrent seizures and a facial hemangioma. What is the diagnosis?

Encephalofacial angiomatosis. ***Encephalofacial angiomatosis*** - This condition, also known as **Sturge-Weber syndrome**, is characterized by a **facial port-wine stain (hemangioma)**, intellectual disability, and recurrent seizures due to **leptomeningeal angiomatosis** as seen in the CT image. - The CT scan shows characteristic unilateral **pial angiomatosis with underlying cortical calcifications**, often described as "tram-track" calcifications, representing the brain involvement. *Epiloias* - This is an older term for **tuberous sclerosis**, which presents with **facial angiofibromas** (not hemangioma), intellectual disability, and seizures. - CT scans in tuberous sclerosis typically show **subependymal nodules** and cortical tubers, not leptomeningeal angiomatosis with tram-track calcifications. *Louis Bar syndrome* - This is also known as **ataxia-telangiectasia**, a progressive neurodegenerative disease characterized by **cerebellar ataxia**, oculocutaneous telangiectasias, and immunodeficiency. - It does not present with hemangiomas or the specific CT findings of leptomeningeal angiomatosis and calcifications. *Neuronal ceroid lipofuscinoses* - This is a group of **lysosomal storage disorders** characterized by the accumulation of **lipopigment** in neurons and other cells, leading to progressive neurodegeneration. - Clinical features include progressive intellectual decline, seizures, and vision loss, but they are not associated with hemangiomas or the specific CT findings of Sturge-Weber syndrome.

Q: Pine-tree bladder is a sign of.

Bilharziasis. ***Bilharziasis*** - The "pine-tree bladder" appearance on a retrograde cystogram is characteristic of **chronic bilharzial cystitis**, also known as **schistosomiasis of the bladder**. - This appearance results from **fibrosis**, **granulomas**, and **calcification** of the bladder wall leading to multiple irregular diverticula and trabeculations, which resemble pine-tree branches. *Pelvic abscess* - A pelvic abscess causes an **extrinsic compression** on the bladder, leading to mass effect or displacement, rather than intrinsic wall changes. - It would typically present with symptoms of infection, such as fever and localized pain, and imaging would show a fluid collection. *Intraperitoneal bladder rupture* - An intraperitoneal bladder rupture would lead to extravasation of urine into the peritoneal cavity, which would be visible on imaging as **free fluid** around abdominal organs. - The bladder itself would appear flaccid and potentially collapsed, without the characteristic "pine-tree" appearance. *Neurogenic bladder* - Neurogenic bladder is characterized by **detrusor-sphincter dyssynergia** or loss of bladder sensation, leading to features like **trabeculation**, cellules, and diverticula due to high intravesical pressure. - While it can cause some bladder wall changes, the specific "pine-tree" pattern is not its hallmark, and it is usually associated with neurological deficits.

Q: Which of the following conditions typically presents with spinal cord edema on MRI?

Myelomalacia. ***Myelomalacia*** - Myelomalacia refers to softening or liquefaction of the spinal cord, which is often a result of **ischemia** or **trauma**, and it typically presents with **edema** on MRI in its acute phase. - The edema observed on MRI is indicative of **acute tissue injury** and can later progress to cystic changes or atrophy. - MRI shows **T2 hyperintense signal** throughout the affected cord segment without mass effect. *Myelodysplasia* - Myelodysplasia refers to a group of **congenital developmental anomalies** of the spinal cord and vertebral column, such as spina bifida. - While it involves structural abnormalities, it does not primarily present with acute spinal cord **edema** as a defining feature. *Myeloschisis* - Myeloschisis is a severe form of **spina bifida aperta** where the neural plate fails to fuse and remains open to the surface, resulting in an exposed spinal cord. - This is a gross structural defect and does not typically involve spinal cord **edema** as its primary imaging characteristic. *Cord tumors* - Spinal cord tumors (intramedullary or extramedullary) often cause **perilesional edema**, but the primary imaging finding is an **enhancing mass lesion** on post-contrast MRI. - Unlike myelomalacia, which shows diffuse edema without a discrete mass, cord tumors present as a focal **expansile lesion** with associated edema, making the tumor itself the defining feature rather than isolated edema.

