Neuroradiology Practice Questions

Q: The CT head of this infant with macrocephaly shows:

Dandy-Walker syndrome. ***Dandy-Walker syndrome*** - The image shows a **markedly enlarged posterior fossa** with a **cystic dilatation** that communicates with the fourth ventricle (indicated by arrows on the axial scan). There is also **hypoplasia of the cerebellar vermis** and **hydrocephalus**, characteristic features of Dandy-Walker syndrome. - This condition is a congenital brain malformation affecting the cerebellum and the fluid-filled spaces around it, leading to symptoms like macrocephaly due to hydrocephalus. *Aqueductal stenosis* - Aqueductal stenosis would primarily cause **dilatation of the lateral and third ventricles**, with a normal-sized fourth ventricle due to the blockage. - It would not typically present with the characteristic large posterior fossa cyst and cerebellar vermian hypoplasia seen here. *Tubercular meningitis* - Tubercular meningitis on imaging typically shows **basal meningeal enhancement**, hydrocephalus, and sometimes infarctions or tuberculomas. - It does not present with a primary cerebellum malformation or a large posterior fossa cyst as demonstrated in the image. *Neurocysticercosis* - Neurocysticercosis involves parasitic cysts (larval stage of *Taenia solium*) in the brain parenchyma, subarachnoid space, or ventricles, often seen as **cystic lesions with a scolex**. - While it can cause hydrocephalus if cysts block CSF flow, it does not involve the specific malformations of the posterior fossa and cerebellum seen in Dandy-Walker syndrome.

Q: The given MRI head shows:

Craniopharyngioma. ***Craniopharyngioma*** - This MRI shows a suprasellar **cystic and solid mass** with heterogeneous signal intensity, which is characteristic of a craniopharyngioma. - The location extending into the **third ventricle** and the heterogeneous nature with possible calcifications (though not clearly visible in this T1 image) are typical features. *Pontine glioma* - A **pontine glioma** would be located within the **pons** (part of the brainstem), typically showing an expansive lesion intrinsic to the brainstem. - The lesion in the image is clearly suprasellar and not originating from the pons. *Cerebellar astrocytoma* - A **cerebellar astrocytoma** would be located within the **cerebellum**, in the posterior fossa, commonly presenting as a cystic lesion with a mural nodule. - The pictured mass is above the sella turcica, indicating a supratentorial location, and not within the cerebellum. *Pinealoma* - A **pinealoma** arises in the **pineal gland** region, posterior to the third ventricle and superior to the superior colliculi. - The lesion in the image is anterior to this location, in the suprasellar cistern and extending into the third ventricle, which is not consistent with a pinealoma.

Q: What does the CECT head show?

Brain abscess. ***Brain abscess*** - The CECT image displays a **hypodense lesion with a well-defined hyperdense rim** after contrast administration, characteristic of a ring-enhancing lesion - The arrow specifically points to a **fluid-level within the lesion**, suggesting a collection of fluid with varying densities, a key feature of pyogenic brain abscess - Brain abscess typically presents with **thick, smooth, and uniform ring enhancement** with a hypodense necrotic center, exactly as seen in this image - The presence of a **fluid-fluid level** is highly suggestive of an abscess with pus and debris layering *Ring enhancing lesion* - While this is a correct **descriptive finding** of what is seen on imaging, it is not the most specific diagnosis - "Ring enhancing lesion" is a **general radiological term** that encompasses multiple pathologies including abscesses, necrotic tumors, metastases, and tuberculomas - In medical education and clinical practice, identifying the **specific diagnosis** (brain abscess) is more valuable than just describing the imaging pattern *Brain infarction* - **Brain infarction** typically appears as a **hypodense area** on CT corresponding to ischemic tissue - Infarcts generally do not show ring enhancement in acute or subacute phases - There is no evidence of **wedge-shaped hypodensity** or vascular territory distribution consistent with infarction *Pneumocephalus* - **Pneumocephalus** refers to the presence of **air within the cranial vault** - Air would appear as sharply demarcated, very low-density (black/hypodense) areas on CT scans - The observed lesion with fluid level and ring enhancement is not consistent with **intracranial air**

Q: The given MRI head shows:

