RITE Images 2003

Question 1

Answer 1

Axonal spheroids in diffuse axonal injury

“shear injury” -> immediately unconscious w/ trauma à chronic closed head injury

Question 2

Answer 2

Pituitary adenoma

• Not MEGS*
• Meningioma ependymoma glioma Schwannoma*

Question 3

Which cranial nerve would be involved?

Answer 3

Bony erosion involving the stylomastoid foramen -> CN7 involved

Question 4

Answer 4

Cystic astrocytoma

Question 5

Answer 5

FTD

Question 6

Answer 6

Schwannoma of the vestibular branch of the 8th cranial nerve

Question 7

Answer 7

14&6 Hz positive spikes best seen in referential montage

Seen in adolescents in the posterior regions during light sleep

Question 8

Answer 8

Wilson’s

High signal intensity in Thalamus & Putamen

Question 9

Answer 9

Cerebellar cystic hemangioblastoma

Question 10

Answer 10

Subacute SDH w/ mass effect on ventricles -> surgery

Question 11

Answer 11

Colloid cyst

Question 12

Answer 12

NCS with temporal dispersion, conduction block, and slow conduction -> CIDP

Question 13

Answer 13

AVM

Can do amytal test and intravascular embolization to make surgery & radiation therapy more effective

Question 14

Answer 14

Arachnoid cyst

Patient presents with cluster headache -> breath oxygen rich mixture if HA were to return

Do not need to drain or decompress arachnoid cyst b/c there’s no mass effect

Question 15

Answer 15

neurosarcoidosis

Question 16

Answer 16

Congenital retinoblastoma

Pineal gland shouldn’t be calcified until age 2 -> pineoblastoma

Question 17

Answer 17

ALS - Degeneration of the corticospinal tracts

Question 18

Answer 18

Thrombosed superior saggital sinus

Question 19

Answer 19

Intracranial hypotension secondary to persistent CSF leak

Question 20

Answer 20

Epidural metastasis

Bone & inner table shows irregularity & infiltration of tumor into the epidural space (metastatic prostate CA)

Question 21

Answer 21

Sleep spindles generated in the reticular thalamic nucleus

Question 22

Answer 22

Trichinella organism acquired by ingestion of undercooked pork

Question 23

Answer 23

Chiari malformation w/ syringomyelia

Can get hydrocephalus due to cerebellar tonsils protruding into the foramen magnum

Question 24

Answer 24

Cryptococcus infection

Question 25

Answer 25

No flow in basilar artery

Question 26

Answer 26

Germinal matrix hemorrhage – complication of premature birth Germinal matrix = located in walls of lateral ventricles – very vascular & delicate 4 subtypes - I – localized to germinal matrix - II – ruptured into ventricle w/o ventricular dilation - III – ruptured into ventricle WITH ventricular dilation - IV – ruptured into ventricle AND cerebral parenchyma

Question 27

2 T2 images scanned 6 months apart

Answer 27

abnormal signal in GP & white matter disease adjacent to trigone of R lateral ventricle; cerebral atrophy & enlarged CSF spaces; ventricular & subarachnoid spaces have increased -\> parenchymal tissue loss **Anoxic injury** in GP – If GP affected -\> CHAMWA Canavan’s & Krabbe’s – white matter lesions!

Question 28

Answer 28

B symmetric, *parasagittal, cortical & BG venous infarctions* due to **thrombosis of superior sagittal sinus & deep cerebral veins**

Question 29

Answer 29

**Methotrexate neurotoxicity** – multiple _PERIVENTRICULAR_ discrete or confluent **foci of necrosis** in cerebral or spinal **white matter**

Question 30

Answer 30

Tethered cord syndrome – Pts w/ back pain, thickened filum terminale, widened SC, Posterior lipoma Low lying SC Axial L1/L2 should only show you filum terminale & not cord

Question 31

Answer 31

**PICA infarct** – occlusion of vertebral artery

Question 32

Answer 32

**Rosenthal fibers** – Alexander’s Disease

Question 33

Answer 33

Onion bulbs – demyelination & remyelination Seen in: CMT CIDP Dejerine Sottas Refsum

Question 34

Answer 34

Gray Matter heterotopia or heterotopic gray matter

Question 35

Answer 35

Aspergillosis -\> hemorrhagic infarcts

Question 36

Answer 36

**Dandy Walker Malformation** No vermis No posterior corpus callosum Large posterior fossa cyst

Question 37

Answer 37

No inferior vermis & hypoplasia of 2 cerebellar hemispheres

Question 38

Answer 38

Tabes Dorsalis Paraneoplastic Panel Vit E deficiency Cu deficiency

Question 39

Answer 39

**Canavan’s** – U-fibers not spared

Question 40

Answer 40

Colloid cyst

Question 41

Answer 41

**Cryptococcus** – multiple **bubbly cysts** in **white matter, caudate, & putamen**

Question 42

Answer 42

NF1

Question 43

Answer 43

Subdural empyema

Question 44

Answer 44

Caudate – chorea STN -\> hemiballismus SN -\> PD

Question 45

Answer 45

Atrophic cerebellar vermis & loss of both Purkinje & Granule cell neurons -\> alcoholic cerebellar degeneration