Q: Which of the following tumors shows a radiological sign called "pneumosinus dilatans"?

Meningiomas. ***Meningiomas*** - **Pneumosinus dilatans** is a radiological finding characterized by an abnormal enlargement of a paranasal sinus or mastoid air cells without cortical bone destruction or hyperostosis. - Meningiomas, particularly those located near the **skull base** or paranasal sinuses, are classically associated with this phenomenon due to chronic pressure and possible osteoblastic stimulation. *Ependymomas* - These are typically **intracranial** or **intraspinal tumors** arising from ependymal cells lining the ventricles and central canal. - They are not associated with **pneumosinus dilatans** as they do not typically interact with paranasal sinuses. *Medulloblastomas* - These are highly malignant embryonal tumors found in the **cerebellum** of children. - They do not cause **pneumosinus dilatans** due to their posterior fossa location and aggressive growth pattern. *Hemangioblastomas* - These are benign, highly vascular tumors typically found in the **cerebellum**, **brainstem**, or **spinal cord**, often associated with **von Hippel-Lindau disease**. - They do not lead to **pneumosinus dilatans** as their location and growth characteristics do not involve the paranasal sinuses.

Q: Absent swallow tail sign is seen in which of the following conditions?

Parkinson's disease. ***Parkinson's disease*** - The **swallow tail sign** refers to the appearance of the dopaminergic neurons in the **substantia nigra pars compacta** on **magnetic resonance imaging (MRI)**. - In Parkinson's disease, the degeneration of these neurons leads to the **loss of the typical bidentate shape** (like a swallow's tail) and is replaced by a more uniform, often hypointense, appearance on susceptibility-weighted imaging. *Wilson's disease* - This is a disorder of **copper metabolism** leading to copper accumulation, primarily affecting the liver, brain, and cornea. - While it can cause neurological symptoms, the **absent swallow tail sign** is not a characteristic imaging finding for Wilson's disease. *Alzheimer's disease* - Characterized by the progressive degeneration of neurons, particularly in the **hippocampus** and **cerebral cortex**, leading to cognitive decline. - While brain atrophy is common, the **swallow tail sign** is not an imaging marker used in the diagnosis or evaluation of Alzheimer's disease. *Progressive supranuclear palsy* - A neurodegenerative disorder characterized by problems with balance, movement, vision, and speech, often associated with generalized brain atrophy, particularly in the midbrain. - While it can cause changes in the midbrain structures, the **hummingbird sign** or **Mickey Mouse sign** (due to midbrain atrophy) are more characteristic, rather than the specific swallow tail sign which is related to the substantia nigra.

Q: Which condition is associated with a 'wine glass' appearance on T2-weighted MRI of the brain?

Normal Pressure Hydrocephalus. ***Normal Pressure Hydrocephalus*** - The "wine glass" appearance on **T2-weighted MRI** of the brain is characteristic of **Normal Pressure Hydrocephalus (NPH)**, particularly seen when visualizing the **temporal horns** of the lateral ventricles. - This appearance suggests the **symmetric dilation** of the lateral ventricles, with disproportionate enlargement of the temporal horns, due to increased CSF volume without significantly increased intracranial pressure. *Multiple Sclerosis* - Characterized by **demyelinating plaques** that appear as **hyperintense lesions** on T2-weighted MRI, often in the periventricular, juxtacortical, infratentorial, and spinal cord regions. - These lesions are typically **ovoid** or round and often perpendicular to the ventricular surface (Dawson's fingers), not presenting as a "wine glass" shape. *Leukodystrophy* - A group of genetic disorders that affect the **white matter** of the brain, leading to diffuse and often symmetric abnormalities on T2-weighted MRI. - While they show widespread white matter changes, these do not typically present as a distinct "wine glass" configuration of the ventricles. *Binswanger's Disease* - A form of **subcortical vascular dementia** characterized by diffuse, irregular **white matter hyperintensities** and lacunar infarcts on T2-weighted MRI due to chronic ischemia. - The ventricular enlargement, if present, is usually due to **global brain atrophy** rather than a specific, disproportionate temporal horn dilation forming a "wine glass" shape.

