Q Bank Neuro 01~100

Front 1

Silicon rubber band

Back 1

previous operation for retinal detachment

Front 2

Inferior sagittal sinus (angio)

Back 2

2008 05

Front 3

Sylvian vein (angio)

Back 3

superficial middle cerebral vein (SMCV) (also knwon as the Sylvian vein)

Front 4

Name the anatomy:
masticator m.
Submandibular gland
---------------------------------------------
a. cingulate gyrus b. insula
----------------------------------------------
septum pellucidium
venous angle of internal cerebral vein
==============================
Foramen rotundum
Pterygoid canal (= Vidian canal)

Back 4

2010 新光x3, 長庚

Front 5

artery of Percheron

Back 5

a solitary arterial trunk that arises from one of the proximal segments of a posterior cerebral artery and supplies the paramedian thalami and the rostral midbrain bilaterally. Occlusion of this artery results in bilateral thalamic and mesencephalic infarctions.

Front 6

Marginal tentorial artery (angio)

Back 6

Q: name the feeding artery of meningioma.

Branch of meningohypophyseal trunk
the artery of Bernasconi and Cassinari
runs posteriorly along the free (medial) margin, ascends and approaches the midlines as it progresses posteriorly
frequently enlarged in the presence of vascular tumors of the tentorium or other states, such as when involved with a dural arteriovenous malformation.

Front 7

Middle mengingeal artery origin of ophthalmic artery

Back 7

栓塞時, 風險為Blindness after embolization 。

(正常ophthalmic artery是從ICA發出, 而非ECA的middle meningeal artery)

Front 8

Angio:
(A): inferolateral trunk
(B): accessotry meningeal artery

Back 8

2010 奇美
考古彙整

Front 9

Onodi cell

Back 9

pneumatization of the most posterosuperior ethmoid air cells over the sphenoid sinus

Front 10

Physiological calcification

Back 10

CT: bil. BG, cerebellum (?)

Front 11

Posterior pituitary bright spot

Back 11

T1WI
an accumulation of neurosecretory granules consisting of an antidiuretic hormone (ADH)–neurophysin (carrier protein) complex, and these granules are packaged within the phospholipid membrane
Its presence in the posterior lobe indicates normal function of the infundibuloneurohypophyseal (INH) system. Any process that disturbs ADH transport from the hypothalamus to the posterior lobe has been known to result in accumulation of PPBS material in the pituitary stalk proximal to the obstruction

Front 12

Pterygomaxillary fissure, PMF (ct)

Back 12

Facial b. and temporal b.相關structures: Foramen ovale, Foramen spinosum, Carotid canal, Internal acoustic canal……

Front 13

Salivary gland ducts

Back 13

Parotid duct -- Stensen's duct
Submandibular duct -- Wharton's duct, submaxillary duct
Major sublingual duct -- duct of Bartholin, Bartholin's duct

Front 14

Soft palate, left

Back 14

Q: tumor位於哪個anatomic location

Front 15

32F, 請問箭頭所指的是實施那一條神經的 nerve block?

Back 15

32F, 請問箭頭所指的是實施那一條神經的 nerve block?

Front 16

The anterior falx artery is coming from Ophthalmic artery.

Back 16

The anterior falx artery is coming from Ophthalmic artery.

Front 17

Vallecula -- CSF space

Back 17

a deep depression between cerebellar hemispheres, lodges the posterior part of the medulla oblongata

Front 18

Virchow-Robin space

Back 18

小黃主任

Front 19

Acute disseminated encephalomyelitis(ADEM)

Back 19

D/D with MS

Front 20

adrenal leukodystrophy
Adrenoleukodystrophy

Back 20

sex-linked inherited dx
Innitial degeneration of deep white matter around the trigone of the lateral ventricles
Imaging features include symmetric posterior white matter involvement including the splenium, with a rind of enhancement along the advancing edges.

