Neuroradiology Flashcards
Which of the following is a risk factor for clinically evident neurologic complications in the first 24 hours after cerebral angiography?
I. Age over 70 years
II. Duration of angiogram over 90 minutes
III. History of transient ischemic attack (TIA) or stroke
IV. History of systemic hypertension
A. I, II, III
B. I, III
C. II, IV
D. IV
E. All of the above
A. I, II, III
B. I, III
C. II, IV
D. IV
E. All of the above
Risk factors for clinically evident neurologic complications in the first 24 hours
after cerebral angiography include age over 70 years (I), duration of angiogram . 90 minutes (II), history of TIA or stroke (III), and history of systemic hypertension (IV). Other risk factors include patients w ith m ore than
50 to 70% stenosis of the cerebral vessels, patients whose angiograms require a
higher volume of contrast, and patients referred for subarachnoid hemorrhage
or who are immediately postoperative
The most common nonneurologic complication of cerebral angiography via a femoral artery approach is
A. Angina
B. Allergic reaction
C. Hematoma
D. Myocardial infarction (MI)
E. Pseudoaneurysm
A. Angina
B. Allergic reaction
C. Hematoma
D. Myocardial infarction (MI)
E. Pseudoaneurysm
Significant hematoma (C) form ation occurs at a rate of 6.9 to 10.7%. Angina
(A), allergic reaction (B), and myocardial infarction (MI [D]) all occur with
an incidence of less than 1 to 2%. Pseudoaneurysms are rare, occurring 0.05
to 0.55% of the time
Branches of the meningohypophysial trunk include the
I. Tentorial artery
II. Inferior hypophysial artery
III. Dorsal m eningeal artery
IV. Superior hypophysial artery
A. I, II, III
B. I, III
C. II, IV
D. IV
E. All of the above
A. I, II, III
B. I, III
C. II, IV
D. IV
E. All of the above
The meningohypophyseal trunk, the largest and most proximal branch of the
cavernous carotid artery, typically has three branches: the tentorial artery
(of Bernasconi and Cassinari [I]), the dorsal meningeal artery (III), and
the inferior hypophyseal artery (the inferolateral trunk [II]). The superior
hypophyseal artery (IV) is a branch of the supraclinoid carotid artery
The most common of the persistent anastomoses
A. Cervical intersegmental artery
B. Proatlantal intersegmental artery
C. Primitive hypoglossal artery
D. Primitive otic artery
E. Primitive trigeminal artery
A. Cervical intersegmental artery
B. Proatlantal intersegmental artery
C. Primitive hypoglossal artery
D. Primitive otic artery
E. Primitive trigeminal artery
The primitive trigeminal artery (E) is the most common persistent fetal anastomosis (except for the fetal posterior communicating artery, which is not an answer choice). The primitive trigeminal artery (E) connects the cavernous internal carotid artery (ICA) to the basilar artery. The primitive otic artery (D) is rare and connects the petrous ICA to the basilar artery via the internal auditory meatus. The prim itive hypoglossal artery (C) is the second m ost common persistent fetal circulation, connecting the cervical ICA to
the basilar artery via the hypoglossal canal. The proatlantal intersegm ental
artey (B) connects the external carotid artery (ECA) or cervical ICA with the
vertebral artery, coursing between the arch of C1 and the occiput
Petrous internal carotid artery to the basilar artery
A. Cervical intersegmental artery
B. Proatlantal intersegmental artery
C. Primitive hypoglossal artery
D. Primitive otic artery
E. Primitive trigeminal artery
A. Cervical intersegmental artery
B. Proatlantal intersegmental artery
C. Primitive hypoglossal artery
D. Primitive otic artery
E. Primitive trigeminal artery
The primitive trigeminal artery (E) is the most common persistent fetal anastomosis (except for the fetal posterior communicating artery, which is not an answer choice). The primitive trigeminal artery (E) connects the cavernous internal carotid artery (ICA) to the basilar artery. The primitive otic artery (D) is rare and connects the petrous ICA to the basilar artery via the internal auditory meatus. The prim itive hypoglossal artery (C) is the second m ost common persistent fetal circulation, connecting the cervical ICA to
the basilar artery via the hypoglossal canal. The proatlantal intersegm ental
artey (B) connects the external carotid artery (ECA) or cervical ICA with the
vertebral artery, coursing between the arch of C1 and the occiput
Proximal cavernous internal carotid artery to basilar artery
A. Cervical intersegmental artery
B. Proatlantal intersegmental artery
C. Primitive hypoglossal artery
D. Primitive otic artery
E. Primitive trigeminal artery
A. Cervical intersegmental artery
B. Proatlantal intersegmental artery
C. Primitive hypoglossal artery
D. Primitive otic artery
E. Primitive trigeminal artery
The primitive trigeminal artery (E) is the most common persistent fetal anastomosis (except for the fetal posterior communicating artery, which is not an answer choice). The primitive trigeminal artery (E) connects the cavernous internal carotid artery (ICA) to the basilar artery. The primitive otic artery (D) is rare and connects the petrous ICA to the basilar artery via the internal auditory meatus. The prim itive hypoglossal artery (C) is the second m ost common persistent fetal circulation, connecting the cervical ICA to
the basilar artery via the hypoglossal canal. The proatlantal intersegm ental
artey (B) connects the external carotid artery (ECA) or cervical ICA with the
vertebral artery, coursing between the arch of C1 and the occiput
The precentral cerebellar vein usually drains into the
A. Internal cerebral vein
B. Lateral mesencephalic vein
C. Posterior mesencephalic vein
D. Straight sinus
E. Vein of Galen
A. Internal cerebral vein
B. Lateral mesencephalic vein
C. Posterior mesencephalic vein
D. Straight sinus
E. Vein of Galen
The precentral cerebellar vein is a midline vessel that courses medially over
the brachium pontis, parallels the roof of the fourth ventricle, and curves
upward behind the inferior colliculus and precentral lobule of the verm is to
drain into the vein of Galen (E).
Anterior temporal lobe masses characteristically displace the
A. Anterior choroidal artery laterally
B. Anterior choroidal artery medially
C. Anterior choroidal artery upward
D. Posterior choroidal artery downward
E. Posterior choroidal artery upward
A. Anterior choroidal artery laterally
B. Anterior choroidal artery medially
C. Anterior choroidal artery upward
D. Posterior choroidal artery downward
E. Posterior choroidal artery upward
Anterior temporal lobe masses characteristically displace the anterior choroidal artery medially (B)
Oxyhemoglobin (0–24 hours)
A. Isointense on T1, isointense to hyperintense on T2
B. Hyperintense on T1 and T2
C. Hypointense on T1 and T2
D. Isointense on T1, hypointense on T2
E. Hyperintense on T1, hypointense on T2
F. Hypointense on T1, hyperintense on T2
A. Isointense on T1, isointense to hyperintense on T2
B. Hyperintense on T1 and T2
C. Hypointense on T1 and T2
D. Isointense on T1, hypointense on T2
E. Hyperintense on T1, hypointense on T2
F. Hypointense on T1, hyperintense on T2
Blood products can be staged by their appearance on m agnetic resonance imaging (MRI). Hyperacute blood contains oxyhemoglobin and is isointense on
T1 and hyperintense on T2 (A). Acute blood (1–3 days) contains deoxyhemoglobin and is isointense on T1 and hypointense on T2 (D). The early subacute phase is associated with intracellular methemoglobin and appears hyperintense on T1 and hypointense on T2 (E). The late subacute phase is associated
w ith extracellular methemoglobin and appears hyperintense on both T1 and
T2 weighted im ages (B). The chronic phase contains hemosiderin around the
periphery and appears hypointense on both T1 and T2 (C). Nonparamagnetic
heme pigments appear hypointense on T1 and hyperintense on T2 (F).
Deoxyhemoglobin (1–3 days)
A. Isointense on T1, isointense to hyperintense on T2
B. Hyperintense on T1 and T2
C. Hypointense on T1 and T2
D. Isointense on T1, hypointense on T2
E. Hyperintense on T1, hypointense on T2
F. Hypointense on T1, hyperintense on T2
A. Isointense on T1, isointense to hyperintense on T2
B. Hyperintense on T1 and T2
C. Hypointense on T1 and T2
D. Isointense on T1, hypointense on T2
E. Hyperintense on T1, hypointense on T2
F. Hypointense on T1, hyperintense on T2
Blood products can be staged by their appearance on m agnetic resonance imaging (MRI). Hyperacute blood contains oxyhemoglobin and is isointense on
T1 and hyperintense on T2 (A). Acute blood (1–3 days) contains deoxyhemoglobin and is isointense on T1 and hypointense on T2 (D). The early subacute phase is associated with intracellular methemoglobin and appears hyperintense on T1 and hypointense on T2 (E). The late subacute phase is associated
w ith extracellular methemoglobin and appears hyperintense on both T1 and
T2 weighted im ages (B). The chronic phase contains hemosiderin around the
periphery and appears hypointense on both T1 and T2 (C). Nonparamagnetic
heme pigments appear hypointense on T1 and hyperintense on T2 (F).
