Neuroradiology (Brain Tumors, Stroke, Demyelinating, Congenital Anomalies) MCQs

Radiology · 54 free questions with answers & explanations.

1. A 42-year-old woman presents with progressive headache and visual deterioration. MRI brain shows a well-defined, homogeneously enhancing extra-axial mass attached to the dura at the sphenoid wing, with a CSF cleft between it and the brain, causing adjacent bone hyperostosis. What is the most likely diagnosis?
2. A 70-year-old hypertensive man collapses and is brought to the emergency department unconscious. Non-contrast CT head performed within one hour shows a hyperdense lesion in the right basal ganglia with surrounding low-density edema and midline shift. What is the most likely diagnosis?
3. A 35-year-old woman presents with an acute episode of right-sided weakness and blurred vision that partially resolved. MRI brain shows multiple ovoid T2-hyperintense lesions in the periventricular white matter oriented perpendicular to the lateral ventricles. On sagittal imaging, these lesions appear to extend along medullary veins. What is this pattern called and what is the most likely diagnosis?
4. A 55-year-old man presents with sudden-onset severe headache described as the 'worst headache of his life.' Non-contrast CT head shows hyperdensity filling the basal cisterns and sulci of the sylvian fissures symmetrically. Which diagnosis should be urgently confirmed?
5. A newborn is found to have a cystic posterior fossa mass on cranial ultrasound. MRI shows complete absence of the cerebellar vermis with the fourth ventricle communicating directly with a large posterior fossa cyst, and the posterior fossa itself is enlarged with upward displacement of the tentorium. Which congenital anomaly is this?
6. On MR spectroscopy of a brain mass, the presence of elevated choline, decreased NAA, and presence of a large lipid/lactate peak with absent normal metabolites is most consistent with:
7. A 45-year-old HIV-positive patient develops hemiparesis. MRI shows a solitary ring-enhancing lesion in the basal ganglia with surrounding edema. Thallium-201 SPECT shows a 'hot spot' in the lesion. The most likely diagnosis is:
8. Diffusion-weighted imaging (DWI) in acute ischemic stroke shows restricted diffusion because:
9. A young adult with severe headache has a non-contrast CT showing a small round hyperdense lesion in the right sylvian fissure region with surrounding edema. MRI shows a 'popcorn-like' lesion with a hemosiderin rim and mixed signal core. The diagnosis is:
10. Regarding MRI characteristics of multiple sclerosis plaques, which finding is MOST specific for active demyelinating lesions?
11. On MRI spectroscopy of a glioblastoma multiforme, which metabolite pattern is expected compared to normal brain tissue?
12. A 35-year-old woman with acute onset severe headache ('thunderclap') has normal CT head. Lumbar puncture is traumatic on the first attempt. Which MRI sequence most reliably detects subarachnoid haemorrhage in this scenario?
13. MRI of a 6-year-old child shows a posterior fossa cyst communicating with the fourth ventricle, enlarged posterior fossa, and hypoplasia/agenesis of the cerebellar vermis. What is the diagnosis?
14. On DWI (diffusion-weighted imaging), an acute ischaemic infarct appears bright (restricted diffusion) due to which mechanism?
15. A 40-year-old with relapsing-remitting MS has MRI showing a lesion adjacent to the corpus callosum on sagittal FLAIR, oriented perpendicular to the ventricular surface. This is known as:
16. MRI brain of a 40-year-old with seizures shows a well-defined lesion in the temporal lobe that is T1 hypointense, T2/FLAIR hyperintense, with no surrounding oedema, no mass effect, no post-gadolinium enhancement, and restricted diffusion is absent. The apparent diffusion coefficient (ADC) value is high. The most likely diagnosis is:
17. A 28-year-old female presents with relapsing-remitting neurological deficits. MRI brain shows multiple periventricular ovoid T2 hyperintense lesions oriented perpendicular to the lateral ventricles. These lesions are described as 'Dawson's fingers'. Gadolinium-enhancing lesions are present along with non-enhancing lesions. The dissemination in space and time criterion is met. What does enhancement in MS lesions specifically indicate?
18. A CT angiogram of the brain in a 55-year-old with sudden severe headache ('thunderclap') shows subarachnoid blood in the basal cisterns. The CT angiogram identifies a saccular aneurysm at the junction of the internal carotid artery and posterior communicating artery (PCoA). Which cranial nerve palsy is classically associated with this location of aneurysm?