Front 21

X-linked Adrenoleukodystrophy

Back 21

X-linked adrenoleukodystrophy: severe progressive form, pre-teen males.
Adrenomyeloneuropathy: mild adult form, (spino-cerebellar form), 50% cerebral involvemnt

Inherited disorders of peroxisome metabolism  impaired β-oxidation of very long chain fatty acids
Images: enhancing (CT or MRI) peritrigonal demyelination [enhanced處為intermediate zone of inflammation, 正在progression]
symmetrical, confluent, posterior involvement, central (splenium) to peripheral gradient

Front 22

AIDS-related CNS infections

Back 22

HIV encephalitis (AIDS dementia complex)

Progressive multifocal leukoencephalopathy (PML)
2009 台大

Toxoplasmosis
2006 中國
2009 中國

CMV infection

Fungal infection
Cryptococcosis
2005 中榮, 2009 新光
Aspergillosis

Tuberculosis
Neurosyphilis
Bacterial infections
Immune reconstitution inflammatory syndrome

Primary CNS lymphoma

Front 23

Triad of Albright Syndrome
(McCune-Albright syndrome)

Back 23

Triad: café au lait macules, polyostotic fibrous dysplasia, and endocrine dysfunction with precocious puberty.

Front 24

Alexander’s disease
Fibrinoid leukodystrophy

Back 24

Sporadic leukoencephalopathy of unknown etiology
Age: as early as first few weeks of life

macrocephaly (Megalencephaly with massive deposition of Rosenthal fibers)
failure to attain developmental milestones, intellectual failure, progressive spastic quadriparesis
Location: frontal white matter gradually extending posteriorly into parietal region + internal capsule
(Predilection for the frontal white matter, BG, thalami and hypothalamus)
CT:
low-density white matter lesion
contrast enhancement near tip of frontal horn
MR:
prolonged T1 + T2 relaxation times
Prognosis: death in infancy / early childhood

DD: Canavna's disease, MPS

Front 25

Amyotrophic lateral sclerosis

Back 25

Bilateral hyperintensities along corticospinal tract extending from corona radiata to brainstem on T2W/PD/FLAIR
T2 hyperintense corticospinal tract may be specific for ALS when visible on corresponding PD images (most specific finding)

Front 26

Giant distal left ICA anuerysm with thrombosis;
Vertebral artery thrombosed aneurysm , /L't MCA???

Back 26

Large and giant aneurysms tend to thrombose, usually partially, keeping a residual lumen.
The thrombus as well as the wall of the aneurysm may calcify.
Plain film -- an eggshell calcification
CT -- better shows the entire aneurysm, iso- or hyperintense with different densities according to the extent of calcification. The residual lumen enhances markedly as well as the wall and sometimes the thrombus.
MRI -- complex signal pattern with an area of flow void corresponding to the residual lumen and patchy or laminated T1 hyperintensities due to methaemoglobin and T2 hypointensities due to haemosiderin. Following gadolinium injection different degrees of enhancement may be observed.
Angio -- mass effect

Front 27

Common location of Arachnoid cyst

Back 27

Common locations include the middle cranial fossa(50-60%), cerebral convexity, perisellar, retrocerebellar, cerebellopontine angle, and quadrigeminal plate cisterns.
same attenuation (on CT) or signal (on all MRI pulse sequences) as that of CSF.

Front 28

Extradural meningeal (arachnoid) cyst

Back 28

Arachnoid cyst is often located at the
Intradural space, rare at extradural
space, it should DDx with meningocele

Front 29

Arachnoiditis MR 特徵?
何種藥物易引起?