Intracellular methemoglobin (3–6 days)
A. Isointense on T1, isointense to hyperintense on T2
B. Hyperintense on T1 and T2
C. Hypointense on T1 and T2
D. Isointense on T1, hypointense on T2
E. Hyperintense on T1, hypointense on T2
F. Hypointense on T1, hyperintense on T2
A. Isointense on T1, isointense to hyperintense on T2
B. Hyperintense on T1 and T2
C. Hypointense on T1 and T2
D. Isointense on T1, hypointense on T2
E. Hyperintense on T1, hypointense on T2
F. Hypointense on T1, hyperintense on T2
Blood products can be staged by their appearance on m agnetic resonance imaging (MRI). Hyperacute blood contains oxyhemoglobin and is isointense on
T1 and hyperintense on T2 (A). Acute blood (1–3 days) contains deoxyhemoglobin and is isointense on T1 and hypointense on T2 (D). The early subacute phase is associated with intracellular methemoglobin and appears hyperintense on T1 and hypointense on T2 (E). The late subacute phase is associated
w ith extracellular methemoglobin and appears hyperintense on both T1 and
T2 weighted im ages (B). The chronic phase contains hemosiderin around the
periphery and appears hypointense on both T1 and T2 (C). Nonparamagnetic
heme pigments appear hypointense on T1 and hyperintense on T2 (F).
Extracellular methemoglobin (6 days–2 months)
A. Isointense on T1, isointense to hyperintense on T2
B. Hyperintense on T1 and T2
C. Hypointense on T1 and T2
D. Isointense on T1, hypointense on T2
E. Hyperintense on T1, hypointense on T2
F. Hypointense on T1, hyperintense on T2
A. Isointense on T1, isointense to hyperintense on T2
B. Hyperintense on T1 and T2
C. Hypointense on T1 and T2
D. Isointense on T1, hypointense on T2
E. Hyperintense on T1, hypointense on T2
F. Hypointense on T1, hyperintense on T2
Blood products can be staged by their appearance on m agnetic resonance imaging (MRI). Hyperacute blood contains oxyhemoglobin and is isointense on T1 and hyperintense on T2 (A). Acute blood (1–3 days) contains deoxyhemoglobin and is isointense on T1 and hypointense on T2 (D). The early subacute phase is associated with intracellular methemoglobin and appears hyperintense on T1 and hypointense on T2 (E). The late subacute phase is associated
w ith extracellular methemoglobin and appears hyperintense on both T1 and
T2 weighted im ages (B). The chronic phase contains hemosiderin around the
periphery and appears hypointense on both T1 and T2 (C). Nonparamagnetic
heme pigments appear hypointense on T1 and hyperintense on T2 (F).
Nonparamagnetic heme pigments
A. Isointense on T1, isointense to hyperintense on T2
B. Hyperintense on T1 and T2
C. Hypointense on T1 and T2
D. Isointense on T1, hypointense on T2
E. Hyperintense on T1, hypointense on T2
F. Hypointense on T1, hyperintense on T2
A. Isointense on T1, isointense to hyperintense on T2
B. Hyperintense on T1 and T2
C. Hypointense on T1 and T2
D. Isointense on T1, hypointense on T2
E. Hyperintense on T1, hypointense on T2
F. Hypointense on T1, hyperintense on T2
Blood products can be staged by their appearance on magnetic resonance imaging (MRI). Hyperacute blood contains oxyhemoglobin and is isointense on T1 and hyperintense on T2 (A). Acute blood (1–3 days) contains deoxyhemoglobin and is isointense on T1 and hypointense on T2 (D). The early subacute phase is associated with intracellular methemoglobin and appears hyperintense on T1 and hypointense on T2 (E). The late subacute phase is associated
w ith extracellular methemoglobin and appears hyperintense on both T1 and
T2 weighted im ages (B). The chronic phase contains hemosiderin around the
periphery and appears hypointense on both T1 and T2 (C). Nonparamagnetic
heme pigments appear hypointense on T1 and hyperintense on T2 (F).
Hemosiderin around periphery
A. Isointense on T1, isointense to hyperintense on T2
B. Hyperintense on T1 and T2
C. Hypointense on T1 and T2
D. Isointense on T1, hypointense on T2
E. Hyperintense on T1, hypointense on T2
F. Hypointense on T1, hyperintense on T2
A. Isointense on T1, isointense to hyperintense on T2
B. Hyperintense on T1 and T2
C. Hypointense on T1 and T2
D. Isointense on T1, hypointense on T2
E. Hyperintense on T1, hypointense on T2
F. Hypointense on T1, hyperintense on T2
Blood products can be staged by their appearance on magnetic resonance imaging (MRI). Hyperacute blood contains oxyhemoglobin and is isointense on T1 and hyperintense on T2 (A). Acute blood (1–3 days) contains deoxyhemoglobin and is isointense on T1 and hypointense on T2 (D). The early subacute phase is associated with intracellular methemoglobin and appears hyperintense on T1 and hypointense on T2 (E). The late subacute phase is associated
w ith extracellular methemoglobin and appears hyperintense on both T1 and
T2 weighted im ages (B). The chronic phase contains hemosiderin around the
periphery and appears hypointense on both T1 and T2 (C). Nonparamagnetic
heme pigments appear hypointense on T1 and hyperintense on T2 (F).
Potential supply to vascular tumors of the middle ear
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
The caroticotympanic artery (A) is a vestigial hyoid artery remnant that supplies the middle and inner ear; it can provide blood supply to vascular tumors
of the middle ear (i.e., glomus tympanicum ). The meningohypophysial trunk gives rise to three vessels, the tentorial artery (F) of Bernasconi and Cassinari, the inferior hypophysial artery (B), and the dorsal meningeal artery. The inferolateral trunk (C), or the artery of the inferior cavernous sinus, is a remnant of the embryonic dorsal ophthalmic artery and provides branches to
cranial nerves III, IV, V, and VI. The mandibulovidian artery (D) is a branch
of the petrous internal carotid artery and is a common supply to juvenile angiofibromas. The medial trunk, or McConnell’s capsular vessels (E), provides blood supply to the pituitary gland
Vestigial hyoid artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
The caroticotympanic artery (A) is a vestigial hyoid artery remnant that supplies the middle and inner ear; it can provide blood supply to vascular tumors
of the middle ear (i.e., glomus tympanicum ). The meningohypophysial trunk gives rise to three vessels, the tentorial artery (F) of Bernasconi and Cassinari, the inferior hypophysial artery (B), and the dorsal meningeal artery. The inferolateral trunk (C), or the artery of the inferior cavernous sinus, is a remnant of the embryonic dorsal ophthalmic artery and provides branches to
cranial nerves III, IV, V, and VI. The mandibulovidian artery (D) is a branch
of the petrous internal carotid artery and is a common supply to juvenile angiofibromas. The medial trunk, or McConnell’s capsular vessels (E), provides blood supply to the pituitary gland
Common supply to juvenile angiofibromas
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
The caroticotympanic artery (A) is a vestigial hyoid artery remnant that supplies the middle and inner ear; it can provide blood supply to vascular tumors
of the middle ear (i.e., glomus tympanicum ). The meningohypophysial trunk gives rise to three vessels, the tentorial artery (F) of Bernasconi and Cassinari, the inferior hypophysial artery (B), and the dorsal meningeal artery. The inferolateral trunk (C), or the artery of the inferior cavernous sinus, is a remnant of the embryonic dorsal ophthalmic artery and provides branches to
cranial nerves III, IV, V, and VI. The mandibulovidian artery (D) is a branch
of the petrous internal carotid artery and is a common supply to juvenile angiofibromas. The medial trunk, or McConnell’s capsular vessels (E), provides blood supply to the pituitary gland
Also called the artery of Bernasconi and Cassinari
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
The caroticotympanic artery (A) is a vestigial hyoid artery remnant that supplies the middle and inner ear; it can provide blood supply to vascular tumors
of the middle ear (i.e., glomus tympanicum ). The meningohypophysial trunk gives rise to three vessels, the tentorial artery (F) of Bernasconi and Cassinari, the inferior hypophysial artery (B), and the dorsal meningeal artery. The inferolateral trunk (C), or the artery of the inferior cavernous sinus, is a remnant of the embryonic dorsal ophthalmic artery and provides branches to
cranial nerves III, IV, V, and VI. The mandibulovidian artery (D) is a branch
