RITE Images 2004

Question 1

Answer 1

Congenital toxoplasmosis –

periventricular and cortical calcifications in premature brain

Question 2

Answer 2

L5/S1 herniated disc, displacing a left nerve root

Question 3

Answer 3

Right parietal watershed infarction

NOT colloid cyst b/c it would be hypodense ->it’s a calcified pineal gland

Question 4

Answer 4

Pantothenate kinase deficiency (PKAN), AKA NBIA 1 (Hallervorden-Spatz disease).

EYE of the TIGER sign – globus pallidus

can also be seed in

Cortico basal ganglionic degeneration

PSP

Question 5

Answer 5

Proximal ICA occlusion from ulcerated plaque.

NOT dissection or total occlusion of L ICA -> No surgery

Question 6

Answer 6

Arrow is pointing at substantia nigra

Receives fibers from caudate & putamen

Question 7

Answer 7

R M1 branch of MCA occlusion

Chronic infarct of R cerebral hemisphere

Question 8

Answer 8

Enlarged vascular structure = venous angioma

Sag T1 – linear hypointense flow void

Question 9

Answer 9

Accoustic neuroma / neurinoma

Small R enhancing intracanalicular lesion

Question 10

Answer 10

Air in the right frontal lobe due to loss of brain substance from a prior focal hemorrhagic contusion ; caused by fracture of skull (through frontal sinus)

Question 11

Answer 11

Left MCA occlusion; hyperdense left MCA sign.

Question 12

Answer 12

Subdural hematoma; caused by disruption of the bridging veins

Question 13

Answer 13

Early subacute blood from rupture of an AVM

Deoxyhemoglobin centrally & intracellular methemoglobin

Question 14

Answer 14

Subarachnoid blood (B) from rupture of MCA aneursym seen in image A.

Question 15

Answer 15

Embolization of the pulmonary venous circulation by microspheres occluding some of the thin arterial perforators in the brain.

Question 16

Answer 16

Spinal cord with syringomyelia

Muscle atrophy with vibratory, position, & touch senses spared

Question 17

Answer 17

Bithalamic mass L>R. tumor, NOS.

Tumor causing mass effect in a young 17YO patient

Question 18

Answer 18

Duchenne’s muscular dystrophy

Young patient with

Degenerating fibers undergoing phagocytosis

Hypercontracted fibers

Excessive fibrosis and varitation in fiber size

Question 19

Answer 19

Multicystic encephalopathy or multicystic encephalomalacia.

Circulatory disturbances during the latter ½ of pregnancy or neonatal period

Question 20

Answer 20

LEMS

Patient presents with weakness & dry mouth with

Increase in CMAP after brief exercise

Question 21

Answer 21

meningioma

Question 22

Answer 22

Herpes encephalitis

Low signal on T1 and high signal on T2

Post gad in acute/subacute setting – cortical & leptomeningeal enhancement

Question 23

Answer 23

Subacute subdural hematoma

Question 24

Answer 24

Chordoma

Most common neural crest derived tumor of sacrum & arises within bone

Question 25

Answer 25

**Cortical dysplasia** @ posterior extent of L sylvian fissure as thick cortical ribbon

Question 26

Answer 26

**Lissencephaly / agyria** Due to arrest of neuronal migration leading to thick cortex w/ improper layering

Question 27

Answer 27

**Moyamoya** Dark foci in axial T1 representing flow void in collateral vessels due to occluded distal ICAs and collateral circulation MRA – lack of flow in distal ICA & multiple collateral vessels in region of flow void seen in axial T1 weighted image

Question 28

Answer 28

**Cortical tuber = tuberous sclerosis** Broad pale gyrus w/ loss of G/W matter delineation

Question 29

Answer 29

Hydrocephalus and meningomyelocele; DISCUSSION BOOK says Chiari II.

Question 30

Answer 30

**Holoprosencephaly** Assoc w/ **midline facial defects** **Failure of cleavage of prosencephalon**

Question 31

Answer 31

**Obstructive hydrocephalus** secondary to **aqueductal stenosis**. Enlarged 3rd & lateral ventricles w/ normal 4th ventricle *NOT communicating hydrocephalus*

Question 32

Answer 32

Bacterial brain abscess

Question 33

Answer 33

**Aspergillus** (multiple septate fungi with invasion of a blood vessel)

Question 34

Answer 34

Lipoma superior to a myelomeningocele

Question 35

Answer 35

**Cowdry A inclusion** produced by **HSV**. CMV can also produce this inclusion but will show cytoplasmic enlargement due to viral particles in the cytoplasm

Question 36

Answer 36

Alcoholic cerebellar degeneration (atrophy of superior vermis)

Question 37

Answer 37

**Acute bacterial endocarditis** with destruction of one leaf of aortic valve. Brain can contain infarctions, hemorrhages, abscesses. Usually due to staph

Question 38

Answer 38

**Hypothalamic hamartoma** – nonenhancing

Question 39

Answer 39

**Pontine glioma**- heterogeneously enhances

Question 40

Answer 40

**heterotopic grey matter** in L frontal region (laminar type); Caused by **migrational arrest** of affected neuroblasts; lesion here is destructive

Question 41

Answer 41

**hemangioblastoma** capillary rich neoplasm with abundant foamy cells can arise independently or in conjunction with **von-hippel-lindau disease** most common location is cerebellum \> spinal cord

Question 42

Answer 42

**congenital abnormality / syringohydromyelia** _Hydromyelia_ = dilatation of cord around central cystic cavity Commonly seen with ***Chiari I and II***

Question 43

Answer 43

**Septic emboli from endocarditis** Cerebral abscesses Pt had hx of endocarditis 2ndary to IV drug abuse

Question 44

Answer 44

**Neurosarcoidosis** – intra axial leptomeningeal, parynchymal enhancement with involvement of pituitary stalk/hypothalamic involvement

