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Neuroradiolgy Neuroradiolgy Quiz for Medical Quiz for Medical
StudentsStudentsDr. Thanh Binh NguyenDr. Thanh Binh Nguyen
September 2009September 2009
Some of the pictures are from the PBL Some of the pictures are from the PBL sessions in the neuroscience block.sessions in the neuroscience block.
Go through the cases on your own and Go through the cases on your own and write it on a piece of paper.write it on a piece of paper.
The answers will be at the end.The answers will be at the end.
Case 1Case 1a) Describe the findingsa) Describe the findingsb) What is the most likely b) What is the most likely diagnosis? diagnosis?
Axial T2-weighted images Axial T1-weighted images Sagittal proton dense images
T2-weighted images
Sag T1-weighted images
Case 2 a) Identify the Case 2 a) Identify the anatomical structures.anatomical structures.
Artère vertébrale1
23 4
Case 2 b)Case 2 b)
1
234
5
6
78
9
10
Case 3Case 3a) what is the finding?a) what is the finding?b) what is the differential b) what is the differential diagnosis?diagnosis?
Case 4Case 4a) Describe the findinga) Describe the findingb) Give a list of 3 diseases b) Give a list of 3 diseases which can present as such.which can present as such.
Case 5 a) what is the Case 5 a) what is the finding?finding?
b) Give 2 b) Give 2 diagnoses which can diagnoses which can
present as suchpresent as such
Case 6 Case 6 Give the diagnosis in a) Give the diagnosis in a) and b)and b)
b)a)
ANSWERSANSWERS
Case 1Case 1a) Describe the findingsa) Describe the findingsb) What is the most likely b) What is the most likely diagnosis? diagnosis?
Axial T2 MR images show multiple Axial T2 MR images show multiple hyperintense T2 lesions in the hyperintense T2 lesions in the periventricular white matter (long periventricular white matter (long arrow) and in the corpus callosum arrow) and in the corpus callosum (short arrow)(short arrow)
Most likely dx is multiple sclerosis.Most likely dx is multiple sclerosis.
Case 2 a) Identify the Case 2 a) Identify the anatomical structures.anatomical structures.
Artère vertébrale1
23 4
1.1. Ventral ramus (sensory)Ventral ramus (sensory)
2.2. Vertebral arteryVertebral artery
3.3. LaminaLamina
4.4. Neural foramenNeural foramen
Case 2 b)Case 2 b)
1
234
5
6
78
9
10
1.1. PonsPons2.2. Basilar arteryBasilar artery3.3. Mammillary bodyMammillary body4.4. Pituitary glandPituitary gland5.5. Optic chiasmOptic chiasm6.6. Cingulate gyrusCingulate gyrus7.7. Corpus callosumCorpus callosum8.8. FornixFornix9.9. Thalamus (massa intermedia)Thalamus (massa intermedia)10.10. Aqueduct of SylviusAqueduct of Sylvius
Case 3Case 3a) what is the finding?a) what is the finding?b) what is the differential b) what is the differential diagnosis?diagnosis?
Hyperintense T2 lesion in the right Hyperintense T2 lesion in the right temporal lobetemporal lobe
The differential diagnosis would The differential diagnosis would include an infarct, neoplasm (glioma) include an infarct, neoplasm (glioma) and herpes encephalitis. In patient and herpes encephalitis. In patient with suspected herpes encephalitis, with suspected herpes encephalitis, an urgent MR is indicated (after the an urgent MR is indicated (after the patient has been placed on patient has been placed on intravenous antiviral therapy)intravenous antiviral therapy)
Case 4Case 4a) Describe the findinga) Describe the findingb) Give a list of 3 diseases b) Give a list of 3 diseases which can present as such.which can present as such.
There is a left frontoparietal There is a left frontoparietal hemorrhagehemorrhage
Common causes of intraparenchymal Common causes of intraparenchymal hemorrhage include vascular hemorrhage include vascular malformations (arteriovenous malformations (arteriovenous malformations, cavernomas), malformations, cavernomas), neoplasms, amyloid angiopathy.neoplasms, amyloid angiopathy.
Case 5 a) what is the Case 5 a) what is the finding?finding?
b) Give 2 b) Give 2 diagnoses which can diagnoses which can
present as suchpresent as such
There is subarachnoid hemorrhage There is subarachnoid hemorrhage in the basal cisterns.in the basal cisterns.
The two most common causes of The two most common causes of SAH are ruptured aneurysm and SAH are ruptured aneurysm and trauma.trauma.
Case 6 Case 6 Give the diagnosis in a) Give the diagnosis in a) and b)and b)
b)a)
On picture a) there is a right crescentic On picture a) there is a right crescentic hyperdense collection in keeping with hyperdense collection in keeping with an acute subdural hematoma. It is an acute subdural hematoma. It is causing subfalcine herniatoncausing subfalcine herniaton
On picture b) there is a lentiform On picture b) there is a lentiform collection in the left frontal lobe in collection in the left frontal lobe in keeping with an epidural hematoma. keeping with an epidural hematoma. There is hemorrhagic contusion also in There is hemorrhagic contusion also in the left parietal lobe.the left parietal lobe.
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