of the petrous internal carotid artery and is a common supply to juvenile angiofibromas. The medial trunk, or McConnell’s capsular vessels (E), provides blood supply to the pituitary gland
Together with the inferior hypophysial artery, these vessels supply the pituitary
gland
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
The caroticotympanic artery (A) is a vestigial hyoid artery remnant that supplies the middle and inner ear; it can provide blood supply to vascular tumors
of the middle ear (i.e., glomus tympanicum ). The meningohypophysial trunk gives rise to three vessels, the tentorial artery (F) of Bernasconi and Cassinari, the inferior hypophysial artery (B), and the dorsal meningeal artery. The inferolateral trunk (C), or the artery of the inferior cavernous sinus, is a remnant of the embryonic dorsal ophthalmic artery and provides branches to
cranial nerves III, IV, V, and VI. The mandibulovidian artery (D) is a branch
of the petrous internal carotid artery and is a common supply to juvenile angiofibromas. The medial trunk, or McConnell’s capsular vessels (E), provides blood supply to the pituitary gland
Together with the caroticotympanic artery, it is a branch of the petrous internal carotid artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
The caroticotympanic artery (A) is a vestigial hyoid artery remnant that supplies the middle and inner ear; it can provide blood supply to vascular tumors
of the middle ear (i.e., glomus tympanicum ). The meningohypophysial trunk gives rise to three vessels, the tentorial artery (F) of Bernasconi and Cassinari, the inferior hypophysial artery (B), and the dorsal meningeal artery. The inferolateral trunk (C), or the artery of the inferior cavernous sinus, is a remnant of the embryonic dorsal ophthalmic artery and provides branches to
cranial nerves III, IV, V, and VI. The mandibulovidian artery (D) is a branch
of the petrous internal carotid artery and is a common supply to juvenile angiofibromas. The medial trunk, or McConnell’s capsular vessels (E), provides blood supply to the pituitary gland
Anastomoses with the superior hypophysial artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
The caroticotympanic artery (A) is a vestigial hyoid artery remnant that supplies the middle and inner ear; it can provide blood supply to vascular tumors
of the middle ear (i.e., glomus tympanicum ). The meningohypophysial trunk gives rise to three vessels, the tentorial artery (F) of Bernasconi and Cassinari, the inferior hypophysial artery (B), and the dorsal meningeal artery. The inferolateral trunk (C), or the artery of the inferior cavernous sinus, is a remnant of the embryonic dorsal ophthalmic artery and provides branches to
cranial nerves III, IV, V, and VI. The mandibulovidian artery (D) is a branch
of the petrous internal carotid artery and is a common supply to juvenile angiofibromas. The medial trunk, or McConnell’s capsular vessels (E), provides blood supply to the pituitary gland
Remnant of the embryonic dorsal ophthalmic artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
The caroticotympanic artery (A) is a vestigial hyoid artery remnant that supplies the middle and inner ear; it can provide blood supply to vascular tumors
of the middle ear (i.e., glomus tympanicum ). The meningohypophysial trunk gives rise to three vessels, the tentorial artery (F) of Bernasconi and Cassinari, the inferior hypophysial artery (B), and the dorsal meningeal artery. The inferolateral trunk (C), or the artery of the inferior cavernous sinus, is a remnant of the embryonic dorsal ophthalmic artery and provides branches to
cranial nerves III, IV, V, and VI. The mandibulovidian artery (D) is a branch
of the petrous internal carotid artery and is a common supply to juvenile angiofibromas. The medial trunk, or McConnell’s capsular vessels (E), provides blood supply to the pituitary gland
Provides important branches to some of the cranial nerves
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
A. Caroticotympanic artery
B. Inferior hypophysial artery
C. Inferolateral trunk
D. Mandibulovidian artery
E. McConnell’s capsular vessels
F. Tentorial artery
The caroticotympanic artery (A) is a vestigial hyoid artery remnant that supplies the middle and inner ear; it can provide blood supply to vascular tumors
of the middle ear (i.e., glomus tympanicum ). The meningohypophysial trunk gives rise to three vessels, the tentorial artery (F) of Bernasconi and Cassinari, the inferior hypophysial artery (B), and the dorsal meningeal artery. The inferolateral trunk (C), or the artery of the inferior cavernous sinus, is a remnant of the embryonic dorsal ophthalmic artery and provides branches to
cranial nerves III, IV, V, and VI. The mandibulovidian artery (D) is a branch
of the petrous internal carotid artery and is a common supply to juvenile angiofibromas. The medial trunk, or McConnell’s capsular vessels (E), provides blood supply to the pituitary gland
The correct order of the named segments of the anterior choroidal artery is
A. Cisternal segment, plexal point, plexal segment
B. Cisternal segment, plexal segment, plexal point
C. Plexal point, cisternal segment, plexal segment
D. Plexal point, plexal segment, cisternal segment
E. Plexal segment, plexal point, cisternal segment
A. Cisternal segment, plexal point, plexal segment
B. Cisternal segment, plexal segment, plexal point
C. Plexal point, cisternal segment, plexal segment
D. Plexal point, plexal segment, cisternal segment
E. Plexal segment, plexal point, cisternal segment
The anterior choroidal artery (AChA) is best seen on the anteroposterior angiogram arising from the medial internal carotid artery. The cisternal AChA
curves medially and posteriorly around the uncus. An abrupt “kink” is seen at the plexal point where the AChA enters the choroidal ssure. The plexal AChA then courses through the temporal horn
In the most common anatomic variation, the named branches of the proximal
right subclavian artery from proximal to distal are
A. Internal mammary artery, thyrocervical trunk, vertebral artery, costocervical
trunk
B. Internal mammary artery, vertebral artery, thyrocervical trunk, costocervical
trunk
C. Vertebral artery, internal mammary artery, costocervical trunk, thyrocervical
trunk
D. Vertebral artery, internal mammary artery, thyrocervical trunk, costocervical
trunk
E. Vertebral artery, thyrocervical trunk, internal mammary artery, costocervical
trunk
A. Internal mammary artery, thyrocervical trunk, vertebral artery, costocervical
trunk
B. Internal mammary artery, vertebral artery, thyrocervical trunk, costocervical
trunk
C. Vertebral artery, internal mammary artery, costocervical trunk, thyrocervical
trunk
D. Vertebral artery, internal mammary artery, thyrocervical trunk, costocervical
trunk
E. Vertebral artery, thyrocervical trunk, internal mammary artery, costocervical
trunk
Although this is the most common variation, others include the inferior thyroid
artery sharing a common trunk with the vertebral artery, the vertebral artery
from the thyrocervical trunk, the vertebral artery from the proximal commoncarotid artery, and the vertebral artery from the subclavian artery distal to the thyrocervical trunk
The most common site of origin of the recurrent artery of Heubner is the
A. A1 segment
B. A2 segment
C. Internal carotid artery
D. M1 segment
E. M2 segment
A. A1 segment
B. A2 segment
C. Internal carotid artery
D. M1 segment
E. M2 segment
The recurrent artery of Heubner (one of the medial striate arteries) takes origin from the A2 segment (B) 34 to 50% of the time, from the A1 segment (A) 17 to 45% of the time, and from the anterior communicating artery 5 to 20% of the time.
Intracranial hypotension related to leakage or removal of cerebrospinalfluid
(CSF) is most closely associated with which magnetic resonance finding?
A. Diffuse dural enhancement
B. Ependymal enhancement
C. Pneumocephalus
D. Slitlike ventricles
E. Ventriculomegaly
A. Diffuse dural enhancement
B. Ependymal enhancement
C. Pneumocephalus
D. Slitlike ventricles
E. Ventriculomegaly
This enhancem ent (A) is thought to represent an increase in blood volume in the dura. Inferior displacement of the structures in the posterior fossa may accompany this finding in such cases of intracranial hypotension
Which of the following imaging characteristics is least likely for pleomorphic xanthoastrocytoma?