Q: Widened neural foramina are frequently seen in:

Neurofibromatosis. ***Correct: Neurofibromatosis*** - **Neurofibromatosis Type 1 (NF1)** often leads to the development of **neurofibromas** along nerve roots, which can erode bone and cause widening of the neural foramina. - This erosion is a classic skeletal manifestation of NF1, particularly in the **spinal column**. - Widened neural foramina are a **characteristic radiological finding** in neurofibromatosis. *Incorrect: Tuberous sclerosis* - Characterized by the growth of **benign tumors (hamartomas)** in the brain and other organs, such as the skin, kidneys, and heart. - While it has neurological manifestations, **widened neural foramina** are not a typical or frequent finding. - Typical imaging findings include cortical/subcortical tubers and subependymal nodules. *Incorrect: Sturge-Weber syndrome* - A rare congenital neurological and skin disorder characterized by a **port-wine stain** on the face and neurological problems such as seizures and glaucoma. - It primarily affects the brain's blood vessels and skin, with characteristic **tram-track calcifications** in the brain. - Does not commonly result in **widened neural foramina**. *Incorrect: Klippel-Feil syndrome* - A congenital condition characterized by the **fusion of two or more cervical vertebrae**, leading to a short neck, low hairline, and restricted neck movement. - While it involves vertebral abnormalities, it does not typically cause **widening of the neural foramina**. - More commonly associated with narrowing of neural foramina or other spinal deformities.

Question 1

Which of the following conditions is most commonly associated with the "doughnut" sign seen on a brain scan?

Accepted Answer

Brain abscess

Answer

Brain metastases

Answer

Glioblastoma multiforme

Answer

Toxoplasmosis

Question 2

A patient with suspected subarachnoid haemorrhage presents with blood isolated in the fourth ventricle on a CT scan. Aneurysmal rupture is likely to have resulted from which of the following?

Accepted Answer

Basilar Artery Tip Aneurysm

Answer

Posterior Inferior Cerebellar Artery Aneurysm

Answer

Anterior Communicating Artery Aneurysm

Answer

Posterior Communicating Artery Aneurysm

Question 3

A middle-aged person is rushed to the emergency department with a history of loss of motor power in the left upper and lower limb since the last 30 minutes. The imaging modality of choice to plan appropriate treatment would be

Accepted Answer

CT scan of the head

Answer

MRI of the brain

Answer

Carotid doppler study

Answer

EEG

Question 4

CT scan of a child with intellectual disability who has recurrent seizures and a facial hemangioma. What is the diagnosis?

Accepted Answer

Encephalofacial angiomatosis

Answer

Epiloias

Answer

Louis Bar syndrome

Answer

Neuronal ceroid lipofuscinoses

Question 5

Pine-tree bladder is a sign of.

Accepted Answer

Bilharziasis

Answer

Pelvic abscess

Answer

Intraperitoneal bladder rupture

Answer

Neurogenic bladder

Question 6

Which of the following conditions typically presents with spinal cord edema on MRI?

Accepted Answer

Myelomalacia

Answer

Myeloschisis

Answer

Cord tumors

Answer

Myelodysplasia

Question 7

Which of the following tumors shows a radiological sign called "pneumosinus dilatans"?

Accepted Answer

Meningiomas

Answer

Ependymomas

Answer

Medulloblastomas

Answer

Hemangioblastomas

Question 8

Absent swallow tail sign is seen in which of the following conditions?

Accepted Answer

Parkinson's disease

Answer

Wilson's disease

Answer

Alzheimer's disease

Answer

Progressive supranuclear palsy

Question 9

Which condition is associated with a 'wine glass' appearance on T2-weighted MRI of the brain?

Accepted Answer

Normal Pressure Hydrocephalus

Answer

Multiple Sclerosis

Answer

Leukodystrophy

Answer

Binswanger's Disease

Question 10

Widened neural foramina are frequently seen in:

Accepted Answer

Neurofibromatosis

Answer

Tuberous sclerosis

Answer

Sturge-Weber syndrome

Answer

Klippel-Feil syndrome

Neuroradiology — MCQs

Neuroradiology — MCQs

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