RITE Images 2006

Question 1

Answer 1

Angiosarcoma – obstructing straight sinus à increased ICP

Question 2

Answer 2

RPLS

Question 3

Answer 3

Alcoholic cerebellar degeneration – atrophic cerebellar vermis & loss of Purkinje & Granule cell neurons

Question 4

Answer 4

Cavernous angioma – T2 images – dark rim b/c of hemosiderin deposition from repeated bleeding

Question 5

Answer 5

No flow in basilar artery

Question 6

Answer 6

L hyperdense MCA sign – occlusion of vessel; early sign of acute stroke

Question 7

Answer 7

Putaminal hemorrhage 2ndary to HTN

Question 8

Pt complains of back pain

Answer 8

Tethered cord syndrome;
see
-thickened filum terminale,
-widening of spinal canal
-Posterior cord lipoma
-Low lying spinal cord

Question 9

Answer 9

CNS fistula communicating the SAS w/ the pleural cavity

Pick section C?

Question 10

Answer 10

Cholesteatoma – an epidermoid tumor

T1 shows the tumor entering the internal auditory canal & altering normal structure of petrous bone

• Does NOT enhance w/ GAD; what enhances w/ GAD? Meningioma schwanomma, chordoma*
• Acoustic neurinomas are usually infratentorial*
• Astrocytoma DOES NOT enhance w/ GAD*

Question 11

Answer 11

Neurofibromatosis

Question 12

Answer 12

Subcortical hemorrhage – the most common cause of this is trauma in young person

Question 13

Answer 13

Persistent trigeminal artery supplying the L posterior circulation; no L PCA b/c of this

Question 14

Answer 14

Embolic infarction – cortical & subcortical lesions; L SMG

Question 15

Answer 15

MS

Question 16

What clinical feature would you expect to see in a patient with this abnormality?

Answer 16

Lesion to caudate ->chorea

Question 17

Answer 17

LMCA ischemic lesion/infarct 2ndary to occlusion;

Question 18

Answer 18

Neurofibromatosis - has focal areas of signal intensity (FASI)

Question 19

Answer 19

Tolosa Hunt Syndrome – painful opthalmoplegia, abnormalities in cavernous sinus

Question 20

Answer 20

Lobar atrophy or Pick’s disease

Question 21

What syndrome would this patient have?

Answer 21

Locked in syndrome – poor prognosis for recovery sufficient to be weaned from mechanical ventilation

Question 22

Answer 22

14-6 positive spikes – sharply contoured in posterior head during light sleep

Best seen on referential montage & most common in adolescent patients

Question 23

Answer 23

GBM

Question 24

Answer 24

Removal of SDH

Question 25

Answer 25

**PLEDS** in L temporal area – think about HSV encephalitis -\> acyclovir

Question 26

Answer 26

Hippocampal atrophy

Question 27

Answer 27

Occlusion to atheroclerosis @ proximal ICA

Question 28

Answer 28

Anterior temporal spikes on EEG + fever + focal seizures -\> cerebral abscesses

Question 29

Answer 29

**Hereditary neuropathy w/ liability to pressure palsies** – sausage-like change in myelin in teased nerve preparation -\> tomaculous neuropathy; ## Footnote **Deletion of PMP22 gene**

Question 30

Answer 30

No MCA

Question 31

Answer 31

Cerebral atrophy is most closely associated w/ PROGRESSION of disability in MS **GAD enhancing plaques** – most important factor for dx **MS**

Question 32

Answer 32

**Focal polymorphic delta activity** – suggestive of **underlying structural lesion**

Question 33

Answer 33

**Arachnoid cyst** – respects the cortex

Question 34

Answer 34

LGN

Question 35

Patient has repeated aphasic episodes

Answer 35

**Perisylvian AVM** -\> causes the pt’s repeated aphasic episodes

Question 36

Answer 36

Symmetrical dilatation of ventricular system & sylvian fissure w/o excessive sulcal widening or hippocampal atrophy

Question 37

Answer 37

Cyst contiguous w/ 4th ventricle from surgial excision of cerebellar astrocytoma

Question 38

Answer 38

**PICA infarct** – inferomedial portion of cerebellar hemisphere

Question 39

Answer 39

**Benign rolandic epilepsy** -\> observe w/o AED

Question 40

Answer 40

**Lipoma** – (small lesion in infundibular region); T1 image w/ fat suppression

Question 41

Answer 41

**Hypoparathyroidism** – symmetrical high density lesions are calcifications in the media of the small vessels in lenticular nuclei, thalami & centrum semiovale of frontal lobe