Pontine glioma. ***Pontine glioma*** - The MRI image clearly shows an **intramedullary lesion** diffusely enlarging the **pons**, consistent with a pontine glioma. - Pontine gliomas, particularly **diffuse intrinsic pontine gliomas (DIPGs)**, are characterized by their location within the brainstem and often have poorly defined borders. *Craniopharyngioma* - Craniopharyngiomas typically arise from the **suprasellar region** near the pituitary gland and optic chiasm. - They are usually characterized by **cystic and solid components** and often show calcifications, which are not seen in the provided image. *Cerebellar astrocytoma* - Cerebellar astrocytomas are located in the **cerebellum**, a region posterior to the brainstem. - While they can be cystic or solid, their primary location is distinct from the **pons** as seen in the MRI. *Pinealoma* - A pinealoma is a tumor of the **pineal gland**, located in the midline dorsal to the midbrain. - This location is superior and posterior to the pons, and the image does not show a lesion in the pineal region.

Q: A 25-year-old AIDS patient who had stopped taking ART for 6 months presented with seizures and altered sensorium. MRI head of the patient shows:

Toxoplasma. ***Toxoplasma*** - The MRI shows multiple **ring-enhancing lesions**, particularly in the basal ganglia and corticomedullary junction, which are characteristic of **Toxoplasma encephalitis** in an immunocompromised patient with AIDS. - The patient's history of **seizures** and **altered sensorium** in the context of advanced AIDS and cessation of ART strongly points towards an opportunistic infection like toxoplasmosis. *Cryptococcus infection* - Cryptococcal infections in AIDS patients frequently manifest as **meningitis** or **meningoencephalitis**, rather than focal brain lesions seen here. - While it can cause **cryptococcomas**, they are less common than Toxoplasma lesions and often appear as non-enhancing or minimally enhancing lesions, or associated with dilated Virchow-Robin spaces. *TB meningitis* - **Tuberculous meningitis** typically presents with meningeal enhancement, **basal exudates**, and sometimes **tuberculomas**. - While tuberculomas can be ring-enhancing, they are usually fewer in number and often associated with hydrocephalus, unlike the pattern seen in the image. *Herpes simplex encephalitis* - **Herpes simplex encephalitis (HSE)** characteristically affects the **temporal and frontal lobes**, leading to edema and sometimes hemorrhagic changes. - The lesions seen in the image are more multifocal and less restricted to the typical HSE regions.

Q: A 35-year-old immunocompromised patient presents with headache and altered sensorium. The following contrast-enhanced MRI head shows:

Ring enhancing lesions. ***Ring enhancing lesions*** - The image distinctly shows multiple circular structures with a bright outer rim and a darker center, characteristic of **ring-enhancing lesions**. - These lesions often suggest conditions like **abscesses, metastases, or certain neuroinflammatory diseases** that cause breakdown of the blood-brain barrier. *Starry sky appearance* - This term is typically used in the context of certain lymphomas or small cell carcinoma, referring to the presence of numerous small, bright, and often uniform lesions against a darker background. - The lesions in the provided image are larger, less uniform, and clearly display a distinct ring enhancement, which doesn't fit the "starry sky" description. *Soap bubble appearance* - This appearance is characteristic of **cryptococcomas** or certain types of **arachnoid cysts**, presenting as multiloculated, often thin-walled cystic lesions. - The image does not show the typical fluid-filled, interconnected cysts associated with a "soap bubble" appearance; instead, it shows solid-appearing lesions with peripheral enhancement. *Dense MCA sign* - The **dense MCA sign** is a finding on **non-contrast CT scans** where the middle cerebral artery appears hyperdense due to a thrombus, indicating an acute ischemic stroke. - This finding is specific to **CT imaging** and acute stroke, and the provided image is an MRI, showing distinct enhancing lesions rather than a thrombosed artery.