A. Calci cation
B. Cyst formation
C. Multiple lesions
D. Superficial location
E. Temporal lobe location
A. Calci cation
B. Cyst formation
C. Multiple lesions
D. Superficial location
E. Temporal lobe location
Pleomorphic xanthoastrocytom a usually presents as a large single mass in a young patient with a long history of seizures. Typical findings include cyst formation (B), calcification (A), superficial location (D), and temporal lobe
location (E).
Choroid plexus papillomas in children are most common in the
A. Fourth ventricle
B. Left lateral ventricle
C. Right lateral ventricle
D. Third ventricle
A. Fourth ventricle
B. Left lateral ventricle
C. Right lateral ventricle
D. Third ventricle
The propensity for the lateralization of choroid plexus papillomas to the left lateral ventricle (B) has not been explained. These large bulky tumors usually arise in the trigone.
Choroid plexus papillomas in adults occur most commonly in the
A. Fourth ventricle
B. Left lateral ventricle
C. Right lateral ventricle
D. Third ventricle
A. Fourth ventricle
B. Left lateral ventricle
C. Right lateral ventricle
D. Third ventricle
Choroid plexus papillomas in the adult population are often found at the caudal aspect of the fourth ventricle (A) and frequently calcify.
Which of the following white matter lesions usually initially involves the parietooccipital regions?
A. Adrenoleukodystrophy
B. Canavan’s disease
C. Metachromatic leukodystrophy
D. Multiple sclerosis
E. Schilder’s disease
A. Adrenoleukodystrophy
B. Canavan’s disease
C. Metachromatic leukodystrophy
D. Multiple sclerosis
E. Schilder’s disease
The lesions of adrenoleukodystrophy (A) are usually symmetrical, begin in
the parieto-occipital region, and spread anteriorly
Caudal displacement of cerebellar tonsils
A. Chiari I malformation
B. Chiari II malformation
C. Both
D. Neither
A. Chiari I malformation
B. Chiari II malformation
C. Both
D. Neither
Chiari I malformations (A) consist of inferior displacement of the cerebellar
tonsils through the foramen magnum . They usually present in early adulthood. In Chiari II malform ations (B), the caudal displacem ent of the hindbrain is more severe, with beaking of the tectum and medullary kinking often
seen. Myelomeningoceles are virtually always present. Chiari II malform ations (B) usually present in infancy. Chiari III malformations display the most severe displacement of posterior fossa structures and are often associated
with a high cervical or occipital meningocele
Beaking of the midbrain tectum is characteristic
A. Chiari I malformation
B. Chiari II malformation
C. Both
D. Neither
A. Chiari I malformation
B. Chiari II malformation
C. Both
D. Neither
Chiari I malformations (A) consist of inferior displacement of the cerebellar
tonsils through the foramen magnum . They usually present in early adulthood. In Chiari II malform ations (B), the caudal displacem ent of the hindbrain is more severe, with beaking of the tectum and medullary kinking often
seen. Myelomeningoceles are virtually always present. Chiari II malform ations (B) usually present in infancy. Chiari III malformations display the most severe displacement of posterior fossa structures and are often associated
with a high cervical or occipital meningocele
A meningomyelocele is virtually always present
A. Chiari I malformation
B. Chiari II malformation
C. Both
D. Neither
A. Chiari I malformation
B. Chiari II malformation
C. Both
D. Neither
Chiari I malformations (A) consist of inferior displacement of the cerebellar
tonsils through the foramen magnum . They usually present in early adulthood. In Chiari II malform ations (B), the caudal displacem ent of the hindbrain is more severe, with beaking of the tectum and medullary kinking often
seen. Myelomeningoceles are virtually always present. Chiari II malform ations (B) usually present in infancy. Chiari III malformations display the most severe displacement of posterior fossa structures and are often associated
with a high cervical or occipital meningocele
Medullary kinking is seen
A. Chiari I malformation
B. Chiari II malformation
C. Both
D. Neither
A. Chiari I malformation
B. Chiari II malformation
C. Both
D. Neither
Chiari I malformations (A) consist of inferior displacement of the cerebellar
tonsils through the foramen magnum . They usually present in early adulthood. In Chiari II malform ations (B), the caudal displacem ent of the hindbrain is more severe, with beaking of the tectum and medullary kinking often
seen. Myelomeningoceles are virtually always present. Chiari II malform ations (B) usually present in infancy. Chiari III malformations display the most severe displacement of posterior fossa structures and are often associated
with a high cervical or occipital meningocele
Occipital or high cervical encephalocele is present
A. Chiari I malformation
B. Chiari II malformation
C. Both
D. Neither
A. Chiari I malformation
B. Chiari II malformation
C. Both
D. Neither
Chiari I malformations (A) consist of inferior displacement of the cerebellar
tonsils through the foramen magnum . They usually present in early adulthood. In Chiari II malform ations (B), the caudal displacem ent of the hindbrain is more severe, with beaking of the tectum and medullary kinking often
seen. Myelomeningoceles are virtually always present. Chiari II malform ations (B) usually present in infancy. Chiari III malformations display the most severe displacement of posterior fossa structures and are often associated
with a high cervical or occipital meningocele
Usually presents in young adulthood
A. Chiari I malformation
B. Chiari II malformation
C. Both
D. Neither
A. Chiari I malformation
B. Chiari II malformation
C. Both
D. Neither
Chiari I malformations (A) consist of inferior displacement of the cerebellar
tonsils through the foramen magnum . They usually present in early adulthood. In Chiari II malform ations (B), the caudal displacem ent of the hindbrain is more severe, with beaking of the tectum and medullary kinking often
seen. Myelomeningoceles are virtually always present. Chiari II malform ations (B) usually present in infancy. Chiari III malformations display the most severe displacement of posterior fossa structures and are often associated
with a high cervical or occipital meningocele
The term bovine arch refers to
A. Bi-innom inate arteries
B. Left common carotid artery origin from the aortic arch
C. Left common carotid artery origin from the right brachiocephalic trunk
D. Right aortic arch
E. Right subclavian artery distal to the left subclavian artery
A. Bi-innom inate arteries
B. Left common carotid artery origin from the aortic arch
C. Left common carotid artery origin from the right brachiocephalic trunk
D. Right aortic arch
E. Right subclavian artery distal to the left subclavian artery
The left common carotid artery usually arises from the aortic arch distal to
the right brachiocephalic artery. In the bovine arch variant, the left common
carotid artery arises from the proxim al right brachiocephalic artery (C).
The presence of bi-innominate arteries (A) is rare. A right aortic arch (D) may be incidental or associated w ith congenital heart disease. A right subclavian artery take-off distal to the left subclavian artery (E) is associated with Downʼs syndrome.
The differential diagnosis of colpocephaly, or dilatation of the posterior portion of the lateral ventricles, includes
I. Agenesis of the corpus callosum
II. Leigh’s disease
III. Periventricular leukom alacia
IV. Pantothenate kinase-associated neurodegeneration
A. I, II, III
B. I, III
C. II, IV
D. IV
E. All of the above
A. I, II, III
B. I, III
C. II, IV
D. IV
E. All of the above
Agenesis of the corpus callosum (I) and periventricular leukom alacia (III)
can both result in colpocephaly. Leigh’s disease (II) and pantothenate kinase associated neurodegeneration (form erly Hallervorden-Spatz disease [IV]) can both cause symmetric lesions of the globus pallidus but are not associated with colpocephaly
Schizencephaly is essentially a
A. Demyelinating illness
B. Disease that first develops in the elderly
C. Disorder of neuronal migration
D. Neurodegenerative disorder
E. Psychiatric disorder
A. Demyelinating illness
B. Disease that first develops in the elderly
C. Disorder of neuronal migration
D. Neurodegenerative disorder
E. Psychiatric disorder
The cleft of schizencephaly can be unilateral or bilateral, but it usually involves the region near the central sulcus. Patients can present w ith seizures
or focal deficits. It is a disorder of neuronal migration (C)
The differential diagnosis of optic nerve thickening includes
I. Optic nerve sheath meningioma
II. Orbital pseudotumor
III. Optic nerve glioma
IV. Graves’ disease
A. I, II, III
B. I, III
C. II, IV
D. IV
E. All of the above
A. I, II, III
B. I, III
C. II, IV
D. IV
E. All of the above
Optic nerve thickening may be caused by nonneoplastic processes like Graves’
disease (IV), orbital pseudotum or (II), optic neuritis, papilledema, and
vascular malformations, or by tumors like gliomas (III), meningiomas (I),
lymphomas, leukemia, and metastases
The most common primary benign tumor of the adult orbit is (a)
A. Cavernous hemangioma
B. Dermoid cyst
C. Lymphangioma
D. Optic nerve glioma
E. Sarcoidosis
A. Cavernous hemangioma
B. Dermoid cyst
C. Lymphangioma
D. Optic nerve glioma
E. Sarcoidosis
Cavernous hemangiom as (A) of the orbit are usually well-demarcated, vascular, intraconal lesions with smooth or lobulated borders
Which of the following is a branch of the ophthalmic artery?
