Ned Divine Review

Question 1

CN II is derived from ____

The other CNs are derived from ___

Answer 1

CN II is derived from the diencephalon

The other CNs are derived from neural crest cells

Question 2

Fungal/TB meningitis CSF tap markers

Answer 2

Basically looks like bacterial meingitis, but with lymphocytes instead of neutrophils

Question 3

CSF tap in major depressive disorder

Answer 3

Cortisol elevated

Monoamines low

Question 4

CSF tap in anxiety disorder

Answer 4

Elevated cortisol

Maybe relatively preserved monoamines

Question 5

CSF tap in narcolepsy

Answer 5

Decreased orexin/hypocretin-1

Question 6

CSF in conduct/anti-social persoanlity disorder

Answer 6

Low levels of serotonin

Question 7

CSF tap in Alzheimer’s

Answer 7

Low acetylcholine (loss of nucleus of Meynert)

Elevated tau

Low amyloid

Question 8

“Loss of convexity of frontal bone” on prenatal ultrasound

Answer 8

Spina bifida

Question 9

Frontal lobe mass with coarse calcifications

Answer 9

Oligodendroglioma

Question 10

“Ice-cream-cone mass” at the cerebellopontine angle

Answer 10

Schwannoma/acoustic neuroma

If not, meningioma

Question 11

“Enhancement at the skull base” in the setting of a chronic meningitic picture

Answer 11

TB meningitis

Question 12

Hydrocephalus ex-vacuo

Answer 12

aka “compensatory enlargement of CSF spaces”. Often in lateral ventricles or in stroke distribution.

Occurs secondary to brain atrophy/degeneration as that space fills with CSF

Typically asymptomatic, may occur in elderly individuals or those with cerebral atrophy

Question 13

Ventricular system

Answer 13

Question 14

What is the classic brain finding in patients with Korsakoff syndrome?

Answer 14

Question 15

Classical brain imaging finding of carbon monoxide poisoning

Answer 15

Bilateral hyperintensities in the globus pallidus

Question 16

Ways to differentiate cystic medulloblastoma and pilocytic astrocytoma

Answer 16

If it has solid and cystic components, probably medulloblastoma. Also, medulloblastoma loves to metastasize through the ventricular system (“drop metastasis”)

Question 17

Child with a calcified posterior cerebellar mass and hematocrit of ~80%

What is the diagnosis?

Answer 17

Hemangioblastoma

This kid probably has VHL

Question 18

Intraventricular mass in a person with hydrocephalus

Sometimes called “toothpaste-like” since they appear to be squeezing out into the ventricles

Answer 18

Ependymoma

Remember that the ependymal cells secrete CSF!

Question 19

What is going on in this patient with slowly progressive unilateral vision loss?

Answer 19

Optic nerve glioma

Typically before, but proximal to the optic chiasm

Often in the setting of NF type 1, so they may also have lisch nodules!

Question 20

Well-circumscribed, lytic lesions in the skull

Answer 20

Langerhans cell histiocytosis

Associated with “burbek granules”/tennis racket granules on biopsy

Question 21

Blood supply to the superior colliculus

Answer 21

Derived from the superior cerebellar artery

So, SCA infarct causes acute onset Parinaud syndrome

Question 22

Osteomyelitis that “spares the intervertebral discs”

Answer 22

Highly suggestive of TB osteomyelitis

Usually in an immigrant or someone returning from a long period of travel

Question 23

“Calcifications anterior to the vertebral bodies”

Answer 23

The draped aorta sign

Ruptured AAA