Question 46

Answer 46

**Clivus chordoma** – arise from embryonic notochord (mesodermal derivative) 3rd & 4th decades; extrapontine lesion Cartilaginous tumors – 20-60YO; extradural, arise adjacent to body of sphenoid bone;

Question 47

Answer 47

**Hamartoma** in tuber cineureum - \*pt would have **precocious puberty**

Question 48

Answer 48

Cavum septum pellucidum & cavum vergae

Question 49

Answer 49

lipoma

Question 50

Answer 50

ventriculitis

Question 51

Answer 51

MRI is effective in demonstrating a **displaced optic chiasm** b/c it’s mo

Question 52

Answer 52

Lateral Geniculate Nucleus (LGN)

Question 53

Answer 53

oligodendroglioma

Question 54

Question 55

Answer 55

Cyclopia - holoprosencephaly

Question 56

Answer 56

stroke

Question 57

Answer 57

NPH

Question 58

Tissue resected from intraventricular mass

Answer 58

**Tuberous sclerosis** abundant eosinophilic cytoplasm w/ prominent single nucleoli – **subependymal giant cell astrocytomas – SEGA!**

Question 59

Answer 59

**Healed toxoplasmosis** – multiple calcified lesions seen in brain parenchyma, & cerebellum @ G/W junction – AIDS AIDS patients have generalized atrophy *Sarcoidosis – calcification is NOT a feature Sturge-Weber – intracranial calcification 2ndary to pial angiomatosis w/ curvilinear calcification following contour of cortex typically in occipital / parieto-occipital lobe* * Hyperparathyroidism – B symmetric BG calcification, dentate nuclei of cerebellum & periventricular white matter* * Tuberous sclerosis – subependymal tubers lining ventricles*

Question 60

Answer 60

Flaky keratin – epidermoid/dermoid

Question 61

Answer 61

Neuritic plaques!

Question 62

Answer 62

**GBM!** Poorly circumscribed variegated mass w/ foci of necrosis & hemorrhage NOT infarct, abscess, meningioma or Huntington’s

Question 63

What is disease? Clinical presentation? Treatment?

Answer 63

**Tolosa-Hunt syndrome** – enhancing lesion in cavernous sinus Idiopathic noncaseating granulomatous inflammation in the cavernous sinus; Acute painful ophthalmoplegia, progression over days to weeks, CN 3 & 6 involved; 4 & V1 in 1/3 Optic nerve 20%, V2 10%; may have elevated ESR & SLE; recurring attacks over months to eyars Tx: high dose prednisone

Question 64

Answer 64

Small pons & cerebellar atrophy, & olive atrophy – **cerebellar pontine olivary atrophy** – look for **loss of belly of pons**!

Question 65

Answer 65

Severe pontine atrophy – **olivopontocerebellar atrophy** – part of MSA; alpha synuclein

Question 66

Answer 66

**Schizencephaly w/ septo optic dysplasia** – cavity lined w/ gray matter *Porencephalic cyst – cavity would be lined w/ white matter*

Question 67

Answer 67

**Tumor seeding** – sagittal MR post gad who multiple round enhancing lesions on surface of spinal cord & dorsal aspect of upper thoracic cord *Cord contusions would have high signal intensity w/in the cord*

Question 68

Answer 68

Hemosiderin from prior repeated SAH

Question 69

Answer 69

Centronuclear myopathy Type I myofiber predominance

Question 70

Answer 70

**Substantia nigra** – Damage to one SN -\> hemi parkinsonism contralateral to lesion

Question 71

Answer 71

**Indusium griseum** Coronal section of CC & cingulate gyri Indusium – direct continuation of hippocampal formation

Question 72

Answer 72

Thrombosed aneurysm

Question 73

Answer 73

Ill defined ring enhancement w/ edema -\> **malignant brain neoplasm**

Question 74

Answer 74

**Arnold Chiari Malformation** – herniation of cerebellar vermis & medulla kinking of upper cervical cord beaking of quadrigeminal plate

Question 75

Answer 75

Anatomical variant of both ACA originating from LICA RPCA originates from anterior circulation – (fetal origin)

Question 76

Answer 76

**Negri body** – eosinophilic intracytoplasmic inclusion in cortical neuron; seen in **rabies**

Question 77

Answer 77

**Leigh’s disease** – abnormal signal in brain stem & BG symmetric -see metabolic acidosis & elevated lactate

Question 78

Answer 78

**Ependymoma** – b/c tumor arises from spinal canal & molds the vertebral bodies *Chordoma – arise FROM vertebral bodies or scrum*

Question 79

Answer 79

Caudate atrophy

Question 80

Answer 80

**Meningioma** Non contrast CT on L -\> isointense extra-axial mass Contrast enhancement is homogeneous & intense

Question 81

Answer 81

Dissection – flame shaped “stump” of ICA

Question 82

What is E?

Answer 82

E – superior medullary velum thin, transparent lamina of white matter, which stretches between the superior cerebellar peduncles It forms, together with the superior cerebellar peduncle, the roof of the upper part of the fourth ventricle

Question 83

Question 84

Answer 84

**Quadrantic sectoranopia** – stroke in the LGN Anterior choroidal artery involved