A. Anterior ethmoidal artery
B. Posterior ethmoidal artery
C. Both
D. Neither
A. Anterior ethmoidal artery
B. Posterior ethmoidal artery
C. Both
D. Neither
The ethmoidal arteries (C) are branches of the ophthalmic artery. They supply a portion of the anterior cranial fossa and the mucosa of the nasal
septum . During embolization of the internal maxillary artery, dangerous potential anastomoses from the sphenopalatine branches of the internal
maxillary artery to branches of the ophthalmic artery may be present.
Which of the following sets of findings on a lumbar MRI scan performed immediately after contrast injection is most characteristic of a recurrent disk herniation and epidural fibrosis, respectively?
A. A rim of enhancement in the recurrent disk, diffuse enhancement in the
fibrosis
B. A rim of enhancement in the fibrosis, di use enhancement in the recurrent
disk
C. A rim of enhancement in the recurrent disk, no enhancement in the fibrosis
D. Diffuse enhancement in the recurrent disk, no enhancement in the fibrosis
E. No enhancement of either the recurrent disk or fibrosis
A. A rim of enhancement in the recurrent disk, diffuse enhancement in the
fibrosis
B. A rim of enhancement in the fibrosis, di use enhancement in the recurrent
disk
C. A rim of enhancement in the recurrent disk, no enhancement in the fibrosis
D. Diffuse enhancement in the recurrent disk, no enhancement in the fibrosis
E. No enhancement of either the recurrent disk or fibrosis
Scar tissue contains vascular granulation tissue that enhances more diffusely
than a residual or recurrent disk
Lesions in diffuse axonal injury are commonly found in the
I. Corpus callosum
II. Gray-white junction
III. Rostral brainstem
IV. Temporal lobe
A. I, II, III
B. I, III
C. II, IV
D. IV
E. All of the above
A. I, II, III
B. I, III
C. II, IV
D. IV
E. All of the above
Lesions in diffuse axonal injury are commonly found in the corpus callosum, gray-white junction, and rostral brainstem .
Acute subarachnoid hemorrhage is more difficult to diagnose on T1- and T2-
weighted MRI sequences than on computed tomography (CT) because
A. Extracellular methemoglobin is isointense on T1 and T2
B. Hem osiderin is isointense on T1 and T2
C. Most radiologists are not familiar with the appearance of acute subarachnoid hemorrhage on MRI
D. The high oxygen tension in the subarachnoid space prevents conversion of oxyhemoglobin to deoxyhemoglobin
E. The low oxygen tension in the subarachnoid space prevents conversion of deoxyhemoglobin to oxyhemoglobin
A. Extracellular methemoglobin is isointense on T1 and T2
B. Hem osiderin is isointense on T1 and T2
C. Most radiologists are not familiar with the appearance of acute subarachnoid hemorrhage on MRI
D. The high oxygen tension in the subarachnoid space prevents conversion of oxyhemoglobin to deoxyhemoglobin
E. The low oxygen tension in the subarachnoid space prevents conversion of deoxyhemoglobin to oxyhemoglobin
Acute subarachnoid hem orrhage is m ore di cult to diagnose on MRI than computed tomography (CT) because the high oxygen tension in the subarachnoid space prevents the conversion of oxyhemoglobin to deoxyhemoglobin (D). Hyperacute-appearing blood containing oxyhemoglobin appears isointense on T1 and hyperintense on T2, similar to cerebrospinalfluid
(CSF) signal. Susceptibility weighted images, such as gradient echo sequences,
are quite sensitive for blood products in all stages, however.
Which of the following is true of the choroidal blush?
A. It is an indicator of the choroidal plexus in the lateral ventricle.
B. It is best seen on the anteroposterior projection.
C. It is from the posterior ethmoidal branches of the ophthalmic artery.
D. Its configuration is usually a thin, dense crescent.
E. Its presence usually indicates an elevated intraocular pressure.
A. It is an indicator of the choroidal plexus in the lateral ventricle.
B. It is best seen on the anteroposterior projection.
C. It is from the posterior ethmoidal branches of the ophthalmic artery.
D. Its configuration is usually a thin, dense crescent.
E. Its presence usually indicates an elevated intraocular pressure.
The choroidal blush signifies the choroidal plexus of the eye (A is false) and
is supplied by the ciliary branches of the ophthalmic artery (C is false). It is
characteristically seen as a thin crescent on the lateral projection (B is false)
of the internal carotid angiogram . Its absence (E is false) can be an indirect
sign of elevated intraorbital or intraocular pressure
The m ost likely etiology of this neonate’s pathology is
A. Astrocytom a
B. Metastatic tum or
C. Staphylococcus aureus
D. Citrobacter
A. Astrocytom a
B. Metastatic tum or
C. Staphylococcus aureus
D. Citrobacter
Large neonatal brain abscesses are usually caused by Citrobacter (D), Bacteroides, Proteus, and various gram -negative bacilli
A. Eosinophilic granuloma
B. Epidermoid cyst
C. Fibrous dysplasia
D. Hemangioma
E. Multiple myeloma
F. Osteoma
A. Eosinophilic granuloma
B. Epidermoid cyst
C. Fibrous dysplasia
D. Hemangioma
E. Multiple myeloma
F. Osteoma
Sclerosis and thickening of the left orbit is present in this X-ray of a patient
with fibrous dysplasia (C)
A. Eosinophilic granuloma
B. Epidermoid cyst
C. Fibrous dysplasia
D. Hemangioma
E. Multiple myeloma
F. Osteoma
A. Eosinophilic granuloma
B. Epidermoid cyst
C. Fibrous dysplasia
D. Hemangioma
E. Multiple myeloma
F. Osteoma
A discrete radiolucent area is seen that does not have sclerotic margins, consistent with eosinophilic granuloma (A)
A. Eosinophilic granuloma
B. Epidermoid cyst
C. Fibrous dysplasia
D. Hemangioma
E. Multiple myeloma
F. Osteoma
A. Eosinophilic granuloma
B. Epidermoid cyst
C. Fibrous dysplasia
D. Hemangioma
E. Multiple myeloma
F. Osteoma
The honeycomb or sunburst pattern is characteristic of a calvarial hemangioma (D)
A. Eosinophilic granuloma
B. Epidermoid cyst
C. Fibrous dysplasia
D. Hemangioma
E. Multiple myeloma
F. Osteoma
A. Eosinophilic granuloma
B. Epidermoid cyst
C. Fibrous dysplasia
D. Hemangioma
E. Multiple myeloma
F. Osteoma
A discrete high-density lesion with smooth contours is seen, most consistent
with osteoma (F)
A. Eosinophilic granuloma
B. Epidermoid cyst
C. Fibrous dysplasia
D. Hemangioma
E. Multiple myeloma
F. Osteoma
A. Eosinophilic granuloma
B. Epidermoid cyst
C. Fibrous dysplasia
D. Hemangioma
E. Multiple myeloma
F. Osteoma
Multiple round discrete punched-out lesions are characteristic of multiple myeloma (E).
