Image Based Questions On Neurology

Diagnosis: Neurocysticercosis

NCCT image shows a ring enhancing lesion which can be either Tuberculoma or Neurocysticercosis · Hypodensity inside the ring enhancing lesion which is the scolex of the worm that is developing which suggest neurocysticercosis · Peri-lesional edema can be seen: Reduced by giving dexamethasone · Late presentation: Starry sky pattern · Patient will have Generalized tonic clonic seizure.

Diagnosis: Multiple Sclerosis 

MRI brain shows hyperdense periventricular finger like projection known as Dawson fingers Clinical features:

1. Paraesthesia
2. Pin and needle sensation
3. Multifocal pain
4. Optic Neuritis

Diagnosis: Prion Disease

Variant Creutzfeldt Jakob Disease - It is the progressive neuropsychiatric illness for 6 months with psychiatric symptoms usually preceding the neurological symptoms.

EEG shows periodic sharp wave complexes o Brain MRI shows bilateral symmetrical pulvinar high signal intensity (relative to the signal intensity of the other deep gray matter nuclei and cortical gray matter). MRI findings are: ® Pulvinar Sign ® Hockey stick sign ® Cortical ribboning o Positive findings on tonsil biopsy (biopsy not routinely recommended) ® CSF study tau protein has the best sensitivity (80%) and specificity (94%) of any of the proteins investigated in variant CJD ® The detection of CSF 14-3-3 is nonspecific o Postmortem brain biopsy shows multiple florid plaque with severe spongiform change and neuronal loss.

Diagnosis: Progressive Supranuclear Gaze Palsy 

·A variant of Parkinsonism disease. Clinical presentation suggest Atypical Parkinsonism i.e. resting tremors and fesinating gait are absent · MRI brain showing Humming Bird appearance.

Diagnosis: Sturge Weber Syndrome 

Clinical presentation: Portwine stain, focal seizures · CT Head: Tram-track appearance (Vascular malformation in brain). Confetti lesions o Hypomelanotic macules are seen on the case of tuberous sclerosis.

Diagnosis: Subarachnoid Hemorrhage 

 Thunderclap headache · Bleed in Sylvian fissure: NCCT Head. SAH can have 2 atypical features - Hyponatremia: Due to excessive BNP and  ECG findings of QT prolongation and T wave inversion: Due to catecholamine excess · IOC: NCCT showing Blood in Sylvian fissure.M/C CN involved: 3 CN in both ruptured and unruptured berry aneurysm.

Diagnosis: Knee Jerk. The examiner is performing the test wrongly. Quadriceps femoris muscle is covered and should be exposed during test performance.

Diagnosis: SCLC, Brain Metastasis 

Chest X-ray: Showing mass in the right lung · CECT chest: Ventricular dilaon · Calcified lesions most likely of metastasis · Early morning headache ICP.

Diagnosis: Normal Pressure Hydrocephalus

Triad (This is a idiopathic condition) Dementia, Ataxia/gait apraxia , Urinary incontinence. Other points : Dementia due to pressure on the grey matter due to ventricular dilation. Ataxia is due to pressure on cerebellum. Urinary incontinence is pressure on frontal lobe and damage to paracentral lobule. Gait apraxia is due to pressure on frontal lobe.

Diagnosis: Tuberous Sclerosis

Image shows acneiform lesions in Butterfly distribution: Adenoma sebaceum · NCCT shows Periventricular lesions: Sub ependymal Astrocytoma · 

Diagnosis: Pantothenate Kinase-associated Neurodegeneration

CT Head: Eye of Tiger appearance. Iron deposition in putamen in brain. It is a neurodegenerative disorder K/a Hallevorden - Spatz disease.

Hutchinson Pupil 

On shining the torch on the eye of the patient, on one side the pupil is constricting while on Contralateral side pupil shows a sluggish reaction to light · It is ipsilateral to the ICH.

Diagnosis: Chronic Subdural Hematoma

Hypodensity · CT head shows concavo-convex bleed on the le side; is more black in colour [Hypodensity] appears late. Hence, it is Chronic SDH. · Chronic Epidural Hematoma: Biconvex bleed will be seen (Black appearance in the image shows that the blood is getting absorbed).

Diagnosis: Absence Seizures

Characteristics of absence seizures · EEG shows 3/second spike and slow wave pattern · In Juvenile myoclonic seizure, there will be 4-6 polyspikes pattern.

Burst Suppression Pattern 

Mixture of sharp and slow waves periodically interrupted by episodes of suppression · Typically the period of suppression are longer ( typically 5-10 sec) than the burst of activity (typically 1-3 sec) · Causes - Coma ,Hypothermia, Drug intoxication, Childhood encephalopathies,Prolonged anesthesia.

Diagnosis:  Oppenheim Sign 

Oppenheim sign - Variation of Babinski sign · Dorsiflexion of great toe and fanning of toes · Stroking the skin in the downward direction.

Tuberous Sclerosis Complex

Image I: Adenoma sebaceum also k/a Angiofibroma · Image II: Nail showing fleshy growth is Subungual fibroma.

The NCCT head image is showing left intra-parenchymal hemorrhage.

M/c involves lenticulostriate artery-branch of middle cerebral artery. · Manifestation will be of capsular stroke rather than cortical stroke. · That is, features such as apyrexia, aphasia etc. are not seen; is either sensory or motor manifestations.

Diagnosis: Skeletal Fluorosis 

In Neurolathyrism and Tropical spasctic para-paresis, patient will not be able to walk. · Gullian- Barre syndrome is a condition with Flaccid paraplegia; so it is impossible to walk.

Diagnosis: Marfan syndrome 

Steinberg sign: The thumb projects beyond the border of the ulna while completely opposed within the Clenched hand, also known as Thumb sign.

Diagnosis: Cryptococcus Neoformans in HIV Positive Patients.

MRI showing: Soap Bubble appearance · DOC: Amphotericin B

Diagnosis: Pontine Glioma 

Image shows lesion in the area of the pons suggesting pontine Glioma · Cerebellar astrocytoma and pinealoma can be ruled out as lesion is in pons · Both Craniopharyngioma and Pinealoma can be ruled out as they present with intracranial calcification.

Internal Carotid Artery

The blood vessel marked in the image is the Internal carotid artery.  The thickest blood vessel in the brain circulation.

Mulple Sclerosis

• Electrophoresis in brain is used to see antibodies against myelin.
• Multiple sclerosis is the only brain condition in which CSF electrophoresis is done.

Hope you found this blog helpful for your NEET SS Medicine Neurology Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.