Back 29

Myodil: 舊式contrast用於myelography (in the 1960s and 1970s), 後被發現會引起adhesive arachnoiditis而導致chronic pain。
Arachnoiditis in myelography: thickened or clumped nerve roots, blockage of CSF flow, and the formation of CSF loculations
MR:
Loss of the ability to distinguish the roots in the thecal sac and obliteration of the root sleeves
Adhesion of the nerve root to the thecal sac (“empty sac”) or clumping together of the nerve roots

Front 30

AVM +venous aneurysm
AVM (CT, MR, angio)

Back 30

“bag of black worms”(flow voids) with minimal/no mass effect on MR
Ca++ in 25-30%
No normal brian inside.
DSA: enlarged arteries, nidus of tightly packed vessels, AV shunt ("early draining vein")

Front 31

AVM , left hemisphere

Back 31

Hemiatrophy of left hemisphere due to steal by AVM with numerous collaterals

Front 32

Ankylosing spondylitis with pseudoarthrosis; Andersson's fracture / Andersson lesion

Back 32

2007 08

Front 33

Avascular necrosis, vertebra (T8)

Back 33

need vertebroplasty
has enhancement, and low signal inside on T1WI, T2WI, indicating avascular necrosis with gas containing cavity inside.

Front 34

Baastrup's disease 特徵

Back 34

is characterized by close approximation and contact of adjacent spinous processes (kissing spine) with resultant enlargement, flattening, and reactive sclerosis of apposing interspinous surfaces.

Front 35

Binswanger disease

Back 35

又名leukoariaosis, subcortical arteriosclerotic encephalopathy(SAE)
特徵: age > 60
degenerative changes in the periventricular white matter and lacunar infarcts in the basal ganglia.
subcortical white matter “U” fibers + corpus callosum are spared

Front 36

Brain abscess
Brain abscess and sinusitis

Back 36

central necrotic area is hyperintense to brain tissue on T2-weighted sequences.
The thick somewhat irregularly marginated rim appears isointense to mildly hyperintense on spin-echo T1-weighted images and rim enhances intensely following contrast administration.
Peripheral edema is common.
Satellite lesions may be demonstrated.
DWI and ADC map show diffusion restriction

Front 37

First Branchial Cleft Cyst (5–8%)
= Parotid lymphoepithelial cyst

Back 37

Residual embryonic tract begins near submandibular triangle
+ ascends through the parotid gland, terminates at junction of cartilaginous + bony external auditory canal

Age: middle-aged women

enlarging mass near lower pole of parotid gland
recurrent parotid abscesses
± facial nerve palsy
otorrhea (if cyst drains into EAC)

Front 38

2nd branchial cleft cyst (95%)

Back 38

Incidence: 95% of all branchial cleft anomalies

= incomplete obliteration of 2nd branchial cleft tract (cervical sinus of His) resulting in sinus tract/fistula/cyst (75%)
Age: 10–40 years; M = F
anywhere along a line from the oropharyngeal tonsillar fossa to supraclavicular region of neck
Type II (most common)-- Classically at anteromedial border of SCM muscle + lateral to carotid space + at posterior margin of submandibular gland

CT/MR:
“beak sign” = curved rim of tissue pointing medially between internal + external carotid arteries (PATHOGNOMONIC)
slight enhancement of capsule

Front 39

Capillary hemangioma, orbit

Back 39

poorly-marginated, uniformly-enhancing
tumor of infants, grows during first year of life
most spontaneously regress
steroid therapy is effective
most commonly superomedial extraconal location

Front 40

Carotid cavernous dural arteriovenous fistula (DAVF)

Back 40

Numerous fine fistulas contribute to left cavernous sinus from bilateral ICA and ECA branches
Early venous drainage of left inferior petrosal sinus and jugular vein

Front 41

Caudal regression syndrome with syringohydromyelia

Back 41

abnormal mesodermal formation of the caudal cell mass (possibly from hyperglycemia)
occurs most often in children of diabetic mothers
associated with various other genitourinary, anal, vertebral, and limb anomalies
The seocrest form is sirenomelia (mermaid syndrome).