A. Eosinophilic granuloma
B. Epidermoid cyst
C. Fibrous dysplasia
D. Hemangioma
E. Multiple myeloma
F. Osteoma
A. Eosinophilic granuloma
B. Epidermoid cyst
C. Fibrous dysplasia
D. Hemangioma
E. Multiple myeloma
F. Osteoma
The scalloped border and sclerotic rim are characteristic of a skull epidermoid (B)
A. Hemangioblastoma
B. Juvenile pilocytic astrocytoma
C. Cysticercosis
D. Medulloblastoma
A. Hemangioblastoma
B. Juvenile pilocytic astrocytoma
C. Cysticercosis
D. Medulloblastoma
The smooth and thin-walled intraventricular cyst w ith a mural nodule is classic for cysticercosis
A. Fetal origin of the posterior cerebral artery
B. Moyamoya disease
C. Persistent acoustic artery
D. Persistent hypoglossal artery
E. Persistent trigeminal artery
A. Fetal origin of the posterior cerebral artery
B. Moyamoya disease
C. Persistent acoustic artery
D. Persistent hypoglossal artery
E. Persistent trigeminal artery
A fetal origin of the posterior cerebral artery (A) from the internal carotid circulation is seen in 20% of anatomical dissections
A. Corpus callosum lipoma
B. Craniopharyngioma
C. Giant aneurysm
D. Glioblastoma multiforme
E. Growing skull fracture
A. Corpus callosum lipoma
B. Craniopharyngioma
C. Giant aneurysm
D. Glioblastoma multiforme
E. Growing skull fracture
Peripheral calcification is noted in this curvilinear lipoma of the corpus callosum (A)
A. Cysticercosis
B. Infarct
C. Low-grade astrocytoma
D. Mycotic aneurysm
E. Neurocytoma
A. Cysticercosis
B. Infarct
C. Low-grade astrocytoma
D. Mycotic aneurysm
E. Neurocytoma
A small ring-enhancing lesion surrounded by a zone of low density is typical
of cysticercosis (A)
A. Multifocal glioblastoma multiforme (GBM)
B. Multiple sclerosis
C. Metastatic carcinoma
D. Neurocytoma
E. Tuberous sclerosis
A. Multifocal glioblastoma multiforme (GBM)
B. Multiple sclerosis
C. Metastatic carcinoma
D. Neurocytoma
E. Tuberous sclerosis
Shown are multiple calcified subependymal tubers of tuberous sclerosis (E).
The appearance of these hamartomatous lesions in the subependymal region
is sometimes referred to as “candle guttering.”
A. Ganglioglioma
B. S. aureus
C. Herpes simplex virus
D. Lymphoma
A. Ganglioglioma
B. S. aureus
C. Herpes simplex virus
D. Lymphoma
The inflammation of the mesial temporal lobe w ith diffuse edema is most characteristic of herpes encephalitis (C). There is often associated hemorrhage.
A. Aqueductal stenosis
B. Brainstem astrocytoma
C. Chiari malformation
D. Pituitary tumor
E. Polymicrogyria
A. Aqueductal stenosis
B. Brainstem astrocytoma
C. Chiari malformation
D. Pituitary tumor
E. Polymicrogyria
An expansile lesion of the pons is seen m ost consistently w ith pontine gliom a (brainstem astrocytom a [B])
This patient is most likely to present with
A. Congestive heart failure
B. Fever and chills
C. Headaches
D. Hemiparesis
E. Subarachnoid hemorrhage
A. Congestive heart failure
B. Fever and chills
C. Headaches
D. Hemiparesis
E. Subarachnoid hemorrhage
The signal intensity of colloid cysts is variable on either T1- or T2-weighted
MRI. Short T1 values (hyperintense im ages) reflect proteinaceous material.
These masses arise from the anterior roof of the third ventricle
A. Arteriovenous malformation (AVM)
B. Cavernous hemangioma
C. GBM
D. Metastatic carcinoma
E. Tuberculoma
A. Arteriovenous malformation (AVM)
B. Cavernous hemangioma
C. GBM
D. Metastatic carcinoma
E. Tuberculoma
The dark halo of decreased signal is caused by iron in hemosiderin in this T2-weighted MRI. This is an almost diagnostic image of a cavernous hemangiom a (i.e., cavernous malformation [B])
A. Astrocytoma
B. Chiari malformation
C. Diskitis
D. Metastatic disease
E. Syringomyelia
A. Astrocytoma
B. Chiari malformation
C. Diskitis
D. Metastatic disease
E. Syringomyelia
The diffuse fusiform widening of the cord with variable signal intensity is consistent with a diffuse or fibrillary astrocytoma (A).
Associated with all but
A. Renal cell carcinoma
B. Ash-leaf macules
C. Shagreen patches
D. Cardiac rhabdomyoma
A. Renal cell carcinoma
B. Ash-leaf macules
C. Shagreen patches
D. Cardiac rhabdomyoma
The enhancing intraventricular mass near the foramen of Monro is a subependymal giant-cell astrocytoma that is associated w ith tuberous sclerosis. The right ventricular calcified mass is a subependymal tuber. Renal cell
carcinom a (A) is associated w ith von Hippel-Lindau syndrome, not tuberous
sclerosis. The other options listed are associated with tuberous sclerosis
A. Astrocytoma
B. Ependymoma
C. Meningioma
D. Myelomeningocele
E. Tuberculosis
A. Astrocytoma
B. Ependymoma
C. Meningioma
D. Myelomeningocele
E. Tuberculosis
The discrete lobulated appearance of the myxopapillary ependymoma (B)
is illustrated. These tumors originate from the conus medullaris or filum terminale.
A. Aneurysmal bone cyst
B. Hemangioma
C. Metastatic disease
D. Osteomyelitis
E. Radiation change
A. Aneurysmal bone cyst
B. Hemangioma
C. Metastatic disease
D. Osteomyelitis
E. Radiation change
The typical polka dot, or salt-and-pepper, appearance of a hemangioma (B)
of the vertebral body is seen.
The most appropriate treatment for a patient with multiple ischemic events and the accompanying angiogram is
A. Carotid endarterectomy
B. Encephalomyosynangiosis
C. Heparinization
D. Superficial temporal artery to middle cerebral artery bypass
E. No treatment
A. Carotid endarterectomy
B. Encephalomyosynangiosis
C. Heparinization
D. Superficial temporal artery to middle cerebral artery bypass
E. No treatment
The angiogram illustrates a carotid dissection. The internal carotid gradually tapers distal to its origin: the “string sign.
A. AVM
B. Low-grade astrocytoma
C. Multiple sclerosis
D. Normal CT
E. Sagittal sinus thrombosis
A. AVM
B. Low-grade astrocytoma
C. Multiple sclerosis
D. Normal CT
E. Sagittal sinus thrombosis
This contrast CT scan illustrates the “empty delta sign” suggestive of sagittal sinus thrombosis (E). The triangle develops because of enhancement of vascular channels around the occluded sinus.
A. Astrocytoma
B. Arachnoid cyst
C. Abscess
D. Metastatic tumor
A. Astrocytoma
B. Arachnoid cyst
C. Abscess
D. Metastatic tumor
This low-intensity extra-axial mass without surrounding edema is consistent
with an arachnoid cyst (B). The most common location is the middle fossa.
A patient w ith low back pain only and the accompanying radiograph should
undergo (a)
A. CT-guided biopsy
B. Metastatic workup
C. Multilevel decom pressive lam inectomy
D. Radiation therapy
E. Serum antigen testing
A. CT-guided biopsy
B. Metastatic workup
C. Multilevel decom pressive lam inectomy
D. Radiation therapy
E. Serum antigen testing
The radiograph shows the classic “bamboo spine” con guration of ankylosing spondylitis. Although HLA-B27 testing is indicated, the results should be
interpreted with caution. Although 90% of patients with clinical ankylosing spondylitis are HLA-B27 positive, , 2% of HLA-B27 patients eventually develop ankylosing spondylitis.
A. Calcified disk herniation
B. Epidural hematoma
C. Meningioma
D. Metastatic tumor
E. Ossification of the posterior longitudinal ligament
A. Calcified disk herniation
B. Epidural hematoma
C. Meningioma
D. Metastatic tumor
E. Ossification of the posterior longitudinal ligament
Ossification of the posterior longitudinal ligament (E) is a common cause of cervical myelopathy in patients of Asian descent. Fibrosis and hyperplasia
develop initially, followed by calcification. The ossification may be diffuse or
localized and may involve the dura
A. Disk herniation
B. Diskitis
C. Ependymoma
D. Meningioma
E. Metastatic tumor
A. Disk herniation
B. Diskitis
C. Ependymoma
D. Meningioma
E. Metastatic tumor
This postmyelogram CT illustrates a right-sided, partially calcified herniated disk (A)
A. Astrocytoma
B. Diastematomyelia
C. Ependymoma
D. Lipoma
E. Meningioma
A. Astrocytoma
B. Diastematomyelia
C. Ependymoma
D. Lipoma
E. Meningioma
The split cord malformation (diastematomyelia [B]) and cartilaginous septum
can be seen. Patients may present with signs of a tethered cord or kyphoscoliosis.
A. Craniopharyngioma
B. Chordoma
C. Pituitary adenoma
D. Rathke’s cleft cyst
A. Craniopharyngioma
B. Chordoma
C. Pituitary adenoma
D. Rathke’s cleft cyst
This pituitary adenom a (C) lls and expands the sella and also extends to
the suprasellar space. Craniopharyngiom as (A) are more likely to be mainly
suprasellar. Rathke’s cleft cysts (D) should be cystic and are not usually this
large with upward extension (though they m ay be). Chordom as (B) usually
involve m ore bony invasion of the clivus.
