Neuroradiology — MCQs

Neuroradiology Indian Medical PG Practice Questions and MCQs

Question 61: Suprasellar calcification with growth retardation is seen in which condition?

A. Pineal body tumor
B. Pituitary tumor
C. Thalamic tumor
D. Craniopharyngioma (Correct Answer)

Explanation: **Explanation:** **Craniopharyngioma** is the correct answer because it is the most common suprasellar tumor in children and is classically associated with the triad of **suprasellar calcification**, **visual field defects** (bitemporal hemianopia), and **endocrine dysfunction**. Growth retardation occurs due to the compression of the pituitary stalk or gland, leading to Growth Hormone (GH) deficiency. Radiologically, these tumors often show a "cystic with a solid component" appearance; calcification is seen in approximately 90% of pediatric cases. **Analysis of Incorrect Options:** * **Pineal body tumors:** These are located in the posterior third ventricle (surapineal recess), not the suprasellar region. They typically present with Parinaud syndrome (upward gaze palsy) and precocious puberty. * **Pituitary tumors (Adenomas):** While located in the sella, they are rare in children. Calcification is very uncommon in pituitary adenomas compared to craniopharyngiomas. * **Thalamic tumors:** These present with sensory-motor deficits or signs of increased intracranial pressure due to hydrocephalus. They are deep-seated parenchymal tumors, not primary suprasellar masses. **NEET-PG High-Yield Pearls:** * **Origin:** Derived from remnants of **Rathke’s pouch**. * **Bimodal Distribution:** Peaks at 5–14 years (Adamantinomatous type - "machine oil" fluid, calcification common) and 50–75 years (Papillary type - solid, calcification rare). * **Imaging Gold Standard:** MRI is best for anatomy, but **CT is superior for detecting the characteristic calcification.** * **Clinical Sign:** "Short stature" in a child with headaches and vision loss should immediately trigger suspicion of Craniopharyngioma.

Question 62: A biconvex hyperdense shadow on a non-contrast CT scan is typically seen in which of the following conditions?

A. Extradural hemorrhage (Correct Answer)
B. Subdural hemorrhage
C. Subarachnoid hemorrhage
D. Intraventricular hemorrhage

Explanation: ### Explanation The correct answer is **Extradural Hemorrhage (EDH)**. **1. Why Extradural Hemorrhage is Correct:** An EDH occurs due to bleeding into the potential space between the skull and the dura mater, most commonly following a fracture of the temporal bone and rupture of the **middle meningeal artery**. Because the dura is firmly attached to the skull sutures, the expanding hematoma is restricted at these points. This pressure forces the blood to expand inward toward the brain, creating a characteristic **biconvex (lentiform or lemon-shaped)**, hyperdense (white) appearance on a non-contrast CT (NCCT). **2. Why the Other Options are Incorrect:** * **Subdural Hemorrhage (SDH):** This occurs between the dura and the arachnoid mater, usually due to the tearing of **bridging veins**. Since this space is not limited by sutures, the blood spreads widely along the brain's convexity, resulting in a **crescent-shaped (concave)** appearance. * **Subarachnoid Hemorrhage (SAH):** This involves bleeding into the subarachnoid space (between the arachnoid and pia mater). On NCCT, it appears as hyperdensity within the **sulci, fissures, and basal cisterns** (often described as a "star-shaped" density in the circle of Willis). * **Intraventricular Hemorrhage (IVH):** This refers to blood within the brain's ventricular system, appearing as hyperdense fluid-levels within the lateral, third, or fourth ventricles. **3. High-Yield Clinical Pearls for NEET-PG:** * **Lucid Interval:** Classically associated with EDH (the patient regains consciousness before deteriorating). * **Suture Lines:** EDH **does not** cross suture lines (but can cross the midline/dural attachments), whereas SDH **does** cross suture lines but not dural attachments (like the falx). * **Source of Bleed:** EDH is usually arterial (Middle Meningeal Artery); SDH is usually venous (Bridging Veins).

Question 63: Battered baby syndrome is associated with which of the following conditions?