Imaging:
Group 1:
a blunt, deformed conus medullaris that terminates above the normal level of L1
sometimes associated with a dilated central canal or a cerebrospinal fluid–filled cyst at the lower end of the conus
have major sacral deformities
Group 2:
the conus medullaris is elongated and tethered by a thickened filum terminale or intraspinal lipoma and ends below L1
neurologic disturbances are more severe

Front 42

Cavernous malformation (cavernoma, cavernous angioma), brain

cavernous malformation, cavernoma, cavernous angioma

Back 42

“popcorn ball” with complete hemosederin rim
MR: reticulated “popcorn-like” lesion – mixed signal core, complete hemorsiderin rim, locules of blood with fluid-fluid levels, minimal or no enhancement
bleeding, variable maturation of blood products.
most common angiographically "occult" vascular malformation. slow intralesional flow without AV shunting.
Location: cerebrum (mainly subcortical) > pons > cerebellum; solitary > multiple

Front 43

Cavernous hemangioma, orbit, lat. Neck?; (ct+angio)
Cavernous hemangioma at pons with hemorrhage.
Cavernous hemangioma of right orbit; (ct+mr)

Back 43

S/S: painless proptosis
20 ~40 years; F > M
most common intraorbital tumors found in adults

Front 44

Cavum septum pellucidum (CSP)

Back 44

These CSF collections are termed cysts if their size is >1cm tranversely.
CSP and CV are due to the persistence of normal fetal vavities.

separation of the leaflets of the septum pellucidum anteriorly without posterior extension
nearly 100% of neonates and 3-20% of adults.
obliterated by the age of 3-6months

Front 45

Cavum vergae (CV)

Back 45

separation of the leaflets of the septum pellucidum with posterior extension to the splenium of the corpus callosum
in 30% of neonates and 1-3% of adults.
(rapidly closes with age)
is a posterior extension of the CSP and never occurs without one. (必和CSP伴隨出現)

Front 46

Cavum velum interpositum (CVI)

Back 46

anterior extension of the quadrigeminall plate cistern
lined by pia matter and containes the internal cerebral veins, the posterior medial choroidal artery, and CSF.
distenctive triangular configuration on axial images with apex directed anteriorly toward the columns of the fornix, but never beyond.
on coronal and saggital planes, CVI below the fornix
(D/D: CV--depress the body of fornix inferiorly from above)

Front 47

central neurocytoma
Intraventricular Neurocytoma
Intraventricular neuroblastoma

Back 47

"bubbly" mass in frontal horn/body of lateral ventricle, attached to septum pellucidum. Not invade adjacent parenchyma.
50% calcification
Hydrocephalus common
MRS: large Cho peak

Young adult (20-40y)
Patho: immunopositive for synaptophysin

Front 48

Centropontine myelinolysis;
Central pontine myelinolysis (osmotic demyelination syndrome)
Osmotic myelinolysis

Back 48

demyelinating disorder recognized in alcoholic, debilitated, or malnourished persons with rapid correction of hyponatremia.
rapid shift in serum osmolarity (最常見: iatrogenic correction of hyponatemia, > 12mmol/L/day)
deteriorates subacutely (usually within a few days) to coma, quadriparesis, pseudobulbar palsy, and extrapyramidal motor symtoms.
central pons T2 hyperintensity with sparing of periphery & BG, WM high SI
In the pons, the T2WI exhibits high intensity with sparing of the outermost tegmentum and a peripheral rim of ventral pontine tissue.
Sparing descending corticospinal tracts.
May involve extrapontine structures including the thalamus, putamen, caudate nuclei, interna/external/extreme capsules, claustrum, amygdala, cerebellum.
MR:
T1WI:
acute: can be normal/slightly hypointense
subacute: may be hyperintense at 1-4months
T2WI, FLAIR:
acute: confluent hyperintensity
subacute: hyperintensity normalizes
Contrast: usually doesn't enhance

Demyelination without inflammatory response, with sparing of the blood vessels, most nerve cells, and axons.

