Neuroradiology Flashcards

Question

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

Answer 1

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 ## Footnote 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

Answer 2

A. A1 segment **B. A2 segment** C. Internal carotid artery D. M1 segment E. M2 segment ## Footnote 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.

Answer 3

**A. Diffuse dural enhancement** B. Ependymal enhancement C. Pneumocephalus D. Slitlike ventricles E. Ventriculomegaly ## Footnote 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

Answer 4

A. Calci cation B. Cyst formation **C. Multiple lesions** D. Superficial location E. Temporal lobe location ## Footnote 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).

Answer 5

A. Fourth ventricle **B. Left lateral ventricle** C. Right lateral ventricle D. Third ventricle ## Footnote 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.

Answer 6

**A. Fourth ventricle** B. Left lateral ventricle C. Right lateral ventricle D. Third ventricle ## Footnote Choroid plexus papillomas in the adult population are often found at the caudal aspect of the fourth ventricle (A) and frequently calcify.

Answer 7

**A. Adrenoleukodystrophy** B. Canavan’s disease C. Metachromatic leukodystrophy D. Multiple sclerosis E. Schilder’s disease ## Footnote The lesions of adrenoleukodystrophy (A) are usually symmetrical, begin in the parieto-occipital region, and spread anteriorly

Answer 8

A. Chiari I malformation B. Chiari II malformation **C. Both** D. Neither ## Footnote 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

Answer 9

A. Chiari I malformation **B. Chiari II malformation** C. Both D. Neither ## Footnote 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

Answer 10

A. Chiari I malformation **B. Chiari II malformation** C. Both D. Neither ## Footnote 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

Answer 11

A. Chiari I malformation **B. Chiari II malformation** C. Both D. Neither ## Footnote 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

Answer 12

A. Chiari I malformation B. Chiari II malformation C. Both **D. Neither** ## Footnote 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

Answer 13

**A. Chiari I malformation** B. Chiari II malformation C. Both D. Neither ## Footnote 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

Answer 14

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 ## Footnote 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.

Answer 15

A. I, II, III **B. I, III** C. II, IV D. IV E. All of the above ## Footnote 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

Answer 16

A. Demyelinating illness B. Disease that first develops in the elderly **C. Disorder of neuronal migration** D. Neurodegenerative disorder E. Psychiatric disorder ## Footnote 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)

Answer 17

A. I, II, III B. I, III C. II, IV D. IV **E. All of the above** ## Footnote 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

Answer 18

**A. Cavernous hemangioma** B. Dermoid cyst C. Lymphangioma D. Optic nerve glioma E. Sarcoidosis ## Footnote Cavernous hemangiom as (A) of the orbit are usually well-demarcated, vascular, intraconal lesions with smooth or lobulated borders

Answer 19

A. Anterior ethmoidal artery B. Posterior ethmoidal artery **C. Both** D. Neither ## Footnote 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.

Answer 20

**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 ## Footnote Scar tissue contains vascular granulation tissue that enhances more diffusely than a residual or recurrent disk

Answer 21

**A. I, II, III** B. I, III C. II, IV D. IV E. All of the above ## Footnote Lesions in diffuse axonal injury are commonly found in the corpus callosum, gray-white junction, and rostral brainstem .

Answer 22

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 ## Footnote 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.

Answer 23

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. ## Footnote 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

Answer 24

A. Astrocytom a B. Metastatic tum or C. Staphylococcus aureus **D. Citrobacter** ## Footnote Large neonatal brain abscesses are usually caused by Citrobacter (D), Bacteroides, Proteus, and various gram -negative bacilli

Answer 25

A. Eosinophilic granuloma B. Epidermoid cyst **C. Fibrous dysplasia** D. Hemangioma E. Multiple myeloma F. Osteoma ## Footnote Sclerosis and thickening of the left orbit is present in this X-ray of a patient with fibrous dysplasia (C)