A. Subdural hematoma (Correct Answer)
B. Extradural hematoma
C. Subarachnoid hematoma
D. Acute bleed

Explanation: **Explanation:** **Battered Baby Syndrome** (Non-Accidental Injury or Shaken Baby Syndrome) is a form of child abuse characterized by repetitive physical trauma. The correct answer is **Subdural Hematoma (SDH)** because it is the most common intracranial manifestation of this syndrome. 1. **Why Subdural Hematoma is Correct:** The primary mechanism in Shaken Baby Syndrome is vigorous acceleration-deceleration (whiplash) forces. These forces cause the brain to move within the skull, leading to the tearing of the **bridging veins** that cross the subdural space. This results in SDH, which is often bilateral and may show different stages of healing (chronic and acute), indicating repeated episodes of abuse. 2. **Why other options are incorrect:** * **Extradural Hematoma (EDH):** Usually results from a focused impact (e.g., a fall or blow) causing an arterial bleed (middle meningeal artery). While it can occur in abuse, it is far less common than SDH in shaking injuries. * **Subarachnoid Hematoma:** While it can occur alongside SDH in trauma, it is not the classic pathognomonic finding associated with the repetitive shaking mechanism. * **Acute Bleed:** This is a general term. While SDH is an acute bleed, the specific anatomical location (Subdural) is the hallmark required for diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **The Triad of Shaken Baby Syndrome:** 1. Subdural Hematoma, 2. Retinal Hemorrhages (found in 80% of cases), and 3. Encephalopathy. * **Radiological Signs:** Look for "Metaphyseal Corner Fractures" (Bucket-handle fractures) and posterior rib fractures, which are highly specific for non-accidental injury. * **Imaging Choice:** Non-contrast CT is the initial investigation for acute hemorrhage; MRI is superior for dating the age of the hematomas.

Question 64: Boomerang ventricle is a feature of?

A. Lissencephaly
B. Schizencephaly
C. Holoprosencephaly (Correct Answer)
D. Huntington's Chorea

Explanation: ### Explanation **Correct Answer: C. Holoprosencephaly** **Understanding the Concept:** Holoprosencephaly (HPE) is a spectrum of forebrain malformations resulting from the failure of the embryonic prosencephalon to divide into two cerebral hemispheres. The **"Boomerang Ventricle"** (also known as a monoventricle) is a hallmark of the most severe form, **Alobar Holoprosencephaly**. In this condition, the absence of the midline structures (like the septum pellucidum and falx cerebri) leads to a single, large, horseshoe or boomerang-shaped ventricular cavity that communicates across the midline. **Analysis of Incorrect Options:** * **Lissencephaly:** Characterized by a "smooth brain" due to failure of neuronal migration. Key radiological signs include a **"Figure-of-8" appearance** (due to wide Sylvian fissures) and a thickened cortex, but not a monoventricle. * **Schizencephaly:** A gray matter-lined cleft extending from the ependyma to the pial surface. While it affects the ventricles (often showing a "pointy" appearance at the site of the cleft), it does not create a single boomerang-shaped cavity. * **Huntington’s Chorea:** This neurodegenerative disorder causes atrophy of the **caudate nucleus**. This leads to compensatory enlargement of the lateral ventricles, giving them a **"Box-car" appearance**, rather than a boomerang shape. **Clinical Pearls for NEET-PG:** * **HPE Spectrum:** Alobar (most severe, monoventricle) → Semilobar → Lobar (least severe). * **Associated Sign:** "Face predicts the brain"—HPE is frequently associated with midline facial defects like cyclopia, proboscis, or cleft lip/palate. * **Key Association:** Strongly linked with **Trisomy 13 (Patau Syndrome)**. * **Radiology Tip:** Look for the absence of the **Septum Pellucidum**; if it is missing, always consider the HPE spectrum or Septo-optic Dysplasia.

Question 65: Which of the following is NOT a characteristic of raised intracranial tension on a plain radiograph?