Front 49

Cephalohematoma

cephalhematoma

Back 49

Usually in the parietal region > occipital > frontal.
May not be visible at birth but should appear by day 2-3.
traumatic subperiosteal hematomas of the calvaria (between the skull and the periosteum)
bounded by the outer layer of the periosteum and the sutures so they do not cross the midline.
crescent-shaped lesions adjacent to the outer table of the skull.
Chronic cephalohematomas may calcify and appear hyperattenuating at CT.
approximately 1%–2% of spontaneous vaginal deliveries, 3%–4% in forceps- or vacuum-assisted deliveries.
tend to increase in size after birth and manifest as a tense and firm mass, occasionally with an underlying skull fracture.
Cephalohematomas resolve spontaneously.

Front 50

Chance fracture, Flexion distraction fracture, Seat belt fracture

Back 50

Compression fx with posterior element involvement

Front 51

Choanal atresia

Back 51

part of CHARGE syndrome?

Front 52

Chondroma, skull(mr)

Back 52

Off-midline, heterogenous whorl enhancement

Front 53

Chondrosarcoma, skull base

Back 53

usually arises in the parasellar area, cerebellopontine angle, or paranasal sinuses. And clivus.
most common in men in the fourth decade of life
Off mid-line
Chondroid calcifications: whorl, stippled, finely speckled, amorphous, ringlike
low to intermediate SI on T1WI, high on T2WI, marked enhance
D/D: chordoma, paraganglioma and metastasis.

Front 54

Chordoma, sacrum//coccyx/sacrococcygeal

Back 54

Mass lesion at the sacrococcygeal region with bony destruction

Front 55

Chronic idiopathic demyelinating polyneuropathy

Chronic inflammatory demyelinatiing polyneuropathy (CIDP)

Back 55

Acute form: GBS (Guillain-Barre syndrome)

possible due to autoimmune mechanism
does not follow a flu-like illness or vaccination (different from GBS)
presence of relapsing or progressive sensorimotor deficit.
MRI: enlargement and abnormal T2W high SI of the nerve roots of the cauda equina and proximal peripheral nerves as well as cranial nerves. Gd enhancement of the nerve roots is mild to moderate.

Front 56

何謂Clay shoveler's fracture

Back 56

C7 fracture

Front 57

Cleidocranial dysplasia
Cleidocranial dysostosis

Back 57

The collarbones are partly or completely missing.
The fontanelles of the skull are late in closing, or never close.
Extra teeth.
Permanent teeth not erupting(長出).
Bossing (= bulging) of the forehead.

Front 58

Classification of Chiari malformation

Back 58

Chiari I malformation : peg-like cerebellar tonsils displaced into the upper cervical cancal through the foramen magnum
Chiari II malformation : displacement of the medulla, fourth ventricle and cerebellum through the foramen magnum, usually with associated myelomeningocoele
Chiari III malformation: features of Chiari II with occipital and / or high cervical encephalocoele

Front 59

Chiari I malformation

Chiari I Malformation & Syrinx

Back 59

Low-lying (>5mm below foramen magnum), pointed (not round), "peg(釘子)-like" tonsils with vertical (not horizontal) sulci
Short clivus
Spine: syrinx, low/tethered cord, fatty filum
NOT associated with myelomeningocele!
no symptoms in childhood (unless associated with hydrocephalus / syringomyelia)
"Chiari I spells": cough/headache/ sneeze/syncope

A/W malformation of skull base + cervical spine
10% with Klippel-Feil anomaly
hydrocephalus (25–44%)

Front 60

Arnold-Chiari II malformation (/fetal MRI)

Back 60

a/w neural tube closure defect, usually lumbar myelomeningocele
Small posterior fossa--> contents shifted down into cervical spinal canal
compressed/elongated/low 4th ventricle
Dysgenetic corpus callosum in 90%
Colpocephaly—abnormal enlargement of occipital horns
Large massa intermedia
obstructive hydrocephalus (50–98%) following closure of myelomeningocele