Answer 26

**A. Eosinophilic granuloma** B. Epidermoid cyst C. Fibrous dysplasia D. Hemangioma E. Multiple myeloma F. Osteoma ## Footnote A discrete radiolucent area is seen that does not have sclerotic margins, consistent with eosinophilic granuloma (A)

Answer 27

A. Eosinophilic granuloma B. Epidermoid cyst C. Fibrous dysplasia **D. Hemangioma** E. Multiple myeloma F. Osteoma ## Footnote The honeycomb or sunburst pattern is characteristic of a calvarial hemangioma (D)

Answer 28

A. Eosinophilic granuloma B. Epidermoid cyst C. Fibrous dysplasia D. Hemangioma E. Multiple myeloma **F. Osteoma** ## Footnote A discrete high-density lesion with smooth contours is seen, most consistent with osteoma (F)

Answer 29

A. Eosinophilic granuloma B. Epidermoid cyst C. Fibrous dysplasia D. Hemangioma **E. Multiple myeloma** F. Osteoma ## Footnote Multiple round discrete punched-out lesions are characteristic of multiple myeloma (E).

Answer 30

A. Eosinophilic granuloma **B. Epidermoid cyst** C. Fibrous dysplasia D. Hemangioma E. Multiple myeloma F. Osteoma ## Footnote The scalloped border and sclerotic rim are characteristic of a skull epidermoid (B)

Answer 31

A. Hemangioblastoma B. Juvenile pilocytic astrocytoma **C. Cysticercosis** D. Medulloblastoma ## Footnote The smooth and thin-walled intraventricular cyst w ith a mural nodule is classic for cysticercosis

Answer 32

**A. Fetal origin of the posterior cerebral artery** B. Moyamoya disease C. Persistent acoustic artery D. Persistent hypoglossal artery E. Persistent trigeminal artery ## Footnote A fetal origin of the posterior cerebral artery (A) from the internal carotid circulation is seen in 20% of anatomical dissections

Answer 33

**A. Corpus callosum lipoma** B. Craniopharyngioma C. Giant aneurysm D. Glioblastoma multiforme E. Growing skull fracture ## Footnote Peripheral calcification is noted in this curvilinear lipoma of the corpus callosum (A)

Answer 34

**A. Cysticercosis** B. Infarct C. Low-grade astrocytoma D. Mycotic aneurysm E. Neurocytoma ## Footnote A small ring-enhancing lesion surrounded by a zone of low density is typical of cysticercosis (A)

Answer 35

A. Multifocal glioblastoma multiforme (GBM) B. Multiple sclerosis C. Metastatic carcinoma D. Neurocytoma **E. Tuberous sclerosis** ## Footnote 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.”

Answer 36

A. Ganglioglioma B. S. aureus **C. Herpes simplex virus** D. Lymphoma ## Footnote The inflammation of the mesial temporal lobe w ith diffuse edema is most characteristic of herpes encephalitis (C). There is often associated hemorrhage.

Answer 37

A. Aqueductal stenosis **B. Brainstem astrocytoma** C. Chiari malformation D. Pituitary tumor E. Polymicrogyria ## Footnote An expansile lesion of the pons is seen m ost consistently w ith pontine gliom a (brainstem astrocytom a [B])

Answer 38

A. Congestive heart failure B. Fever and chills **C. Headaches** D. Hemiparesis E. Subarachnoid hemorrhage ## Footnote 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

Answer 39

A. Arteriovenous malformation (AVM) **B. Cavernous hemangioma** C. GBM D. Metastatic carcinoma E. Tuberculoma ## Footnote 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])

Answer 40

**A. Astrocytoma** B. Chiari malformation C. Diskitis D. Metastatic disease E. Syringomyelia ## Footnote The diffuse fusiform widening of the cord with variable signal intensity is consistent with a diffuse or fibrillary astrocytoma (A).

Answer 41

**A. Renal cell carcinoma** B. Ash-leaf macules C. Shagreen patches D. Cardiac rhabdomyoma ## Footnote 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

Answer 42

A. Astrocytoma **B. Ependymoma** C. Meningioma D. Myelomeningocele E. Tuberculosis ## Footnote The discrete lobulated appearance of the myxopapillary ependymoma (B) is illustrated. These tumors originate from the conus medullaris or filum terminale.