Question 42

Answer 42

**Chiari type I** – cerebellar tonsils are descended below the foramen magnum

Question 43

Answer 43

**Substantia nigra** – fxns to facilitate voluntary motor activity originating in the prefrontal 7 motor cortex ipsilateral to SN =\> damage to one SN -\> hemiparkinsonism Hemiparkinsonism is **contralateral** to the lesion

Question 44

Answer 44

Open ring sign -\> demyelinating lesions

Question 45

Answer 45

Ring enhancing lesion osteomyelitis

Question 46

Answer 46

**Obstructive (noncommunicating) hydrocephalus** – marked enlargement of lateral & 3rd ventricles; can be seen in **aqueductal stenosis**

Question 47

Answer 47

Hydatid cysts of the spinal canal w/ involvement of the vertebral bodies in the region of the lesion

Question 48

Answer 48

**Epidermoid** – tumor in prepontine cistern compressing root of trigeminal nerve -\> pain, does NOT enhance w/ GAD, **“whorled appearance on FLAIR”**

Question 49

Answer 49

**Ependymoma** – tumor arises from spinal canal & molds the vertebral bodies; *intramedullary* NOT chordoma -\> would come from vertebral bodies esp sacrum & compress SC

Question 50

Answer 50

**Cysticercosis** – multiple cystic lesions w/ high intensity/density dot = scolex of tenia solium; intraventricular cysts block the CSF pathways -\> hydrocephalus

Question 51

Patient complaining of neck stiffness

Answer 51

**Astrocytoma** – *intramedullary*; pt complaining of neck stiffness b/c tumor eroding vertebral bodies

Question 52

Answer 52

**Subacute hemorrhage** – pick hemorrhagic infarct (b/c of small size) [embolic occlusion of branch of ACA] \> **AVM**

Question 53

Answer 53

**Panthothenate kinase associated neurodegeneration (PKAN)** – progressive neurodegenerative disease w/ neuroaxonal dystrophy, **rust brown discoloration of globus pallidus pars reticulata of substantia nigra** Accumulation of iron; onset \<15 **PANK2 gene**

Question 54

Answer 54

**Normal** scan of **4 month old** child – Gray/white matter signal reversed during 1st year of life

Question 55

Answer 55

**Dolichoectasic vessels** pushes brainstem away from IAC

Question 56

Answer 56

**Tuberous sclerosis –** subependymal nodules white matter lesions following lines of neuronal migration, cyst like white matter lesions

Question 57

Answer 57

**Autosomal dominant SCA type 6** – pure cerebellar atrophy esp superior vermis

Question 58

Answer 58

Conduction block on NCS diagnoses **CIDP**

Question 59

Answer 59

Warfarin is RELATIVELY contraindicated in pts w/ prior lobar ICH

Question 60

Answer 60

**Lambert Eaton syndrome** Weakness in LES **responds to 3’-4’ diamonopyridine** – blocker of K channel on presynaptic membrane

Question 61

Answer 61

**Syringomyelia** w/ cerebellar tonsil herniation -\> **chiari type I** Syringomyelia b/c of T2 hyperintensity in cord on T2

Question 62

Answer 62

Tumor in pituitary fossa

Question 63

Answer 63

**Hypoperfusion of parietal lobe -\> AD**

Question 64

Answer 64

**Infarction**; Pt w/ Horner’s ipsilateral to MCA or ACA territory infarction -\> need to think about **carotid dissection** If affect the PCA territory -\> think about carotid dissection due to the possibility of a persistent trigeminal artery

Question 65

Answer 65

**Enlargement of temporal horns of lateral ventricles** suggesting hippocampal atrophy - **AD**

Question 66

Answer 66

Cavum vergae – developmental cavity of the roof of the 3rd ventricle

Question 67

Answer 67

Pt treated w/ VP shunt for obstructive hydrocephalus

Question 68

Answer 68

Trauma – high signal changes in L temporal & frontal regions Inferior frontal gyrus in A & superior temporal gyrus in B – lesions of the crowns of gyri

Question 69

Answer 69

**C3 myelopathy** – cord signal hyperintensity; sensory level **Upper cervical myelopathy** - possibly caused by *compression of ASA by osteophytes*

Question 70

Answer 70

**Multiple sclerosis** – **periventricular plaque** Extrapontine myelinolysis – lesions @ cortical G/W matter junctions Leukoaraiosis – ill defined white matter loss due to chronic vascular disease &