CNS MOCKS 2016

Tuberculous brain abscess

TB abscess..pic from net

Close lip schizencephaly

Schizencephaly..pics from net

Agenesis of corpus callosum and frontal encephalocele.

net pics.

Meningioma and schwanoma ..NF2

Multiple sclerosis

MS..pics from net

Epidermoid cyst

Fourth ventricle epidermoid cyst showing diffusion restriction..pic from net

Bithalamic glioma

Bilateral thalamic glioma..Pics from net

Extradural lymphoma

Periventricular leukomalacia

PVL..net pics

Post reversible encephalopathy syndrome

PRES..pics from net

Herpes encephalitis

pics from net.

AVM

Craniopharyngoma

Aqueductal stenosis

Low grade glioma

Porencephalic cyst

Hot cross bun sign pons

• The hot cross bun sign refers to the MRI appearance of the pons in a variety of neurodegenerative diseases.

• T2 hyperintensity forms a cross on axial images through the pons, representing selective degeneration of pontocerebellar tracts. It has been described in 1:

• multiple-system atrophy (MSA)• spinocerebellar atrophy types 2 and 3• parkinsonism secondary to vasculitis• variant Creutzfeldt-Jakob disease (vCJD)

Thyroid ophthalmopathy cocola bottle sign

Meningioma occipital region..welldefined radiopaque lesion with smooth ring calcification and internal calcifications

Countre coup injury

• Right subgaleal hematoam,left subdural hematoma,rt temporal fracture,ossicular chain disturbed

Rt optic nerve tram track calcifications.......Meningioma

Pachygyria and band heterotopia

Epidermoid cyst• posterior fossa lesion

showing diffusion restriction.

Thyroid ophthalmopathy left eye

Meningitis sequelae

• Multiple contrast enhancing confluent lesions in cerebellum compressing 4th ventricle with dilatation of lateral and 3rd ventricle and periventricular csf seepage

Early left MCA infarct..PWI shown

Cranial USg..periventricular leukomalacia..dilated ventricles and periventricular multiple cystic lesions..DD is ischemic insult.Stages of PVL?

Extradural arachnoid cyst

Astrocytoma ..long segment involved..

Intradural extramedullary posterior lesion ,,with dense homogenous enhancement and dural tail..Meningioma..DD is neurofibroma

Pachymeningeal enhancement..

Plain CT..history of fever no headache..Hyperdense areas in sulcal spaces with effacement of gyri and sulci..meningitis exudate.

Child history of premature birth..PVL ..Dilated ventricles with irregular outline.Brain atrophic changes..sulci almost reaching the lateral ventricles.

Post contrast T1w axial ..Lesion crossing opposite side ,midline shift ,involving corpus callosum..DD is GBM and Lymphoma..Next we will do MRS ..In GBM more choline peak than lymphoma

Right CP angle lesion.meningioma.DD is schwanoma

Sialadenitis..Left submandibular gland enlarged with fat stranding..calculus in anterior half of floor of mouth in distal duct..not shown here.

Caroticocavernous fistula..Linear flow void in left orbit ..dilated ophthamic vein.Confirm on DSA..

DSA ICA was normal ..Next External carotid angiogram showed fistula and dilated ophthamic vein

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Suprasellar lesion..craniophrangoma iso on T1 hyper on T2..sella is normal.

Abnormal signals in right maxillary.clivus heterogenous ,pterygoids asymmetric,.next image showed altered signals left temporal bone and underlying brain..osteomyelitis...Fubgal if diabetic

High signals from spinal cord anteriorly...Vit B12 deficiency DD is HIV ,syphilis

Well defined hyperdense lesion in interhemispheric region..DD is ACOM aneurysm,hematoma,meningioma

Multiple lytic lesion in skull with one of them at left frontal is showing cortical breach.DD is mets,multiple myeloma

Fahrs disease..Hyperdense areas in basal ganglia.

Ct plain..hyperdense areas in sulcal spaces and loss of gray white matter differentiation,,SAH

Early infarct right basal ganglia loss of gray white matter differentiation..improved image with window settings,,window level 32..window width 8.

Supratentorial cystic lesions DD

PCOM aneurysm

In sulcal spaces air or fat density.

Subependymal nodules and subependymal giant cell astrocytoma in tuberous sclerosis

Left frontal sinus dense and expanded..mucocele

Spina bifida with diastometamyelia

Next MRI to confirm

Bilateral symmetrical hyperintense signals in thalami and brain stem..wilson disease..next ceruloplasmin level which is low

Wilson disease..pic from net

Wernicks syndrome..Thiamine deficiency..next DWI to differentiate from ischemia due to artery of percheron infract

wenickes korasokoff syndrome..pic from net.

wide prevertebral space..vertebra endplates and discs normal.Hypopharyngeal CA further CT or MRi

Multiple hypointense tiny signals on GRE..bleeds of different ages..amyloid angiopathy.pt age is 60yrs.

Encephalitis like japanese..hemorrhagic component,no edema or compression effect..

1)multicystic lesion both orbits in intra and extraconal compartment causing proptosis with micopththalmia....lymphangioma...2)molar tooth sign..joubart syndrome

choanal atresia

choanal atresia..pics from net

Right temporoparital old infarct..encephalomalaciaMultiple lesions high on T1 and low on Flair and T2 with surrounding edema..melanoma mets

Fracture of C2 vertebra causing narrowing of cervicomedullary junction..type 2 fracture

Semilobar holoprosencephaly,cleft palate,hypotelorism,craniosynostosis

Giant cisterna magna..and AVM right parietal region.feeding artery is MCA and draining in superficial cortical veins

Dilated tortuous vessels(AVM)seen at MCA sylvian fissure level..supplied by MCA and drained by two veins superiorly in superior sagittal sinus and inferiorly in sigmoid sinus shown by arrows.

Right hemisphere atrophy with dialed ventricles.calvarial thickening same side..Dyke davidoff DD is sturge weber,rasmussen encephalitis.

Ranula..eccenteric lateral cystic lesion arising from sublingual gland

Ranula..pics from net

Increase in diploic space with decrease bone density..thalessemia...This is not hyperostosis frontalis which occur in late age and in that bone density is increased,,here pt is 15 yr old

History of trauma to eyeball 15 yrs back surgery..hydrocephalus..pneumocephalus.

Choline peak

NAA peak only in one leukodystrophy..canavan