Answer 43

A. Aneurysmal bone cyst **B. Hemangioma** C. Metastatic disease D. Osteomyelitis E. Radiation change ## Footnote The typical polka dot, or salt-and-pepper, appearance of a hemangioma (B) of the vertebral body is seen.

Answer 44

A. Carotid endarterectomy B. Encephalomyosynangiosis **C. Heparinization** D. Superficial temporal artery to middle cerebral artery bypass E. No treatment ## Footnote The angiogram illustrates a carotid dissection. The internal carotid gradually tapers distal to its origin: the “string sign.

Answer 45

A. AVM B. Low-grade astrocytoma C. Multiple sclerosis D. Normal CT **E. Sagittal sinus thrombosis** ## Footnote 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.

Answer 46

A. Astrocytoma **B. Arachnoid cyst** C. Abscess D. Metastatic tumor ## Footnote This low-intensity extra-axial mass without surrounding edema is consistent with an arachnoid cyst (B). The most common location is the middle fossa.

Answer 47

A. CT-guided biopsy B. Metastatic workup C. Multilevel decom pressive lam inectomy D. Radiation therapy **E. Serum antigen testing** ## Footnote 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.

Answer 48

A. Calcified disk herniation B. Epidural hematoma C. Meningioma D. Metastatic tumor **E. Ossification of the posterior longitudinal ligament** ## Footnote 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

Answer 49

**A. Disk herniation** B. Diskitis C. Ependymoma D. Meningioma E. Metastatic tumor ## Footnote This postmyelogram CT illustrates a right-sided, partially calcified herniated disk (A)

Answer 50

A. Astrocytoma **B. Diastematomyelia** C. Ependymoma D. Lipoma E. Meningioma ## Footnote The split cord malformation (diastematomyelia [B]) and cartilaginous septum can be seen. Patients may present with signs of a tethered cord or kyphoscoliosis.

Answer 51

A. Craniopharyngioma B. Chordoma **C. Pituitary adenoma** D. Rathke’s cleft cyst ## Footnote 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.

Answer 52

A. Arachnoid cyst **B. Dandy-Walker malformation** C. Epidermoid cyst D. Porencephaly E. Vein of Galen aneurysm ## Footnote A hypoplastic verm is, high transverse sinus, and cystic dilatation of the fourth ventricle are characteristic of the Dandy-Walker malformation (B).

Answer 53

A. Arachnoid cyst B. Ependymoma **C. Lipomyelomeningocele** D. Meningioma E. Neurenteric cyst ## Footnote A subcutaneous lipoma that extends into the low -lying tethered spinal cord is seen.

Answer 54

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** ## Footnote The classic appearance of pseudomeningoceles from lower cervical nerve root avulsion is seen in this myelogram

Answer 55

A. AVM B. Carotid occlusion C. Dural AVM **D. Meningioma** E. Moyamoya disease ## Footnote This lateral phase angiogram shows the tum or blush of a meningioma (D), with a prominent contribution from the tentorial artery

Answer 56

A. Glioblastoma **B. Lymphoma** C. Fahr’s disease D. Herpes simplex virus ## Footnote 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

Answer 57

A. Disk herniation **B. Epidural abscess** C. Meningioma D. Metastatic disease E. Radiation change ## Footnote 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

Answer 58

A. Ehlers-Danlos disease B. Endocarditis C. Fibromuscular dysplasia D. Radiation therapy **E. Renal cysts** ## Footnote Cerebellar hem angioblastom as (tum or blush is seen in this arterial phase) are associated w ith renal cysts (E) and pancreatic cysts.