A. Arachnoid cyst
B. Dandy-Walker malformation
C. Epidermoid cyst
D. Porencephaly
E. Vein of Galen aneurysm
A. Arachnoid cyst
B. Dandy-Walker malformation
C. Epidermoid cyst
D. Porencephaly
E. Vein of Galen aneurysm
A hypoplastic verm is, high transverse sinus, and cystic dilatation of the fourth
ventricle are characteristic of the Dandy-Walker malformation (B).
A. Arachnoid cyst
B. Ependymoma
C. Lipomyelomeningocele
D. Meningioma
E. Neurenteric cyst
A. Arachnoid cyst
B. Ependymoma
C. Lipomyelomeningocele
D. Meningioma
E. Neurenteric cyst
A subcutaneous lipoma that extends into the low -lying tethered spinal cord is seen.
The patient whose myelogram is shown probably
A. Has developmental cysts
B. Has multiple café-au-lait lesions
C. Is asymptomatic
D. Was recently diagnosed with lung cancer
E. Was thrown from a motorcycle
A. Has developmental cysts
B. Has multiple café-au-lait lesions
C. Is asymptomatic
D. Was recently diagnosed with lung cancer
E. Was thrown from a motorcycle
The classic appearance of pseudomeningoceles from lower cervical nerve root
avulsion is seen in this myelogram
A. AVM
B. Carotid occlusion
C. Dural AVM
D. Meningioma
E. Moyamoya disease
A. AVM
B. Carotid occlusion
C. Dural AVM
D. Meningioma
E. Moyamoya disease
This lateral phase angiogram shows the tum or blush of a meningioma (D),
with a prominent contribution from the tentorial artery
Most possible diagnosis
A. Glioblastoma
B. Lymphoma
C. Fahr’s disease
D. Herpes simplex virus
A. Glioblastoma
B. Lymphoma
C. Fahr’s disease
D. Herpes simplex virus
Bilateral periventricular enhancing masses are most consistent with lymphoma (B). They usually enhance quite brightly. Fahr’s disease (C) is
idiopathic basal ganglia calcification and should be low -intensit y on MRI.
Herpes simplex virus (HSV [D]) infection usually involves the temporal lobes. Glioblastoma (A) m ay be multicentric, but this picture is most likely
a lymphoma
A. Disk herniation
B. Epidural abscess
C. Meningioma
D. Metastatic disease
E. Radiation change
A. Disk herniation
B. Epidural abscess
C. Meningioma
D. Metastatic disease
E. Radiation change
An epidural infection (B) is iso- or hypointense to the cord on T1-weighted MRI and hyperintense on T2-weighted and proton density unenhanced MRIs.
With contrast, the solid portion of the abscess or the periphery of a liquid collection enhances
The lesion shown is associated with
A. Ehlers-Danlos disease
B. Endocarditis
C. Fibromuscular dysplasia
D. Radiation therapy
E. Renal cysts
A. Ehlers-Danlos disease
B. Endocarditis
C. Fibromuscular dysplasia
D. Radiation therapy
E. Renal cysts
Cerebellar hem angioblastom as (tum or blush is seen in this arterial phase) are
associated w ith renal cysts (E) and pancreatic cysts.
A. Dural AVM
B. Moyamoya disease
C. Sagittal sinus thrombosis
D. Subdural hematoma
E. Vein of Galen malformation
A. Dural AVM
B. Moyamoya disease
C. Sagittal sinus thrombosis
D. Subdural hematoma
E. Vein of Galen malformation
Lateral basilar artery angiogram shows early lling of the vein of Galen. Vein of Galen malformations (E) usually present with high-output cardiac failure in the neonate. They also may present with hydrocephalus in the infant, or subarachnoid hemorrhage, epilepsy, or mental retardation in the older child (or adult)
A. Chordoma
B. Diskitis
C. Metastatic disease
D. Neurofibroma
E. Normal lumbosacral radiograph
A. Chordoma
B. Diskitis
C. Metastatic disease
D. Neurofibroma
E. Normal lumbosacral radiograph
Erosion of the inferior anterior L2 end plate is noted. Plain film abnormalities
in diskitis (B) may not become evident for weeks. They include irregularities
of the end plate, loss of disk space height, and bony sclerosis
A. Human immunodeficiency virus (HIV)
B. Glioma
C. Rapid correction of hyponatremia
D. Methotrexate toxicity
A. Human immunodeficiency virus (HIV)
B. Glioma
C. Rapid correction of hyponatremia
D. Methotrexate toxicity
Central pontine myelinolysis is associated w ith the rapid correction of hyponatrem ia (C) and usually occurs in malnourished or alcoholic patients.
The etiology of the process shown is
A. Developmental
B. Iatrogenic
C. Infectious
D. Neoplastic
E. Traumatic
A. Developmental
B. Iatrogenic
C. Infectious
D. Neoplastic
E. Traumatic
This T2-weighted axial MRI shows the split cord of diastematomyelia, a developmental (A) condition.
A. AVM
B. Fusiform aneurysm
C. Misplaced shunt catheter
D. Schizencephaly
E. Venous malformation
A. AVM
B. Fusiform aneurysm
C. Misplaced shunt catheter
D. Schizencephaly
E. Venous malformation
A linear or curvilinear structure with a nidus from which emanates numerous small veins is the typical MRI appearance of a venous angiom a (E)
(i.e., developmental venous anomaly). The angiographic appearance is that of
a caput medusae.
This 8-year-old boy who presented with headaches, nausea, and vomiting is
m ost likely to have a(n)
A. Astrocytoma
B. Dandy-Walker cyst
C. Hem angioblastoma
D. Medulloblastoma
E. Metastatic tumor
A. Astrocytoma
B. Dandy-Walker cyst
C. Hem angioblastoma
D. Medulloblastoma
E. Metastatic tumor
The brightly enhancing mural nodule in a large cyst is the typical appearance of the juvenile pilocytic astrocytom a (A) in this age group. A cerebellar hemangioblastom a (C), w hich would be m ore common in an adult, m ay also
have this appearance on MRI.
A. Acoustic neuroma
B. Chordoma
C. Giant-cell tumor
D. Glomus jugulare
E. Meningioma
A. Acoustic neuroma
B. Chordoma
C. Giant-cell tumor
D. Glomus jugulare
E. Meningioma
The heterogeneous “salt-and-pepper” appearance of the glomus jugulare (D)
tumor is appreciated. These relatively rare tumors arise from rests of paraganglionic tissue along the jugular bulb. Glomus tympanicum tumors occur
in the middle ear.
A. No intervening normal brain
B. Usually multiple
C. Often associated with cavernous malformation
D. Frequently hemorrhage
A. No intervening normal brain
B. Usually multiple
C. Often associated with cavernous malformation
D. Frequently hemorrhage
Venous malform ations (developmental venous anomalies) consist of a large draining cortical vein receiving a collection of medullary veins (caput
medusae). There usually is intervening normal brain (A is false), unlike w ith
arteriovenous malformations (AVMs) and capillary telangiectasias. They
are usually single (B is false), unlike capillary telangiectasias. They rarely
hem orrhage (D is false) and are often found in association with cavernous malformations (C).
Structure 1
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Term inal vein
G. Thalam ostriate vein
H. Vein of Galen
I. Venous angle
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Term inal vein
G. Thalam ostriate vein
H. Vein of Galen
I. Venous angle
Structure 2
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Term inal vein
G. Thalam ostriate vein
H. Vein of Galen
I. Venous angle
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Term inal vein
G. Thalam ostriate vein
H. Vein of Galen
I. Venous angle
Structure 3
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Term inal vein
G. Thalam ostriate vein
H. Vein of Galen
I. Venous angle
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Terminal vein
G. Thalamostriate vein
H. Vein of Galen
I. Venous angle
Structure 4
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Term inal vein
G. Thalam ostriate vein
H. Vein of Galen
I. Venous angle
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Terminal vein
G. Thalamostriate vein
H. Vein of Galen
I. Venous angle
Structure 5
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Term inal vein
G. Thalam ostriate vein
H. Vein of Galen
I. Venous angle
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Terminal vein
G. Thalamostriate vein
H. Vein of Galen
I. Venous angle
Structure 6
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Term inal vein
G. Thalam ostriate vein
H. Vein of Galen
I. Venous angle
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Terminal vein
G. Thalamostriate vein
H. Vein of Galen
I. Venous angle
Structure 7
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Term inal vein
G. Thalam ostriate vein
H. Vein of Galen
I. Venous angle
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Terminal vein
G. Thalamostriate vein
H. Vein of Galen
I. Venous angle
Structure 8
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Term inal vein
G. Thalam ostriate vein
H. Vein of Galen
I. Venous angle
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Terminal vein
G. Thalamostriate vein
H. Vein of Galen
I. Venous angle
Structure 9
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Term inal vein
G. Thalam ostriate vein
H. Vein of Galen
I. Venous angle
A. Anterior caudate vein
B. Atrial vein
C. Basal vein of Rosenthal
D. Internal cerebral vein
E. Septal vein
F. Terminal vein
G. Thalamostriate vein
H. Vein of Galen
I. Venous angle
A. Hemangioblastoma
B. Lymphoma
C. Meningioma
D. Myxopapillary ependymoma
E. Schwannoma
A. Hemangioblastoma
B. Lymphoma
C. Meningioma
D. Myxopapillary ependymoma
E. Schwannoma
This sagittal MRI shows a dural-based mass most consistent with meningioma (C). Large schwannom as (E) usually show more heterogeneous contrast
enhancement.