A. Erosion of the dorsum sellae
B. Ballooning of the sella (Correct Answer)
C. Increased convolutions
D. Sutural diastasis

Explanation: **Explanation:** Raised Intracranial Tension (ICT) manifests on plain skull radiographs through specific pressure-induced changes. **Why "Ballooning of the Sella" is the correct answer:** Ballooning of the sella turcica is a characteristic feature of a **Pituitary Adenoma** (intrasellar mass), not generalized raised ICT. In pituitary tumors, the sella expands uniformly in a "ballooned" fashion. In contrast, raised ICT causes extrinsic pressure on the sella, leading to erosion rather than uniform expansion. **Analysis of other options (Features of Raised ICT):** * **Erosion of the dorsum sellae:** This is the **earliest sign** of raised ICT in adults. The increased pressure causes the posterior clinoid processes and the dorsum sellae to become osteoporotic and eventually erode. * **Increased convolutions (Silver-beaten/Copper-beaten skull):** Chronic raised ICT causes the gyri of the brain to press against the inner table of the skull, creating prominent digital impressions. Note: This can be normal in children (ages 2–12) unless excessive. * **Sutural diastasis:** This is the **earliest sign** of raised ICT in **infants and young children** (before sutures fuse). A suture width >2mm is generally considered abnormal. **High-Yield Clinical Pearls for NEET-PG:** 1. **Earliest sign (Adults):** Erosion of the dorsum sellae. 2. **Earliest sign (Children):** Sutural diastasis. 3. **Pineal Gland Displacement:** A shift of a calcified pineal gland (>2mm from midline) is a sensitive indicator of a space-occupying lesion. 4. **J-shaped Sella:** Associated with Optic Chiasm Glioma or Hurler Syndrome, not generalized raised ICT.

Question 66: All are X-ray findings of retinoblastoma except?

A. Widening of optic canal
B. Intracerebral calcification (Correct Answer)
C. Intraocular calcification
D. Secondaries in cranial bones

Explanation: **Explanation:** Retinoblastoma is the most common primary intraocular malignancy of childhood. The correct answer is **Intracerebral calcification** because, while retinoblastoma frequently calcifies within the eye, it does not typically cause calcifications within the brain parenchyma itself. **1. Why "Intracerebral calcification" is the correct (Except) option:** Retinoblastoma is characterized by **intraocular** calcification (seen in >90% of cases). If the tumor spreads extraocularly, it usually does so via the optic nerve or hematogenous spread. While it can involve the brain via direct extension, it does not manifest as primary "intracerebral calcification." Intracerebral calcifications are more characteristic of conditions like TORCH infections (e.g., CMV, Toxoplasmosis) or Tuberous Sclerosis. **2. Analysis of Incorrect Options:** * **Widening of optic canal:** This occurs when the tumor extends posteriorly along the optic nerve toward the chiasm. On a Rhese view X-ray, a widened optic canal is a classic sign of intracranial extension. * **Intraocular calcification:** This is the hallmark radiologic feature. On X-ray or CT, fine, speckled, or chunky calcification within the globe is highly suggestive of retinoblastoma in a child. * **Secondaries in cranial bones:** Retinoblastoma can metastasize hematogenously to the bone marrow and cortical bone. Cranial bones are a known site for these metastatic deposits, appearing as osteolytic lesions on X-ray. **High-Yield Clinical Pearls for NEET-PG:** * **Most common sign:** Leukocoria (White pupillary reflex). * **Imaging Modality of Choice:** **MRI** (to assess optic nerve involvement and rule out Trilateral Retinoblastoma). **CT** is best for detecting calcification but is avoided due to radiation risk. * **Trilateral Retinoblastoma:** Bilateral retinoblastoma associated with a pineal gland tumor (Pineoblastoma). * **Pathology:** Flexner-Wintersteiner rosettes are pathognomonic.

Question 67: What is the best imaging investigation for parameningeal rhabdomyosarcoma?