Answer 59

A. Dural AVM B. Moyamoya disease C. Sagittal sinus thrombosis D. Subdural hematoma **E. Vein of Galen malformation** ## Footnote 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)

Answer 60

A. Chordoma **B. Diskitis** C. Metastatic disease D. Neurofibroma E. Normal lumbosacral radiograph ## Footnote 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

Answer 61

A. Human immunodeficiency virus (HIV) B. Glioma **C. Rapid correction of hyponatremia** D. Methotrexate toxicity ## Footnote Central pontine myelinolysis is associated w ith the rapid correction of hyponatrem ia (C) and usually occurs in malnourished or alcoholic patients.

Answer 62

**A. Developmental** B. Iatrogenic C. Infectious D. Neoplastic E. Traumatic ## Footnote This T2-weighted axial MRI shows the split cord of diastematomyelia, a developmental (A) condition.

Answer 63

A. AVM B. Fusiform aneurysm C. Misplaced shunt catheter D. Schizencephaly **E. Venous malformation** ## Footnote 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.

Answer 64

**A. Astrocytoma** B. Dandy-Walker cyst C. Hem angioblastoma D. Medulloblastoma E. Metastatic tumor ## Footnote 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.

Answer 65

A. Acoustic neuroma B. Chordoma C. Giant-cell tumor **D. Glomus jugulare** E. Meningioma ## Footnote 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.

Answer 66

A. No intervening normal brain B. Usually multiple **C. Often associated with cavernous malformation** D. Frequently hemorrhage ## Footnote 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).

Answer 67

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

Answer 68

**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

Answer 69

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

Answer 70

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

Answer 71

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

Answer 72

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

Answer 73

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

Answer 74

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

Answer 75

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**

Answer 76

A. Hemangioblastoma B. Lymphoma **C. Meningioma** D. Myxopapillary ependymoma E. Schwannoma ## Footnote This sagittal MRI shows a dural-based mass most consistent with meningioma (C). Large schwannom as (E) usually show more heterogeneous contrast enhancement.

Answer 77

**A. Acquired immunodeficiency syndrome (AIDS)** B. Chiari malformation C. Disk disease D. Neurofibromatosis E. Severe spinal cord trauma ## Footnote 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.

Answer 78

A. Giant-cell tumor B. Osteoblastom a C. Aneurysm al bone cyst **D. Osteoid osteoma** ## Footnote 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

Answer 79

A. Abscesses B. Gliomatosis cerebri C. Metastatic disease D. Multiple infarcts **E. Neurofibromatosis type 2** ## Footnote The bilateral acoustic neurom as and multiple meningiomas are consistent with neurofibromatosis type 2 (E).

Answer 80

A. Aneurysm B. Colloid cyst C. GBM **D. Meningioma** E. Metastasis ## Footnote A parafalcine meningiom a (D) is shown

Answer 81

A. Abscess B. Artifact C. Hemangioblastoma **D. Infarct** E. Metastasis ## Footnote A gyriform pattern of contrast enhancem ent in the distribution of the left anterior cerebral artery (ACA) is suggestive of subacute infarction

Answer 82

A. Aneurysm B. AVM **C. Infarct** D. Normal angiogram E. Persistent trigeminal artery ## Footnote 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

Answer 83

A. Type II fracture B. Usually requires surgery C. Requires traction **D. Treated with external orthosis** ## Footnote 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

Answer 84

A. Abscess **B. Lymphoma** C. Multiple sclerosis D. Periventricular leukom alacia E. Tuberous sclerosis ## Footnote Periventricular involvement by primary central nervous system lymphomas (B) is common.

Answer 85

A. Acute infarction B. Chronic subdural hematoma C. Epidermoid cyst D. Intracranial hypotension **E. Sturge-Weber syndrome** ## Footnote The layer of enhancem ent covering the hypoplastic right hem isphere represents the m eningeal angiom a on this postcontrast coronal MRI

Answer 86

A. Has two peaks; involved in storage of membranous phosphoinositides B. Involved in m aintenance of energy system s and often used as a reference **C. Predecessor of brain lipids and participates in coenzym e A interactions** D. Structural component of cell m em branes E. Typical doublet located around 1.32 ppm