The axial postcontrast MRI shown was obtained in a patient with
A. Acquired immunodeficiency syndrome (AIDS)
B. Chiari malformation
C. Disk disease
D. Neurofibromatosis
E. Severe spinal cord trauma
A. Acquired immunodeficiency syndrome (AIDS)
B. Chiari malformation
C. Disk disease
D. Neurofibromatosis
E. Severe spinal cord trauma
Cytom egalovirus (CMV) is a frequent cause of polyradiculitis and myelitis in patients with acquired immunodeficiency syndrom e (AIDS [A]). The pial enhancement seen is characteristic of this condition.
Most possible dagnosis
A. Giant-cell tumor
B. Osteoblastom a
C. Aneurysm al bone cyst
D. Osteoid osteoma
A. Giant-cell tumor
B. Osteoblastom a
C. Aneurysm al bone cyst
D. Osteoid osteoma
The lytic lesion with surrounding sclerosis and a central nidus is classic for
osteoid osteoma (D). These usually present w ith pain that resolves with aspirin
This postcontrast T1-weighted MRI illustrates
A. Abscesses
B. Gliomatosis cerebri
C. Metastatic disease
D. Multiple infarcts
E. Neurofibromatosis type 2
A. Abscesses
B. Gliomatosis cerebri
C. Metastatic disease
D. Multiple infarcts
E. Neurofibromatosis type 2
The bilateral acoustic neurom as and multiple meningiomas are consistent
with neurofibromatosis type 2 (E).
This postcontrast T1-weighted MRI illustrates a(n)
A. Aneurysm
B. Colloid cyst
C. GBM
D. Meningioma
E. Metastasis
A. Aneurysm
B. Colloid cyst
C. GBM
D. Meningioma
E. Metastasis
A parafalcine meningiom a (D) is shown
A. Abscess
B. Artifact
C. Hemangioblastoma
D. Infarct
E. Metastasis
A. Abscess
B. Artifact
C. Hemangioblastoma
D. Infarct
E. Metastasis
A gyriform pattern of contrast enhancem ent in the distribution of the left
anterior cerebral artery (ACA) is suggestive of subacute infarction
A. Aneurysm
B. AVM
C. Infarct
D. Normal angiogram
E. Persistent trigeminal artery
A. Aneurysm
B. AVM
C. Infarct
D. Normal angiogram
E. Persistent trigeminal artery
The central sulcus artery (branch of the middle cerebral artery) is not filling
on this lateral ICA injection angiogram . These findings are consistent w ith ischemic infarction
Which statement is true regarding the fracture seen here?
A. Type II fracture
B. Usually requires surgery
C. Requires traction
D. Treated with external orthosis
A. Type II fracture
B. Usually requires surgery
C. Requires traction
D. Treated with external orthosis
Type III odontoid fractures usually heal well w ith an external orthosis (D)
(e.g., halo, Som i, Minerva). Type II fractures (A) w ill m ore often require surgical stabilization, especially if there are more than 6 m m of displacem ent
A. Abscess
B. Lymphoma
C. Multiple sclerosis
D. Periventricular leukom alacia
E. Tuberous sclerosis
A. Abscess
B. Lymphoma
C. Multiple sclerosis
D. Periventricular leukom alacia
E. Tuberous sclerosis
Periventricular involvement by primary central nervous system lymphomas
(B) is common.
A. Acute infarction
B. Chronic subdural hematoma
C. Epidermoid cyst
D. Intracranial hypotension
E. Sturge-Weber syndrome
A. Acute infarction
B. Chronic subdural hematoma
C. Epidermoid cyst
D. Intracranial hypotension
E. Sturge-Weber syndrome
The layer of enhancem ent covering the hypoplastic right hem isphere represents the m eningeal angiom a on this postcontrast coronal MRI
The image seen here is an example of
A. Ankylosing spondylitis
B. Diffuse idiopathic skeletal hyperostosis
C. No pathologic process is present
D. Osteoporosis
E. Vertebral osteopetrosis
A. Ankylosing spondylitis
B. Diffuse idiopathic skeletal hyperostosis
C. No pathologic process is present
D. Osteoporosis
E. Vertebral osteopetrosis
This sagit tal CT scan shows an example of vertebral osteopetrosis (E), a process
characterized by de cient osteoclastic reabsorption leading to increased
bone mineral density. Di use sclerosis and cort ical thickening are seen here.
The other choices are incorrect.
The structure seen here most likely represents
A. Atrial vein
B. Internal cerebral vein
C. Median prosencephalic vein
D. Straight sinus
E. Vein of Galen
A. Atrial vein
B. Internal cerebral vein
C. Median prosencephalic vein
D. Straight sinus
E. Vein of Galen
This lateral angiogram shows an example of a vein of Galen malformation,
a type of arteriovenous stula that usually presents during childhood. The
arrow is pointing to a persistent median prosencephalic vein (C), the preservation
of which may be the underlying mechanism of the stula. The arrow is
pointed at a location too distal for the structure to represent an atrial vein (A),
the internal cerebral vein (B), or the vein of Galen (E). The straight sinus
(D) would be at the level of the tentorium; this structure is clearly above the
tentorium.12
The images seen here are consistent with which of the following?
A. Agenesis of the corpus callosum
B. Colpocephaly
C. Septo-optic dysplasia
D. All of the above
E. None of the above
A. Agenesis of the corpus callosum
B. Colpocephaly
C. Septo-optic dysplasia
D. All of the above
E. None of the above
The MRI images shown here demonst rate septo-optic dysplasia (C). This
condition is considered by some to represent the mildest form of holoprosencephaly.
There is absence of the septum pellucidum and hypoplasia of the
optic nerves. The absence of the septum pellucidum gives the box-shaped
con guration to the ventricles (colpocephaly [B]). This pat ient also has agenesis
of the corpus callosum (A), contributing to the parallel con guration of
the vent ricles. The correct answer is D, all of the above
The following image is most consistent with
A. Arachnoid cyst
B. Epidermoid
C. Lipoma
D. Low-grade glioma
E. Meningioma
A. Arachnoid cyst
B. Epidermoid
C. Lipoma
D. Low-grade glioma
E. Meningioma
This postcontrast T1-weighted MRI image shows an example of a cerebellopontine
angle epidermoid cyst (B). An arachnoid cyst (A) would also appear
hypointense on T1; however, this locat ion is more typical for an epidermoid
lesion. A lipoma (C) would appear hyperintense on T1. A low-grade glioma
(D) would be intra-axial, not ext ra-axial. A meningioma (E) would m ost likely
show homogenous enhancement on this postcontrast image
Which of the following is (are) true of the lesion seen here?
A. Associated with cortical dysplasia
B. Contains abnormal neurons and abnormal oligodendrocytes and astrocytes
C. Typically presents with seizures
D. A and C only
E. All of the above
A. Associated with cortical dysplasia
B. Contains abnormal neurons and abnormal oligodendrocytes and astrocytes
C. Typically presents with seizures
D. A and C only
E. All of the above
The lesion seen in this axial MRI is an example of a dysembryoplastic neuroepithelial
tumor (DNET). These lesions usually present with seizures (C) and
are associated with cortical dysplasia (A). The lesion contains abnormal oligodendrocytes
and ast rocytes, but normal neurons (B is false). Ganglioglioma,
not DNET, contains both abnormal neurons and glial cells (B). D is the correct
answer.4,13
