RITE Images 2007

Question 1

Answer 1

Multicystic encephalopathy or multicystic encephalomalacia

Disturbances during latter half of pregnancy

Question 2

Answer 2

NPH

Question 3

Answer 3

Cerebral abscesses (endocarditis 2ndary to IVDA)

Question 4

Answer 4

TORCHES

Question 5

Answer 5

Aicardi syndrome – X-linked dominant; lethal in males

Agenesis of corpus callosum, retinal lacunae, development abnormalities, infantile spasms

Question 6

Answer 6

Focal polymorphic delta – nonspecific in infarct or tumor; seen in white matter processes

Question 7

Answer 7

Spinal infection

Loss of distinction btw endplates, disks, 7 adjacent vertebral bodies on T1 & increased T2

Check T2!

Question 8

Answer 8

oligodendroglioma

Question 9

Answer 9

Lipoma – hyperintense on both T1 & T2!; do not need further workup! No Neurosurgery or Rad Onc consultation, LP or blood cx

Question 10

Answer 10

Displaced optic chiasm

Question 11

Answer 11

Hemangioblastoma

Capillary rich neoplasm w/ abundant foamy cells w/ lipid; can be seen w/ Von-hippel lindau

Usually seen in cerebellum or SC

Question 12

Answer 12

Neurocysticercosis

Question 13

Answer 13

Neurosarcoidosis – look for leptomeningeal ehancement esp @ pituitary stalk/hypothalamus; if pt

Question 14

Answer 14

FTD – see decrease in glucose metabolism in frontal & anterior temporal areas

• Alzheimer’s – parietotemporal association*
• Lewy Body – occipital regions*

Question 15

Answer 15

GBM – see mass effect & extension across corpus callosum

Abnormal contrast enhancement suggests tumor has abnormal vessels w/ marked permeability – another finding in GBM

Question 16

Answer 16

Cryptococcus – likes to hang out in the BG!

Pathology – “soap bubble” abscesses

Question 17

Answer 17

Chiari II – deformity of tectum of mesencepahlon, caudalization of cerebellar vermis into cervical spinal canal, deformity of medial aspect of cerebral hemisphere w/ absent posterior corpus callosum

Question 18

Answer 18

Heterotopia – migrational arrest of affected neuroblasts

Question 19

Answer 19

Aneurysm of vein of Galen

Time of flight – blood backing up into the posterior region of SSS which is dilated

Question 20

Answer 20

Autosomal dominant cerebral Cavernous angioma (malformation) (CCM1) syndrome

Usually in hispanics, intraparenchymal cavernous malformations that can produce seizures, impairment of fxn, & hemorrhage

Question 21

Answer 21

necrotizing vasculitis – “WARP”

W – wegener’s

A – amphetamine induced

R – rheumatoid

P - PAN

Question 22

Answer 22

Diastematomyelia – spinal dysraphism;

Pts – have neuro defects in LE – gait d/o, sphincter disturbance, muscle atrophy

Question 23

Answer 23

infarct

Question 24

Answer 24

Amyloid angiopathy

Primary or secondary systemic amyloidoses cause amyloid deposits

Question 25

Answer 25

ACA infarct

Question 26

Answer 26

**Hemorrhagic conversion** – subacute hematoma c LMCA infarct

Question 27

Answer 27

Pachygyria – occurs during neuronal migration

Question 28

Answer 28

**Syringohydromyelia** – See dilation of cord around a central cystic cavity; inferior cerebellum has herniated à Chiari Can be seen in both **chiari I or II**

Question 29

Answer 29

Central temporal spikes – benign rolandic epilepsy of childhood

Question 30

Answer 30

MS

Question 31

Answer 31

Olivopontinecerebellar atrophy *NOT Dandy-Walker*

Question 32

Answer 32

**Hypoxic injury** – anoxia causes increased T2 signal to GP deep sulci superior cerebellum **Necrotic GP enhances p GAD**

Question 33

Answer 33

Dural venous fistula

Question 34

Answer 34

**Vascular disease Right carotid** does NOT show flow void

Question 35

Answer 35

**Anencephaly** – most common of neural tube closure defects; **need FOLATE** Anti-folate receptor antibodies?

Question 36

Answer 36

SDH

Question 37

Answer 37

**Recurrent artery of Heubner infarct**; -comes off **A1 segment of ACA** Supplies: anteroinferior portion of caudate putamen anterior limb of IC

Question 38

Answer 38

**Wakefulness** * Anterior eyeblinks (first second of page)* * Facial muscle EMG artifact (throughout)* * Occiptial dominant alpha rhythm*

Question 39

Answer 39

Triphasic waves

Question 40

Answer 40

SDH

Question 41

Answer 41

**Syringomyelia** Muscle atrophy results Vibratory, position, & touch senses spared

Question 42

Answer 42

Colloid cyst – low signal in T2

Question 43

Answer 43

**Purulent leptomeningitis** - Hx of alcohlism & asplenism -\> **pneumoccocal meningitis**

Question 44

Answer 44

**Pleomorphic xanthoastrocytoma** – usually arises in temporal or parietal areas Minimal hemosiderin rim w/ no edema à excludes abscess & hematoma

Question 45

Answer 45

**Wallerian degeneration** w/ shrinkage of 1 medullary pyramid & atrophy of ipsilateral cerebral peduncle Wallerian degeneration is 2ndary to **_destruction of corticospinal tract ABOVE this level_** i.e. **infarct in posterior limb of IC**

