NEUROANATOMY
Which cranial nerve is the only one to exit the brainstem dorsally?
Trochlear Nerve (CN4)
Which scale, ranging from 3 to 15, is used to assess level of consciousness in trauma and guides urgency of neurosurgical intervention?
Glasgow Coma Scale (GCS)
A pituitary macroadenoma grows upward and compresses the optic chiasm. Which visual-field defect is most likely?
Bitemporal hemianopia
A 70 year old man on warfarin falls and hits his head. He initially seems fine, but three weeks later presents with headache and mild confusion. CT is obtained. Identify the pathology.
Chronic subdural hematoma
This benign tumor of Schwann cell origin, when arising bilaterally on the vestibulocochlear nerves, is pathognomonic for which genetic syndrome?
Neurofibromatosis type 2 (NF2)
Which limbic white matter tract carries efferent output from the hippocampal formation, arching beneath the corpus callosum before terminating primarily in the mammillary bodies, forming a key link in the Papez circuit?
FORNIX
Which CSF diversion procedure is the definitive treatment for communicating hydrocephalus?
Ventriculoperitoneal (VP) shunt
Which pediatric posterior fossa tumor typically arises from the roof of the fourth ventricle, enhances avidly, and shows restricted diffusion due to high cellularity?
Medulloblastoma
A 24 year old man presents with dysarthria, tremor, and personality change. Slit-lamp exam reveals a rust-colored ring around the periphery of his cornea. MRI of the midbrain is shown. Name the underlying disease and the radiologic sign.
Wilson disease — "giant panda sign"
A 12 year old boy has headaches and looks down more than usual, unable to look up voluntarily. Exam shows convergence-retraction nystagmus on attempted upgaze and pupils that constrict to accommodation but not to light. MRI reveals a mass compressing the dorsal midbrain. What pathology is this?
Parinaud Syndrome
An intervertebral disc has two components: a gelatinous notochord-derived center, and a surrounding ring of concentric fibrocartilage layers with alternating fiber orientation that contains it. Name both structures.
Nucleus pulposus (center) and annulus fibrosus (surrounding ring)
Which surgical emergency, presenting with saddle anesthesia, urinary retention, and bilateral leg weakness from a large central disc herniation, requires decompression within 24 to 48 hours to maximize recovery?
Cauda Equina Syndrome
58 year old woman presents with a six month history of progressive personality change and gradual left leg weakness. MRI shows a well circumscribed, dural based, homogeneously enhancing extra-axial mass with a "dural tail" sign compressing the right parasagittal frontal lobe. Resection is performed, and histopathology shows whorled cell nests with laminated calcified concretions. This finding is consistent with what diagnosis?
MENINGIOMA
A 30 year old woman with relapsing episodes of vision loss and limb weakness over several years undergoes MRI of the brain and spine. MRI is shown. Name the disease and the radiologic sign visible on this image.
Multiple Sclerosis, Dawsons Fingers
Which autosomal dominant syndrome, predisposes to hemangioblastomas of the cerebellum and retina along with renal cell carcinoma and pheochromocytoma?
Von Hippel-Lindau (VHL) disease
Three separate foramina in the middle cranial fossa transmit the three divisions of the trigeminal nerve. Name all three, matched to their respective divisions.
Superior orbital fissure (V1), foramen rotundum (V2), foramen ovale (V3)
During a posterior lumbar interbody fusion, the surgeon must retract the thecal sac and traversing nerve root medially to access the disc space, working within a triangular anatomic corridor bounded by the traversing nerve root, the exiting nerve root above, and the superior endplate of the vertebral body below. Name this surgical corridor.
Kambin's Triangle
For a highly emetogenic regimen, guidelines recommend a four drug combination for prevention: a 5-HT3 antagonist, dexamethasone, an NK1 receptor antagonist, and this additional agent, an atypical antipsychotic that also has antiemetic and appetite stimulating properties. Name this fourth agent.
OLANZAPINE
A 35 year old man presents with new onset headache and a single generalized seizure. He recently emigrated from a region where a specific parasitic infection is endemic. CT of the brain is show. What pathology is this?
Neurocysticercosis
Which eosinophilic, refractile, round to oval intranuclear or intracytoplasmic inclusion, seen in dying neurons following certain viral encephalitides, most classically herpes simplex encephalitis, represents accumulation of misfolded proteins within a specific cellular compartment?
Cowdry type A intranuclear inclusion bodies
Which obscure but high-yield structure, a thin sheet of gray matter located between the external capsule and the extreme capsule, is hypothesized (per Crick and Koch) to play a role in coordinating conscious perception across sensory modalities?
CLAUSTRUM
This surgical triangle, located in the middle cranial fossa, is the working corridor for the anterior petrosal (subtemporal transtentorial) approach to petroclival tumors. Name the three structures that form its boundaries.
Kawase's triangle — bounded by the oculomotor nerve (CN III), the free edge of the tentorium, and the petrous ridge (arcuate eminence/superior petrous apex)
Which paraneoplastic antibody, directed against a intracellular antigen expressed by cerebellar Purkinje cells and associated most strongly with gynecologic and breast malignancies, is one of the "classic" onconeural antibodies alongside anti-Hu and anti-Ri?
anti-Yo (PCA-1) antibody
A 45 year old man with HIV and a CD4 count of 60 presents with progressive gait imbalance, slurred speech, and right hand incoordination. Brain MRI shows a well-defined, non-enhancing T2-hyperintense, T1-hypointense lesion in the deep cerebellar white matter that sharply outlines the dentate nucleus. Name the sign, and the disease it indicates?
Shrimp sign — indicating progressive multifocal leukoencephalopathy (PML), from JC virus reactivation
A newborn delivered via vacuum-assisted vaginal delivery develops a diffuse, boggy scalp swelling that crosses suture lines. Over the next several hours, the swelling progressively extends laterally toward the ears and posteriorly toward the occiput, with increasing head circumference. The infant becomes pale and tachycardic, and hematocrit drops on repeat labs. What is the diagnosis?
Subgaleal hemorrhage