NEURO

Question 1

Confluent white matter lesions - Child

Answer 1

ADEM
MS
Dysmyelinating disease
Treatment-related leukoencephalopathy

Question 2

Confluent white matter lesions - Adult

Answer 2

Vasculopathy
Demyelinating disease
Neoplasm
Atypical infection
Treatment-related leukoencephalopathy

Question 3

Sellar/suprasellar Mass - Child

Answer 3

Craniopharyngioma - cystic w/ calcs
Germ cell tumour
Rathke cleft cyst
Optic nerve/Hypothalamic glioma - NF-1
Hypothalamic hamartoma

Question 4

Posterior Fossa Mass - Child

Answer 4

Medulloblastoma - roof of 4th ventricle, subarachnoid seeding
Juvenile Pilocytic Astrocytoma
Ependymoma - floor of the 4th ventricle
Brainstem glioma
Atypical teratoid rhabdoid tumour - ATRT

Question 5

Posterior Fossa Mass - Adult

Answer 5

Infarction
Metastatic disease
Haemangioblastoma
Vascular Malformation
Hypertensive haemorrhage

Question 6

Calcified Brain Mets

Answer 6

Adenocarcinoma - breast, lung
SCC - lung, cervix
Sarcoma - osteosarcoma
Mucinous adenocarcinoma - colorectal, ovarian

Question 7

Haemorrhagic Brain Mets

Answer 7

Melanoma
RCC
Choriocarcinoma
Thyroid Ca
Lung Ca
Breast Ca
HCC

Question 8

Ring-enhancing Lesion

Answer 8

Neoplasm (mets, multicentric glioma, lymphoma)
Abscess
Subacute infarct
Demyelinating disease
Resolving contusion
Toxoplasmosis

Question 9

Pineal Mass

Answer 9

Pineal cyst
Germ cell tumour - hyperdense, central cals, drop mets
Pineal cell tumour - pineoblastoma vs pineocytoma - periphery cals, drop mets
Tectal plate glioma
Meningioma

Question 10

Posterior Fossa CSF collection/cyst

Answer 10

Mega cisterna magna
Arachnoid cyst
Dandy-Walker continuum - Dandy walker malformation / variant
Blake Pouch Cyst
Joubert syndrome - vermin hypoplasia

Question 11

CPA mass

Answer 11

Vestibular Schwannoma
Meningioma
Arachnoid cyst
Epidermoid - high on T2, hypo on flair
Lipoma - chemical shift artefact and fat suppress

Question 12

Cerebellar Tonsillar Herniation

Answer 12

Chiari malformation
Intracranial hypotension
Ependymoma (mimic)
Posterior fossa mass

Question 13

CSF lined cortical cleft

Answer 13

Schizencephaly - lined by grey matter
Porencephalic cyst - lined by white matter
Encephalomalacia

Question 14

Enhancing intra-medullary spinal lesion /mass

Answer 14

Ependymoma - ADULTS ; haemosiderin T2 hypointense cap ; cellular (cervical) vs myxopapillary variant (conus, film, caudal equina)
Astrocytoma - CHILD ; cervical most common
Demyelinating disease - usually posterolateral cord
Haemangioblastoma - subpial, dorsal location
Mets - lung, breast, melanoma, lymphoma, RCC

Question 15

Intradural extramedullary spinal tumour

Answer 15

Nerve sheath tumour - Schwannoma (MOST COMMON, dumb-bell , foramina enlargement, posterior scalloping) vs neurofibroma (target sign)
Meningioma (broad dural base)
Mets - lung, breast, melanoma ; astrocytoma, medulloblastoma, GCT, choroid plexus neoplasm, ependymoma
Lymphoma/ leukaemia
Paraganglioma - T2 hyperintense avidly enhancing mass, inc MIBG activity

Question 16

Diffuse infiltrating temporal lobe mass/oedema

Answer 16

Herpes encephalitis
Ischaemia/ infarction
Gliomatosis cerebri - diffuse inv 3 or more lobes ; no / minimal enhancement
Limbic encephalitis –> paraneoplastic syndrome - lung, breast ; insidious symptom onset
Status epilepticus

Question 17

Cortically based cystic temporal lobe mass in patient with seizures

Answer 17

Ganglioglioma -> mixed solid cystic, cortical expansion & bone remodelling
DNET -> bubbly multi cystic w/ cortical dysplasia
Pleomorphic astrocytoma -> cystic with enhancing mural nodule
Taylor dysplasia -> cortical signal abnormality tapering toward the ventricles

Question 18

Intraparenchymal haemorrhage

Answer 18

Haemorrhage infarct
Vascular malformation & ass aneurysm ; popcorn appearance on MR
Haemorrhagic neoplasm –> GBM ; lung, breast, RCC, thyroid, melanoma
Contusion
Cerebral amyloid disease

Question 19

Corpus Callosum Lesion

Answer 19

Demyelinating disease
Neoplasm - GBM, Lymphoma
Ischaemia/oedema Diffuse axonal injury
Toxic demyelination - Marchiafava-Bignami

Question 20

Subependymal Nodules

Answer 20

Tuberous Sclerosis
Heterotopic Grey Matter
TORCH infection - esp CMV
Metastatic disease

Question 21

Intraventricular Mass

Answer 21

Meningioma
Choroid plexus tumour
Central neurocytoma - soap bubble appearance
Ependymoma/ Subependymoma
SEGA

Question 22

Cerebellar atrophy

Answer 22

Alcohol abuse
Anticonvulsant therapy
Paraneoplastic syndrome
Multisystem atrophy - hot cross bun in the pons
Ataxia Telengiectasia
Friedreich Ataxia

Question 23

Spinal cord signal abnormality

Answer 23

Demyelinating disease - posterolateral aspect, little oedema
Transverse myelitis
Intramedullary neoplasm - ependymoma / astrocytoma
Cord contusion
Cord Ischaemia
Subacute combined degeneration of the cord - involves posterior columns in inverted V appearance

Question 24

Solitary region of cortical and subcortical signal abnormality in an adult

Answer 24

Ischaemia/infarct
Neoplasm
Cerebritis
Contusion
Seizure oedema

Question 25

Epidural Spinal mass

Answer 25

Disc extrusion Epidural haematoma Epidural abscess Metastatic disease Epidural lipomatosis Synovial cyst

Question 26

Prominent perventricular / basal ganglia cystic lesions

Answer 26

VR spaces Ischaemia Infection - crytococcus (basal ganglia - gelatinous pseudocysts) ; Neurocysticercosis ( vesicular - scolex - cyst with dot sign ; colloidal & granular - ring and nodular enhancement with oedema ; nodular - calcification) Mucoplysaccharidosis Neuroepithelial cyst Cystic neoplasm

Question 27

Clot

Answer 27

Acute: Isointense T1 ; High T2 Subacute: Low T1