Q: The digital subtraction angiography given below shows? (AIIMS Nov 2017)

Carotid-cavernous fistula. ***Carotid-cavernous fistula*** - The image shows early opacification of the **cavernous sinus** and cerebral veins (indicated by the arrow) directly from the internal carotid artery, which is characteristic of a carotid-cavernous fistula. - This high-flow shunt between the arterial and venous systems leads to venous congestion and often presents with **pulsatile exophthalmos**, chemosis, and ophthalmoplegia. *Intra-cranial pseudo-aneurysm* - A pseudo-aneurysm typically appears as a sac-like outpouching from an artery, lacking a true vessel wall, and would not show direct early venous filling. - Pseudo-aneurysms are often caused by **trauma** or infection and may present with signs of hemorrhage if ruptured. *Angiofibroma tumor blush* - An angiofibroma would appear as a **hypervascular mass** with a dense, persistent tumor blush on angiography, but it would not show early direct shunting into veins. - These tumors are typically found in the nasopharynx and present with symptoms like **epistaxis** and nasal obstruction. *Vein of Galen malformation* - A **Vein of Galen malformation** is a developmental anomaly involving an arteriovenous fistula that drains into a dilated median prosencephalic vein, often presenting in infants with high-output heart failure. - While it is an arteriovenous malformation, its typical location and presentation are different from the findings shown in this image, which demonstrates shunting in the region of the cavernous sinus.

Q: A 9-year-old female child presents with history of headache and visual disturbances. X-Ray skull is shown below. What is the possible diagnosis? (Recent NEET Pattern 2018-19)

Craniopharyngioma. ***Craniopharyngioma*** - The X-ray skull image shows significant **intracranial calcifications**, which are a hallmark feature of **craniopharyngiomas**, especially in children (seen in 80-90% of cases). - Clinical symptoms like **headache** and **visual disturbances** are consistent with the mass effect of a suprasellar tumor like craniopharyngioma, which can compress the optic chiasm and cause hydrocephalus. - Craniopharyngioma is the **most common suprasellar tumor in children** and typically presents in this age group. *Hypothalamic hamartoma* - These are **non-neoplastic** lesions that typically do not present with diffuse calcifications on X-ray skull. - While they can cause endocrine abnormalities (precocious puberty) and gelastic seizures, headache and visual disturbances with calcifications point more toward craniopharyngioma. *Histiocytosis-X* - Histiocytosis-X (Langerhans cell histiocytosis) typically presents with **lytic bone lesions** (punched-out "geographic skull" lesions) on skull X-ray, not diffuse intracranial calcifications. - While it can affect the hypothalamic-pituitary axis causing diabetes insipidus, the dominant radiological finding would be bone destruction, not calcification. *Letterer-Siwe disease* - This is a severe, disseminated form of **Langerhans cell histiocytosis** (acute disseminated LCH) primarily affecting infants and young children under 2 years. - It usually presents with skin rash, hepatosplenomegaly, lymphadenopathy, and lytic bone lesions, but **intracranial calcifications are not a characteristic feature** on plain skull X-rays. - The age of presentation (9 years) and imaging findings make this diagnosis unlikely.

Q: A 55 year old male came with history of hoarseness of voice for which direct laryngoscopy was done and the lesion was biopsied to detect squamous cell carcinoma. He now requires investigation to detect extent of cartilage involvement, imaging of pre and paraglottic spaces and any extension to deep neck structures. Most appropriate investigation of choice will be:

MRI. ***MRI*** - **MRI** is superior for evaluating **cartilage involvement** (especially thyroid cartilage), pre-epiglottic, and paraglottic space invasion due to its excellent **soft tissue contrast**. - It also helps in assessing **deep neck invasion**, perineural spread, and for identifying disease recurrence after radiation therapy. *CT Scan* - While CT can show bone and cartilage calcification, its ability to differentiate subtle **cartilage invasion** and **soft tissue involvement** in the pre-epiglottic and paraglottic spaces is inferior to MRI. - It involves **ionizing radiation** and may not provide as detailed information regarding the extent of soft tissue and marrow invasion. *Repeat direct laryngoscopy under general anaesthesia* - This is an **invasive procedure** primarily used for direct visualization, biopsy, and staging of superficial lesions or for therapeutic interventions. - It is not effective for evaluating the **depth of invasion** or spread to **deep neck structures**. *Endo Ultrasound* - **Endoscopic ultrasound (EUS)** is primarily used for evaluating gastrointestinal and sometimes tracheobronchial lesions for depth of invasion and nodal staging. - It is **not the primary imaging modality** for assessing the extent of laryngeal squamous cell carcinoma, especially for cartilage invasion or deep neck structures.