19. MRI brain in a neonate with a history of perinatal asphyxia shows selective injury to the thalami and posterior putamen bilaterally, with involvement of the perirolandic cortex. This pattern of selective injury reflects vulnerability of which metabolic parameter during acute profound hypoxia-ischaemia?
20. A 45-year-old with NF1 presents for MRI brain. Multiple T2/FLAIR hyperintense foci are identified in the globus pallidus, thalamus, and cerebellar white matter that do not enhance and show no mass effect. These are called 'unidentified bright objects' (UBOs) or focal areas of signal intensity (FASIs). What is their histological substrate?
21. On MRI, a brain tumor shows restricted diffusion on DWI (bright DWI, dark ADC), suggesting high cellularity. Ring enhancement with a central necrotic core, mass effect, and surrounding FLAIR hyperintensity are noted. Spectroscopy shows elevated choline, decreased NAA, and a lipid-lactate peak. Which diagnosis is MOST consistent?
22. On DWI-MRI obtained 2 hours after acute stroke onset, an area in the right MCA territory shows restricted diffusion. On PWI (perfusion-weighted imaging), a larger area of reduced cerebral blood flow is noted. The DWI-PWI mismatch represents:
23. On MRI of a patient with multiple sclerosis, Dawson's fingers are best seen on which sequence and orientation?
24. On CT angiography, a patient with SAH has an aneurysm at the junction of the posterior communicating artery (PComA) and the internal carotid artery. The aneurysm is pointing postero-inferiorly. This direction of pointing indicates risk of:
25. On MR spectroscopy of a cerebral abscess, which metabolite peak is classically absent that is present in glioma?
26. On diffusion-weighted MRI (DWI), acute cerebral infarction appears as high signal. The corresponding apparent diffusion coefficient (ADC) map would show:
27. A 35-year-old patient with multiple sclerosis has a new brain MRI. Which MRI pulse sequence is MOST sensitive for detecting cortical and juxtacortical demyelinating plaques?
28. On unenhanced CT brain, a glioblastoma multiforme (GBM) classically appears as:
29. Which of the following MRI spectroscopy (MRS) findings at echo time 135ms is MOST characteristic of meningioma?
30. On CT angiography of the brain performed for subarachnoid haemorrhage, the 'spot sign' within an intracerebral haematoma refers to:
31. MRI brain shows an extra-axial lesion at the cerebellopontine angle with T1 hypointense, T2 hyperintense signal, restricted diffusion on DWI, and no enhancement post-gadolinium. The diagnosis is:
32. MRI brain of a 28-year-old woman shows multiple periventricular white matter T2/FLAIR hyperintensities perpendicular to the corpus callosum (Dawson fingers), with one open-ring enhancing lesion. CSF shows oligoclonal bands. The diagnosis and prognostically relevant lesion feature are:
33. Non-contrast CT head of a 55-year-old hypertensive shows a hyperdense lesion in the right basal ganglia (putamen) with surrounding oedema. The CT attenuation of the acute haematoma is approximately:
34. MRI brain shows bilateral symmetric T2/FLAIR hyperintensities in the medial thalami and periaqueductal grey matter in a malnourished chronic alcoholic admitted for confusion and ophthalmoplegia. The diagnosis and initial treatment are:
35. A 70-year-old hypertensive man presents with sudden severe headache. Non-contrast CT brain shows hyperdensity in the basal cisterns and interpeduncular fossa. MRI confirms subarachnoid hemorrhage. Subsequent CT angiography shows no aneurysm. Repeat MRI 3 days later shows T1 hyperintensity only in the perimesencephalic cisterns. What is the most likely diagnosis?
36. On MRI, a 45-year-old woman has multiple periventricular ovoid T2/FLAIR hyperintense lesions perpendicular to the ventricles, involving the corpus callosum ('Dawson fingers'), with some lesions showing central vein sign on susceptibility-weighted imaging (SWI). Which diagnosis do these features support?
37. A newborn MRI shows absence of the corpus callosum with 'racing car' or 'steer horn' appearance of the lateral ventricles on coronal view, parallel-running non-converging lateral ventricles on axial view, and a midline interhemispheric cyst. Gyri are seen extending medially toward the third ventricle ('radial spoke' pattern). What is this diagnosis?