Question 45

Answer 45

**Tumor** – round, enhancing, mass effect * (NOT abscess or colloid cyst)* * NOT abscess (b/c it’s not a ring)* * NOT mesial temporal sclerosis (b/c doesn’t enhance)*

Question 46

Answer 46

**Meningeal carcinomatosis** \*ring of enhancement around brainstem, meninges and cerebellar sulci

Question 47

Answer 47

**aneurysm**

Question 48

Answer 48

Basal ganglia hemorrhage – secondary to HTN

Question 49

Answer 49

**Wallerian degeneration** w/ shrinkage of 1 medullary pyramid & atrophy of ipsilateral cerebral peduncle; secondary to destruction of CST above that level (**infarction in posterior limb of IC**)

Question 50

Answer 50

Mesial temporal sclerosis

Question 51

Answer 51

**Fahr’s disease** Calcification of basal ganglia and cerebellum – – **idiopathic calcification** Patient has no metabolic derangements to explain calcifications (hyperparathyroidism, Wilson’s, amyloid angiopathy)

Question 52

Answer 52

Radiation necrosis

Question 53

Answer 53

AVM Flow void / low signal region

Question 54

Answer 54

**Intracranial hypotension** - pachymeningeal enhancement, sagging Patient presents with orthostatic headache *Can get enhancement of meningeal structures in intracranial hypotension, carcinomatosis or lymphoma*

Question 55

Answer 55

Spondylitis - Osteomyelitis, discitis, epidural abscess – (esp at L4-5) L4-L5 – active discitis Active spondylitis at L 4-5 Remote spondylitis at L2-3

Question 56

Answer 56

**Chiari II** Cerebral aqueduct not visualized and ventricles not enlarged -\> **aqueductal stenosis w/ functioning shunt** Should have lumbar mylomeningocele They do not have to be mentally retarded Deformity of tectum of mesencephalon, caudalization of cerebellar vermis into cervical spinal canal & deformity of medial aspect of cerebral hemisphere & absent posterior corpus callosum

Question 57

Answer 57

**Pituitary microadenoma** – focal hypointensity, remodeling of sella floor, bowing of cavernous sinus

Question 58

Answer 58

**Myelomeningocele** (mostly CSF) Lipoma is present but it’s located superior to area in question

Question 59

Answer 59

Fusiform cord enlargement – c/w **acute myelitis**, nonspecific Increased intramedullary T2 signal, spinal cord enlargement, and variable enhancement involving several spinal levels NOT contusion, ependemymoma or astrocytoma

Question 60

Answer 60

Triphasic waves – metabolic encephalopathy

Question 61

Answer 61

ACA occlusion

Question 62

Answer 62

**Falcine meningioma** Homogenous enhancement, isointensity on T1

Question 63

Answer 63

Bilateral remote ACA infarcts from single unpaired ACA

Question 64

Answer 64

Amyloid – **cerebral amyloid angiopathy**

Question 65

Answer 65

Spinal muscular atrophy

Question 66

Answer 66

**Sturge Weber** - calcification

Question 67

Answer 67

Remote infarct

Question 68

Answer 68

**Metastasis – multiple lesions** Most common neoplasm of posterior fossa in adults

Question 69

Answer 69

**Pineoblastoma** **Need contrast enhanced imaging of entire spine** to look for **drop mets** - High incidence of subarachnoid seeding

Question 70

Answer 70

Development venous anomaly (venous angioma)

Question 71

Answer 71

SSPE – periodic slow wave complexes

Question 72

Answer 72

**Tumefactive MS** – open ring enhancement affecting white matter

Question 73

Answer 73

Purulent leptomeningitis **Pneumococcal meningitis** – w/ hx of alcoholism & asplenism

Question 74

Answer 74

Picks disease – frontal & temporal atrophy (FTD)

Question 75

Answer 75

**GBM** – spread

Question 76

Answer 76

**Toxoplasma gondii** (bradyzoite form) AIDS patient

Question 77

Answer 77

**Necrotizing vasculitis** seen in WARP **-Wegener’s granulomatosis** **-Amphetamine induced vasculitis** **-Rheumatoid vasculitis** **-Polyarteritis nodosa**

Question 78

Answer 78

Sleep spindles - infant

Question 79

Answer 79

3Hz spike and wave – in **absence seizures**, some can have GTC Treat with valproate

Question 80

Answer 80

MS

Question 81

Answer 81

**Lewy body** – eosinophilic cytoplasmic inclusion in a neuron with melanin granules

Question 82

Answer 82

Cocci

Question 83

What is the structure the arrow points to? What is the associated neurotransmitter?

Answer 83

**Inferior olivary nucleus** (origin of climbing fibers) **Glutamate** is the NT

Question 84

Answer 84

Eclampsia

Question 85

Answer 85

Chiari 1

Question 86

Answer 86

Near occlusion of superior saggital sinus

Question 87

Answer 87

Third ventricle colloid cyst (T2)

Question 88

Answer 88

Arachnoid cyst

Question 89

Answer 89

Drop metastasis and nodular lesions most commonly seen with **medulloblastoma** "PC-GAME" Pineoblastoma Choroid Plexus tumors Germinoma Anaplastic Gliomas Medulloblastomas Ependymomas

Question 90

Answer 90

Normal A - Inominate artery B - External carotid C - Vertebral D - Subclavian E - Basilar

Question 91

What is 3 pointing to? What is the function?

Answer 91

3- **neurohypophysis** – direct extension of neuraxis Contains axons arising from the supraoptic & paraventricular nuclei Carries oxytocin & vasopressin (ADH) Damage to the infundibulum -\> diabetes insipidus