A. Cerebrospinal fluid cytology
B. Magnetic resonance imaging (MRI) (Correct Answer)
C. Contrast-enhanced computed tomography (CECT)
D. Positron emission tomography (PET) scan

Explanation: **Explanation:** **1. Why MRI is the Correct Answer:** Magnetic Resonance Imaging (MRI) is the gold standard for evaluating parameningeal rhabdomyosarcoma (RMS) due to its **superior soft-tissue contrast**. Parameningeal sites (e.g., nasopharynx, infratemporal fossa, paranasal sinuses) are anatomically complex. MRI is essential to assess **perineural spread**, intracranial extension, and involvement of the skull base or cavernous sinus. It provides better visualization of the tumor's relationship with the dura and brain parenchyma compared to CT. **2. Why Other Options are Incorrect:** * **CECT (Option C):** While CT is excellent for detecting bone erosion (destruction of the skull base), it lacks the soft-tissue resolution required to differentiate the tumor from adjacent muscles, nerves, or intracranial structures. It is often used as an adjunct, not the primary investigation. * **CSF Cytology (Option A):** This is used to detect leptomeningeal spread (seeding into the spinal fluid) but is a staging procedure, not the primary imaging investigation for the tumor itself. * **PET Scan (Option D):** PET is valuable for detecting distant metastases and monitoring treatment response (systemic staging), but it does not provide the anatomical detail necessary for local surgical or radiation planning. **3. High-Yield Clinical Pearls for NEET-PG:** * **Parameningeal Sites:** These carry the **worst prognosis** among head and neck RMS due to the high risk of meningeal involvement. * **Imaging Choice:** For any pediatric soft tissue sarcoma of the head and neck, **MRI with Gadolinium** is the investigation of choice. * **Classic Presentation:** A child presenting with a rapidly enlarging mass, cranial nerve palsies, or chronic "sinusitis" that doesn't resolve. * **Management:** Multimodal approach involving chemotherapy, surgery, and radiation.

Question 68: In cerebral infarct, maximum enhancement on a CT scan is typically seen after how many days?

A. 2 days
B. 5 days
C. 9 days
D. 14 days (Correct Answer)

Explanation: **Explanation:** The correct answer is **14 days (Option D)**. This phenomenon is governed by the physiological timeline of the **Blood-Brain Barrier (BBB) breakdown** and subsequent **neovascularization**. 1. **Why 14 days is correct:** Following a cerebral infarct, the BBB begins to break down within the first few days. However, maximal enhancement (often termed "luxury perfusion" or reactive angiogenesis) typically peaks during the **subacute phase**, specifically between **1 to 3 weeks**. On a CT scan, this enhancement is most prominent around **day 14**. This occurs because the newly formed capillaries in the granulation tissue lack tight junctions, allowing contrast to leak into the infarcted parenchyma. 2. **Why other options are incorrect:** * **2 days (Option A):** This is the acute phase. Enhancement is rare at this stage because the BBB is often still relatively intact, and cytotoxic edema predominates. * **5 days (Option B):** Enhancement begins to appear (starting around day 3), but it has not yet reached its peak intensity. * **9 days (Option C):** While enhancement is visible, it continues to increase in intensity throughout the second week, peaking closer to the 14-day mark. **High-Yield Clinical Pearls for NEET-PG:** * **"Fogging Effect":** Occurs between weeks 2 and 3 (around day 10–21). On non-contrast CT, the infarct may temporarily appear isodense to normal brain tissue because the resolution of edema and the presence of petechial hemorrhages "mask" the low density. * **Sequence of Enhancement:** Enhancement typically persists for 6–8 weeks before fading as the glial scar forms. * **Pattern:** Post-infarct enhancement is usually **gyral (cortical)** in distribution, following the ribbon of the gray matter. * **Rule of 3s:** Infarct enhancement starts at 3 days, peaks at 3 weeks (range 1–3), and disappears by 3 months. (Note: For MCQ purposes, 14 days is the standard "peak" answer).

Question 69: What is the investigation of choice for acoustic neuroma?