Answer 87

A. Has two peaks; involved in storage of membranous phosphoinositides B. Involved in maintenance of energy system s and often used as a reference C. Predecessor of brain lipids and participates in coenzym e A interactions **D. Structural component of cell membranes** E. Typical doublet located around 1.32 ppm

Answer 88

A. Has two peaks; involved in storage of membranous phosphoinositides **B. Involved in maintenance of energy systems and often used as a reference** C. Predecessor of brain lipids and participates in coenzym e A interactions D. Structural component of cell membranes E. Typical doublet located around 1.32 ppm

Answer 89

**A. Has two peaks; involved in storage of membranous phosphoinositides** B. Involved in maintenance of energy systems and often used as a reference C. Predecessor of brain lipids and participates in coenzym e A interactions D. Structural component of cell membranes E. Typical doublet located around 1.32 ppm

Answer 90

A. Has two peaks; involved in storage of membranous phosphoinositides B. Involved in maintenance of energy systems and often used as a reference C. Predecessor of brain lipids and participates in coenzym e A interactions D. Structural component of cell membranes **E. Typical doublet located around 1.32 ppm** ## Footnote N-acetylaspartate (NAA) is typically the most visible peak and occurs at 2 ppm. The NAA peak contains a combination of macromolecules containing N-acetyl groups. NAA is thought to function as a predecessor of brain lipids and participate in coenzyme A interactions (C). The choline peak occurs at 3.21 ppm and is a structural component of cell membranes (D). Choline in healthy membranes may not be detected in the choline peak, but the choline peak increases in situations where membranes are being dest royed (m alignant tumors and degenerative disease). The creatine peak occurs at 3.03 ppm and is involved in the maintenance of energy systems (B). The creat ine peak is thought to be relatively stable, so it is often used as a reference. Myo-inositol (MI) has peaks at 3.56 and 4.06 ppm and is a re ect ion of the storage of membranous phosphoinositides, second messengers of cell membranes (A). MI is located primarily in glial cells. The lactate doublet occurs at 1.32 ppm (E).12

Answer 91

A. Increased NAA, increased choline, increased lactate B. Increased NAA, reduced choline, increased lactate C. Increased NAA, reduced choline, reduced lactate **D. Reduced NAA, increased choline, increased lactate** E. Reduced NAA, reduced choline, reduced lactate ## Footnote For ast rocytomas (in general), an increased choline peak, reduct ion of the NAA peak, and appearance of a lactate peak are typical. In cases of glioblastoma, a full reduction of the NAA peak and a sharp increase in the lactate peak often occur, which correlate with the presence of necrosis. Choice D is the correct answer

Answer 92

A. Ankylosing spondylitis B. Diffuse idiopathic skeletal hyperostosis C. No pathologic process is present D. Osteoporosis **E. Vertebral osteopetrosis** ## Footnote 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.

Answer 93

A. Atrial vein B. Internal cerebral vein **C. Median prosencephalic vein** D. Straight sinus E. Vein of Galen ## Footnote 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

Answer 94

A. Agenesis of the corpus callosum B. Colpocephaly C. Septo-optic dysplasia **D. All of the above** E. None of the above ## Footnote 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

Answer 95

A. Arachnoid cyst **B. Epidermoid** C. Lipoma D. Low-grade glioma E. Meningioma ## Footnote 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

Answer 96

A. Diffusion-weighted images B. Fast spin echo C. Fluid-attenuated inversion recovery **D. Gradient echo** E. MR spectroscopy ## Footnote Gradient echo sequences (D) are sensitive to the m agnet ic eld created by the iron in hemoglobin, and are therefore the most sensitive sequence for the detect ion of blood products of the choices listed. Di usion-weighted images (A) are useful in the diagnosis of acute st roke. Fast spin echo (B) sequences generate t radit ional T1- and T2-weighted images. Fluid-attenuated inversion recovery sequences (C) eliminate CSF signal and are useful for lesions adjacent to the vent ricular system. MRI spectroscopy (E) is less sensitive than gradient echo for the detection of blood products

Answer 97

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 ## Footnote 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