Neuroradiology Practice Questions

Q: Eye of the tiger appearance in NCCT is seen in:

Pantothenate kinase-associated neurodegeneration. ***Pantothenate kinase-associated neurodegeneration*** - The **"eye of the tiger" sign** on NCCT (or more typically on T2-weighted MRI) is pathognomonic for **Pantothenate kinase-associated neurodegeneration (PKAN)**, previously known as Hallervorden-Spatz disease. - This sign is characterized by a central region of **pallidal hyperintensity** surrounded by a rim of hypointensity in the globus pallidus, reflecting iron accumulation and neuronal loss. *Huntington chorea* - Huntington's chorea is characterized by **atrophy of the caudate and putamen** seen on NCCT or MRI, leading to an enlargement of the frontal horns of the lateral ventricles. - It does not present with the "eye of the tiger" sign, which is specific to iron deposition in the globus pallidus. *Multiple system atrophy* - Multiple system atrophy (MSA) typically shows **atrophy of the cerebellum**, brainstem, and putamen, along with the "hot cross bun" sign in the pons in some variants. - The "eye of the tiger" sign is not a feature of MSA; it is characterized by different imaging findings related to neurodegeneration in specific brain regions. *Multiple sclerosis* - Multiple sclerosis (MS) is characterized by **demyelinating lesions** in the white matter of the brain and spinal cord, which appear as hyperintense lesions on T2-weighted MRI. - These lesions are distributed throughout the central nervous system, and the "eye of the tiger" sign is not associated with MS.

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: The image given below shows:

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:

Ventriculoperitoneal shunt. ***Ventriculoperitoneal 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 ventriculoperitoneal shunt. - A ventriculoperitoneal shunt is surgically placed to **drain excess cerebrospinal fluid** from the brain's ventricles to the peritoneal cavity, 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:

All of the above. ***All of the above*** - The NCCT image clearly demonstrates hyperdense (bright) blood within the brain parenchyma, distending the ventricles, and filling the sulci, indicating **intraparenchymal, intraventricular, and subarachnoid hemorrhages** simultaneously. - Head trauma can cause a combination of these bleeding patterns due to the significant forces involved, leading to diffuse axonal injury, contusions, and vessel rupture in multiple compartments. *Intraparenchymal bleed* - While there is clear evidence of hyperdense blood within the **brain parenchyma**, this option alone does not encompass all the bleeding observed. - The image shows more widespread involvement than just an isolated intraparenchymal hemorrhage. *Intraventricular bleed* - There is readily apparent hyperdensity within the **ventricles**, confirming an intraventricular hemorrhage. - However, this is not the only location of bleeding on the scan. *Subarachnoid bleed* - The image shows hyperdensity within the **sulci**, consistent with blood in the subarachnoid space. - Like the other options, this is only a partial description of the overall bleeding pattern seen.

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 **left side** of the image, indicating an 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 on the opposite side (left) and 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 right side of the brain**. - The hemorrhage visible in the image is clearly situated on the **left side**, ruling out a right-sided hemorrhage.

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

Intraparenchymal hemorrhage. ***Intraparenchymal hemorrhage*** - The image shows a **hyperdense (bright)** lesion within the brain parenchyma, indicated by the arrows. This appearance on non-contrast CT (NCCT) is characteristic of **acute hemorrhage** (blood) within the brain tissue. - The location and morphology are consistent with blood accumulating directly within the brain substance rather than in the subarachnoid space or as a diffuse cerebral edema. *Acute ischemic stroke* - An **acute ischemic stroke** on NCCT typically appears as a **hypodense (darker)** area due to **edema** and cell death, usually after several hours. The lesion shown in the image is hyperdense. - Early signs of acute ischemic stroke (within the first few hours) can include subtle changes like loss of gray-white matter differentiation or hyperdense vessel signs, but not a distinct hyperdense parenchymal lesion as seen here. *Acute hemorrhagic stroke* - While technically a hemorrhagic stroke, this option is too broad. Hemorrhagic stroke encompasses both intraparenchymal hemorrhage and subarachnoid hemorrhage. - The specific location of the blood within the brain tissue, as opposed to solely in the subarachnoid space, makes "intraparenchymal hemorrhage" a more precise diagnosis. *Subarachnoid hemorrhage* - **Subarachnoid hemorrhage (SAH)** would appear as hyperdensity (blood) in the **sulci, fissures**, and **basal cisterns** surrounding the brain, not within the brain parenchyma itself. - The image clearly shows the lesion within the brain tissue, not in the subarachnoid spaces.

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 white arrow on top) communicating with the fourth ventricle and **agenesis/hypoplasia of the cerebellar vermis** (indicated by the white arrowhead). 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.

Question 1

Eye of the tiger appearance in NCCT is seen in:

Accepted Answer

Pantothenate kinase-associated neurodegeneration

Answer

Huntington chorea

Answer

Multiple system atrophy

Answer

Multiple sclerosis

Question 2

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 3

The image given below shows:

Accepted Answer

Pneumocephalus

Answer

Interventricular bleeding

Answer

Artifact

Answer

Ventriculoperitoneal shunting

Question 4

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 5

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 6

The image given below shows presence of:

Accepted Answer

Ventriculoperitoneal shunt

Answer

Enlarged sella turcica

Answer

Craniosynostosis

Answer

Pneumocephalus

Question 7

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

Accepted Answer

All of the above

Answer

Intraparenchymal bleed

Answer

Intraventricular bleed

Answer

Subarachnoid bleed

Question 8

The given NCCT shows the presence of:

Accepted Answer

Left intraparenchymal hemorrhage

Answer

Left intraventricular hemorrhage

Answer

Right intraventricular hemorrhage

Answer

Right intraparenchymal hemorrhage

Question 9

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

Accepted Answer

Intraparenchymal hemorrhage

Answer

Acute ischemic stroke

Answer

Acute hemorrhagic stroke

Answer

Subarachnoid hemorrhage

Question 10

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

Neuroradiology — MCQs

Neuroradiology — MCQs

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