38. On DWI-MRI, a 65-year-old woman with acute left hemiplegia shows a wedge-shaped area of restricted diffusion in the right MCA territory involving cortex and subcortical white matter. The ADC map shows a corresponding dark (low ADC) area. What is the earliest MRI sequence to show ischemic infarction, and what is the mechanism of restricted diffusion?
39. A 35-year-old man with neurofibromatosis type 2 (NF2) undergoes contrast MRI of the brain. Bilateral enhancing masses are found at the internal auditory meatuses, expanding bilaterally. Which tumor is pathognomonic of NF2?
40. A 45-year-old woman presents with progressive headache. MRI shows a T1 hypointense, T2 hyperintense ring-enhancing lesion in the white matter with surrounding oedema and an inner hypointense rim on T2* (susceptibility-weighted imaging). Spectroscopy shows elevated choline, decreased NAA, and a lipid/lactate peak. What is the most likely diagnosis?
41. DWI-MRI of a patient with acute right-sided weakness shows diffusion restriction in the left posterior limb of internal capsule with corresponding ADC map hypointensity. At what time window after symptom onset is DWI most sensitive for ischaemic infarction?
42. A posterior fossa MRI shows a midline T1 hypointense T2 hyperintense cyst communicating with the fourth ventricle, with complete vermian agenesis and a large posterior fossa with elevation of the torcular herophili. What is the diagnosis?
43. A 32-year-old woman with relapsing sensory symptoms and optic neuritis has MRI brain showing periventricular ovoid T2/FLAIR lesions perpendicular to the lateral ventricles. What is the name of this sign and what condition does it indicate?
44. A 70-year-old hypertensive man presents with sudden onset severe headache described as 'the worst headache of his life.' CT brain performed 2 hours after onset is reported as normal. Lumbar puncture shows xanthochromia. What is the gold-standard next investigation to identify an underlying vascular cause?
45. MRI brain of a 35-year-old woman presenting with relapsing and remitting neurological symptoms shows multiple oval lesions in the periventricular white matter oriented perpendicular to the corpus callosum on a sagittal FLAIR sequence, along with a lesion in the posterior limb of the internal capsule and a juxtacortical lesion. What is this periventricular perpendicular orientation sign called and what diagnosis does it support?
46. A 60-year-old man with known atrial fibrillation presents with sudden left hemiplegia 1.5 hours after onset. Non-contrast CT brain is performed. An ASPECTS score is calculated by evaluating 10 regions of the MCA territory. Which two regions form the subcortical component of the ASPECTS scoring?
47. A neonate presents with seizures on day 3 of life. MRI brain shows bilateral symmetrical signal abnormality involving the posterior limb of the internal capsule, ventrolateral thalami, basal ganglia, and perirolandic cortex on DWI and T1-weighted sequences with corresponding restricted diffusion. What pattern of injury does this represent and what is the most common underlying cause?
48. A 45-year-old woman presents with progressive headache and diplopia. MRI brain shows a well-defined extra-axial mass in the left parasellar region. The mass is isointense to grey matter on T1 and T2, shows homogeneous avid enhancement with gadolinium, and a dural tail is noted extending from its margins. There is no surrounding oedema. What is the most likely diagnosis?
49. MRI brain shows a ring-enhancing lesion in the basal ganglia with surrounding oedema in an HIV-positive patient with CD4 count of 50 cells/µL. The MOST likely diagnosis is:
50. MRI shows a mass at the cerebellar vermis in a 7-year-old child, which is isointense on T1, hyperintense on T2, shows restricted diffusion, homogeneous enhancement, and 'drop metastases' along the spinal cord. The MOST likely diagnosis is:
51. Diffusion-weighted MRI (DWI) shows restricted diffusion in a region of the brain. True restricted diffusion on DWI requires confirmation on which sequence to rule out 'T2 shine-through'?
52. MRI brain in a 35-year-old woman shows multiple ovoid periventricular T2/FLAIR hyperintense lesions perpendicular to the corpus callosum ('Dawson fingers'), juxtacortical lesions, and one infratentorial lesion. One lesion shows ring enhancement. These findings are MOST consistent with:
53. CT angiography of the brain in a 45-year-old with sudden severe headache shows an aneurysm at the junction of the internal carotid artery and posterior communicating artery (PComA). Which cranial nerve palsy is classically associated with this aneurysm's location?
54. In MRI of the brain, which sequence is MOST sensitive for detecting acute cortical vein thrombosis (cerebral venous sinus thrombosis)?