Q: Identify the diagnosis using the MRI provided.

Chiari type 1 malformation. ***Chiari type 1 malformation*** - The sagittal MRI image clearly shows the **cerebellar tonsils prolapsing below the foramen magnum** into the cervical spinal canal, which is the hallmark of a Chiari type 1 malformation. - This condition can lead to symptoms like headaches, neck pain, and neurological deficits due to compression of the brainstem and spinal cord. *Dandy-Walker malformation* - This malformation involves the **agenesis or hypoplasia of the cerebellar vermis** and persistent cystic dilation of the fourth ventricle, creating a large posterior fossa cyst. - The image does not show an enlarged posterior fossa with a cystic fourth ventricle or a severely hypoplastic vermis. *Vein of Galen malformation* - This is a **rare congenital vascular malformation** involving a direct arteriovenous shunt without an intervening capillary bed, typically presenting as an enlarged vein of Galen. - The provided image is a sagittal view demonstrating cerebellar tonsillar herniation, not a prominent or malformed vein of Galen. *Agenesis of the corpus callosum* - This condition is characterized by the **partial or complete absence of the corpus callosum**, the band of white matter connecting the two cerebral hemispheres. - On sagittal MRI, this would show absence of the corpus callosum and typically radial gyral patterns, which are not seen in this image.

Question 1

The CT head of this infant with macrocephaly shows:

Accepted Answer

Dandy-Walker syndrome

Answer

Aqueductal stenosis

Answer

Tubercular meningitis

Answer

Neurocysticercosis

Question 2

The given MRI head shows:

Accepted Answer

Craniopharyngioma

Answer

Pontine glioma

Answer

Cerebellar astrocytoma

Answer

Pinealoma

Question 3

What does the CECT head show?

Accepted Answer

Brain abscess

Answer

Ring enhancing lesion

Answer

Brain infarction

Answer

Pneumocephalus

Question 4

The given MRI head shows:

Accepted Answer

Pontine glioma

Answer

Craniopharyngioma

Answer

Cerebellar astrocytoma

Answer

Pinealoma

Question 5

A 25-year-old AIDS patient who had stopped taking ART for 6 months presented with seizures and altered sensorium. MRI head of the patient shows:

Accepted Answer

Toxoplasma

Answer

Cryptococcus infection

Answer

TB meningitis

Answer

Herpes simplex encephalitis

Question 6

A 35-year-old immunocompromised patient presents with headache and altered sensorium. The following contrast-enhanced MRI head shows:

Accepted Answer

Ring enhancing lesions

Answer

Starry sky appearance

Answer

Soap bubble appearance

Answer

Dense MCA sign

Question 7

The digital subtraction angiography given below shows? (AIIMS Nov 2017)

Accepted Answer

Carotid-cavernous fistula

Answer

Intra-cranial pseudo-aneurysm

Answer

Angiofibroma tumor blush

Answer

Vein of Galen malformation

Question 8

A 9-year-old female child presents with history of headache and visual disturbances. X-Ray skull is shown below. What is the possible diagnosis? (Recent NEET Pattern 2018-19)

Accepted Answer

Craniopharyngioma

Answer

Hypothalamic hamartoma

Answer

Histiocytosis- X

Answer

Letterer-Siwe disease

Question 9

A 55 year old male came with history of hoarseness of voice for which direct laryngoscopy was done and the lesion was biopsied to detect squamous cell carcinoma. He now requires investigation to detect extent of cartilage involvement, imaging of pre and paraglottic spaces and any extension to deep neck structures. Most appropriate investigation of choice will be:

Accepted Answer

MRI

Answer

CT Scan

Answer

Repeat direct laryngoscopy under general anaesthesia

Answer

Endo Ultrasound

Question 10

Identify the diagnosis using the MRI provided.

Accepted Answer

Chiari type 1 malformation

Answer

Dandy-Walker malformation

Answer

Vein of Galen malformation

Answer

Agenesis of the corpus callosum

Neuroradiology — MCQs

Neuroradiology — MCQs

On this page

Practice by Chapter

Want unlimited practice?