cns mocks radiology fcps
TRANSCRIPT
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CNS MOCKS 2016
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Tuberculous brain abscess
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TB abscess..pic from net
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Close lip schizencephaly
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Schizencephaly..pics from net
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Agenesis of corpus callosum and frontal encephalocele.
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net pics.
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Meningioma and schwanoma ..NF2
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Multiple sclerosis
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MS..pics from net
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Epidermoid cyst
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Fourth ventricle epidermoid cyst showing diffusion restriction..pic from net
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Bithalamic glioma
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Bilateral thalamic glioma..Pics from net
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Extradural lymphoma
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Periventricular leukomalacia
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PVL..net pics
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Post reversible encephalopathy syndrome
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PRES..pics from net
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Herpes encephalitis
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pics from net.
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AVM
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Craniopharyngoma
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Aqueductal stenosis
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Low grade glioma
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Porencephalic cyst
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Hot cross bun sign pons
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• 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)
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Thyroid ophthalmopathy cocola bottle sign
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Meningioma occipital region..welldefined radiopaque lesion with smooth ring calcification and internal calcifications
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Countre coup injury
• Right subgaleal hematoam,left subdural hematoma,rt temporal fracture,ossicular chain disturbed
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Rt optic nerve tram track calcifications.......Meningioma
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Pachygyria and band heterotopia
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Epidermoid cyst• posterior fossa lesion
showing diffusion restriction.
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Thyroid ophthalmopathy left eye
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Meningitis sequelae
• Multiple contrast enhancing confluent lesions in cerebellum compressing 4th ventricle with dilatation of lateral and 3rd ventricle and periventricular csf seepage
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Early left MCA infarct..PWI shown
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Cranial USg..periventricular leukomalacia..dilated ventricles and periventricular multiple cystic lesions..DD is ischemic insult.Stages of PVL?
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Extradural arachnoid cyst
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Astrocytoma ..long segment involved..
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Intradural extramedullary posterior lesion ,,with dense homogenous enhancement and dural tail..Meningioma..DD is neurofibroma
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Pachymeningeal enhancement..
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Plain CT..history of fever no headache..Hyperdense areas in sulcal spaces with effacement of gyri and sulci..meningitis exudate.
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Child history of premature birth..PVL ..Dilated ventricles with irregular outline.Brain atrophic changes..sulci almost reaching the lateral ventricles.
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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
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Right CP angle lesion.meningioma.DD is schwanoma
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Sialadenitis..Left submandibular gland enlarged with fat stranding..calculus in anterior half of floor of mouth in distal duct..not shown here.
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Caroticocavernous fistula..Linear flow void in left orbit ..dilated ophthamic vein.Confirm on DSA..
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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.
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Abnormal signals in right maxillary.clivus heterogenous ,pterygoids asymmetric,.next image showed altered signals left temporal bone and underlying brain..osteomyelitis...Fubgal if diabetic
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High signals from spinal cord anteriorly...Vit B12 deficiency DD is HIV ,syphilis
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Well defined hyperdense lesion in interhemispheric region..DD is ACOM aneurysm,hematoma,meningioma
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Multiple lytic lesion in skull with one of them at left frontal is showing cortical breach.DD is mets,multiple myeloma
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Fahrs disease..Hyperdense areas in basal ganglia.
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Ct plain..hyperdense areas in sulcal spaces and loss of gray white matter differentiation,,SAH
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Early infarct right basal ganglia loss of gray white matter differentiation..improved image with window settings,,window level 32..window width 8.
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Supratentorial cystic lesions DD
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PCOM aneurysm
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In sulcal spaces air or fat density.
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Subependymal nodules and subependymal giant cell astrocytoma in tuberous sclerosis
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Left frontal sinus dense and expanded..mucocele
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Spina bifida with diastometamyelia
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Next MRI to confirm
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Bilateral symmetrical hyperintense signals in thalami and brain stem..wilson disease..next ceruloplasmin level which is low
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Wilson disease..pic from net
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Wernicks syndrome..Thiamine deficiency..next DWI to differentiate from ischemia due to artery of percheron infract
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wenickes korasokoff syndrome..pic from net.
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wide prevertebral space..vertebra endplates and discs normal.Hypopharyngeal CA further CT or MRi
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Multiple hypointense tiny signals on GRE..bleeds of different ages..amyloid angiopathy.pt age is 60yrs.
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Encephalitis like japanese..hemorrhagic component,no edema or compression effect..
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1)multicystic lesion both orbits in intra and extraconal compartment causing proptosis with micopththalmia....lymphangioma...2)molar tooth sign..joubart syndrome
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choanal atresia
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choanal atresia..pics from net
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Right temporoparital old infarct..encephalomalaciaMultiple lesions high on T1 and low on Flair and T2 with surrounding edema..melanoma mets
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Fracture of C2 vertebra causing narrowing of cervicomedullary junction..type 2 fracture
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Semilobar holoprosencephaly,cleft palate,hypotelorism,craniosynostosis
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Giant cisterna magna..and AVM right parietal region.feeding artery is MCA and draining in superficial cortical veins
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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.
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Right hemisphere atrophy with dialed ventricles.calvarial thickening same side..Dyke davidoff DD is sturge weber,rasmussen encephalitis.
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Ranula..eccenteric lateral cystic lesion arising from sublingual gland
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Ranula..pics from net
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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
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History of trauma to eyeball 15 yrs back surgery..hydrocephalus..pneumocephalus.
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Choline peak
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NAA peak only in one leukodystrophy..canavan
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