Question 46

Answer 46

**Transverse myelitis** – Spinal tap – lymphocytic predominance & increased protein

Question 47

Answer 47

**Pick’s disease** – lobar atrophy of Frontal & Temporal Lobes

Question 48

Answer 48

Spinal stenosis

Question 49

Answer 49

**Hemorrhage 2ndary to amyloid (congophilic) angiopathy**

Question 50

Answer 50

**Friedrich’s Ataxia** - Dorsal spinocerebellar columns & posterior columns

Question 51

Answer 51

**Ne****urofibroma or meningioma** -\> need SURGERY! Intradural extramedullary * NO**T Rad Onc b/c neither is radiosensitive* * Do NOT need further imaging!*

Question 52

Answer 52

Carotid immediately proximal to takeoff of MCA (to R) & ACA (to L)

Question 53

Answer 53

HSV – low signal on T1 & high on T2 crosses vascular boundaries à t/f NOT infarct

Question 54

Answer 54

**Spongiform change** – **prion disease** Also add gliosis & neuronal loss à classic triad Misfolding may be induced by mutation or exposure of normal cellular prion protein to pathogenic prions; misfolding alters 2ndary structure so that the protein becomes highly resistant to chemical or thermal methods of sterilization.

Question 55

Answer 55

**Prior focal hemorrhagic contusion** – **AIR in R frontal lobe** w/ Air-fluid level -\> air would gain access is if there was a break in the skull, most often in the air containing sinuses of cranial base; in order for air to occupy the space, there would have to be loss of substance at this site

Question 56

Answer 56

**Communicating hydrocephalus –** Dilation of sylvian fissure? Coronal image – sulci at high parietal convexity are compressed as compared to markedly dilated posterior extent of Sylvian fissure

Question 57

Answer 57

meningioma

Question 58

Answer 58

Multiple sclerosis **Large lesion (schilder’s) variety of MS** Enhancement affecting only white matter

Question 59

Answer 59

Developmental venous anomaly (DVA) or venous angioma Pt w/ HA, sz

Question 60

Answer 60

**Obstructive hydrocephalus w/ obstruction at aqueduct** Normal 4th ventricle w/ enlarged 3rd ventricle

Question 61

Answer 61

Near occlusion of superior saggital sinus No flow in SSS

Question 62

Answer 62

**Spinal Infection** Decreased disk height, disk hypointensity on T1 & hyperintense on T2, disk enhancement, erosion of vertebral endplates, loss of distinction btw endplate & disk, along w/ adjacent vertebral bodies on T1

Question 63

Answer 63

Atherosclerosis of intracranial vessels **Bilateral remote ACA infarctions** – 2ndary to \***single unpaired ACA** -\>B ACA infarctions _apathy, lack of motivational intent, akinetic mutism, weakness of LE, urinary incontinence_ Hydrocephalus ex vacuo

Question 64

Answer 64

**Brain abscess** Enhanced ring w/ GAD Dark rim on FLAIR

Question 65

Answer 65

**GBM** – multiple irregular ring enhancing lesions adjacent to & compressing lateral ventricles; white matter vasogenic edema **spread through both hemispheres**

Question 66

Answer 66

**Arachnoid cysts** extraaxial

Question 67

Answer 67

Positive occipital sharp transients of sleep **POSTS** Occur during drowsiness; Normal

Question 68

Answer 68

**Metastatic disease** – b/c **bone is destroyed!**

Question 69

Answer 69

BG hemorrhage w/ rupture into ventricular system; HTN ICH

Question 70

Answer 70

Cocci

Question 71

Answer 71

Active Spondylitis L4-L5 Remote spondylitis L2-L3 osteomyelitis, discitis, & epidural abscess formation @ L4-L5 *Metastatic disease does NOT X-over disc space*

Question 72

Answer 72

meningioma

Question 73

Answer 73

Large ulcerate plaque *NOT dissection*

Question 74

Answer 74

SAH

Question 75

Answer 75

**Listeria** – prefers ***brainstem*** Subacute process w/ quick worsening

Question 76

Answer 76

**Subacute sclerosing panencephalitis** – periodic long interval diffuse discharges recurring q 4-15 secs

Question 77

Answer 77

Cavernous angioma

Question 78

Answer 78

**Generalized polyspikes & spike-wave D/C** –***EEG correlate of primary generalized epilepsy syndromes*** GTC, generalized myoclonic seizures, absence

Question 79

Answer 79

**Astrocytoma** – lesion in L optic nerve; L optic nerve is thickened but DOES NOT ENHANCE *Lesions that enhance – meningioma, schwannoma, neurofibroma*

Question 80

Answer 80

En-plaque variant meningioma

Question 81

Answer 81

?increased vascular permeability – eclampsia?

Question 82

Answer 82

**Periventricular leukomalacia (PVL)** – immature brain c small foci fo dystrophic calcification in white matter Principal ischemic lesion of prematurity

Question 83

Answer 83

\*REM – mixed frequency EEG & REM, **sawtooth pattern**; EMG lowest level of recording \*Minimum duration required for respiratory event to be called OSA or hypopnea is **10 secs** in adult \*AHI c moderate OSA -\> use **CPAP** use **dental appliance** if mild OSA

Question 84

Answer 84

**Sturge Weber Syndrome** Lesions in parietal occipital area; parenchymal calcification, serpentine calcification

Question 85

Answer 85

**Laminar necrosis** due to hypoxic/ischemic injury

Question 86

Answer 86

**Pituitary apoplexy** – syndrome of infarction or hemorrhage of the pituitary; HA, opthalmoparesis, visual defects, encephalopathy