A. CT scan
B. Gadolinium-enhanced MRI (Correct Answer)
C. Angiography
D. Four-vessel digital subtraction angiography

Explanation: **Explanation:** **Acoustic Neuroma (Vestibular Schwannoma)** is a benign tumor arising from the Schwann cells of the vestibular nerve (CN VIII). **Why Gadolinium-enhanced MRI is the Correct Answer:** MRI is the gold standard for evaluating the posterior fossa and internal auditory canal (IAC). **Gadolinium-enhanced MRI** is the investigation of choice because it provides superior soft-tissue contrast, allowing for the detection of even tiny intracanalicular tumors (as small as 1-2 mm). These tumors are typically **T1-isointense/hypointense**, **T2-hyperintense**, and show **intense, homogenous enhancement** with gadolinium. **Analysis of Incorrect Options:** * **A. CT Scan:** While CT can show widening of the internal auditory canal or large tumors, it often misses small intracanalicular lesions due to "bone hardening" artifacts in the posterior fossa. It is only used if MRI is contraindicated. * **C & D. Angiography/DSA:** These are invasive procedures used to visualize vascular anatomy or map blood supply for highly vascular tumors (like glomus jugulare). Acoustic neuromas are not primarily vascular lesions, making these tests unnecessary. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Presentation:** Progressive sensorineural hearing loss (SNHL), tinnitus, and dysequilibrium. * **Radiological Sign:** The **"Ice-cream cone appearance"** (the intracanalicular component is the cone, and the cerebellopontine angle component is the scoop). * **Bilateral Acoustic Neuromas:** Pathognomonic for **Neurofibromatosis Type 2 (NF2)**. * **Anatomical Location:** Most commonly occurs at the Cerebellopontine (CP) angle.

Question 70: Central T2 hypo intensity is a characteristic imaging feature of which of the following conditions?

A. Neurocysticercosis
B. Tuberculous granuloma with a solid center (Correct Answer)
C. Tuberculous granuloma with a liquefied center
D. Tubercular abscess

Explanation: **Explanation:** The imaging appearance of a **Tuberculoma (Tuberculous granuloma)** evolves through distinct pathological stages, which is a high-yield concept for NEET-PG. **1. Why Option B is Correct:** A **solid caseating tuberculoma** (solid center) is characterized by a dense collection of caseous necrosis. This solid material has relatively low water content and high cellular density, which leads to **shortened T2 relaxation times**. Consequently, it appears **hypointense (dark) on T2-weighted images**. This is a classic "radiology sign" used to differentiate it from most other ring-enhancing lesions (like neurocysticercosis or abscesses), which are typically T2 hyperintense. **2. Analysis of Incorrect Options:** * **Option A (Neurocysticercosis):** In the vesicular stage, the cyst fluid is similar to CSF (T2 hyperintense). In the colloidal stage, the fluid becomes turbid but remains relatively hyperintense compared to the solid core of a tuberculoma. * **Option C (Liquefied center):** As a tuberculoma matures, the solid center undergoes liquefaction. This increase in water content causes the center to become **T2 hyperintense**. * **Option D (Tubercular abscess):** These are larger, pus-filled cavities. Like pyogenic abscesses, the liquid pus is **T2 hyperintense** and shows marked restricted diffusion on DWI. **Clinical Pearls for NEET-PG:** * **T1 Imaging:** Tuberculomas are usually isointense to hypointense. * **T2 Imaging:** Solid caseation = **T2 Hypointense** (Key differentiator). * **Enhancement:** Both tuberculomas and NCC show **ring enhancement**, but tuberculomas are usually larger (>2cm), often conglomerate, and associated with more significant perilesional edema. * **MR Spectroscopy:** Tuberculomas characteristically show a prominent **Lipid/Lactate peak** at 1.3 ppm due to caseous necrosis.

Practice by Chapter

Neuroanatomy for Radiologists

Practice Questions

Cerebrovascular Diseases

Practice Questions

Intracranial Tumors

Practice Questions

CNS Infections

Practice Questions

Demyelinating and Degenerative Diseases

Practice Questions

Head Trauma Imaging

Practice Questions

Spine Imaging: Trauma and Degenerative Disease

Practice Questions

Spine Tumors and Infections

Practice Questions

Pediatric Neuroradiology

Practice Questions

Congenital CNS Anomalies

Practice Questions

Functional Neuroimaging

Practice Questions

Neurointerventional Procedures

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free