A 76 year old female presents today with progressive, severe low back pain. She has a history of osteoarthritis, type 2 diabetes, osteoporosis, hypertension, COPD, and osteoporotic compression fractures. Her last osteoporotic compression fracture was 2 years ago. She has been on alendronate since her last fracture. Pain is described as dull and achy, nine out of 10 in severity, without radiation pain. Her walking is limited due to her back pain. She denies any numbness or tingling into her lower extremities, or bowel or bladder incontinence at this time. On physical exam, there is point tenderness over her lower lumbar spine at the L4-L5 vertebral levels. Muscle strength examination of lower extremities is difficult to perform due to pain. However, plantar flexion and dorsiflexion muscle strength is 5/5 bilaterally, and lower extremity sensation is otherwise intact. Deep tendon reflexes for the L4, S1, are 2/4 bilaterally. Special tests cannot be performed to pain. Pain is elicited immediately upon the patient lying on her back. Kyphoplasty is being considered for the patient.

A sagittal T2-weighted image of a patient with a tethered cord is shown in this image. What is a characteristic of the pathology represented here?

A frontal view digital subtraction angiogram following a right carotid artery injection is shown in this image. What is the likely etiology of the lesion demonstrated?

The ventral cervical plate pictured below spans three vertebral levels, and reveals a pseudoarthrosis. It consists of two screw at each end that are rigidly affixed to the plate. Which of the following biomechanical properties best describe the type of fixation pictured in the radiograph that lead to the pseudoarthrosis?

Prognosa GBM dari paling baik ke paling buruk

A 64 year old Northern Indian man with past medical history of diabetes mellitus and heterozygous MTHFR gene mutation was brought by his son to the emergency department for fever, eye discharge on the right side, painful eye movement on the right side for three days. The patient also reported a headache and vision changes on the right side for two weeks which are unusual for him. He takes only metformin mg BID and insulin shots with meals. There is no significant family history. Blood pressure 110/65 mmHg, heart rate 105 bpm, and temperature 38.5 C. he is alert and oriented to person and place but not time, chemosis, periorbital edema and proptosis on the right eye and mild drooping of the right eyelid. There was poor effort during strength exam. The rest of the exam is unremarkable. WBC, ESR, CRP, and D-dimer are mildly elevated. CT head is unremarkable. Lumbar puncture is done with no WBCs but mildly elevated protein of 120 mg/dL. Brain MRI shows an isointense lesion in the right cavernous sinus close to cranial nerve III with a decreased caliber of the intracavernous internal carotid artery on T1 and hypointense mass on T2. the lesion was well enhanced on T1 contrast. MR angiography shows a cavernous sinus mass and occlusion of the intracavernous carotid artery on the right side.

Endoscopic view from within sphenoid sinus. Which one of the following labels identifies the Opticocarotid recess?

The husband of a 73 year old female calls emergency medical services (EMS) after noticing slurred speech and right-sided weakness in his wife. EMS personnel evaluates the patient and suspects a possible large vessel occlusion stroke using the Los Angeles Motor Scale. The patient’s last know normal was 30 minutes ago. According to the American Heart Association and American Stroke Association ‘Severity-Based Stroke Triage Algorithm for EMS’, to which of the following facilities should the patient be transported?

A 91 year old female becomes acutely unresponsive in her assisted living care facility. She is taken to the hospital for a stroke workup and found to have a right frontal intraparenchymal hemorrhage with intraventricular extension. The estimated blood volume of the hemorrhage is 65 mL. She takes warfarin for non valvular atrial fibrillation and has an INR of 2.1. She has reflux disease, and stress incontinence. On initial exam, her eyes do not open to painful stimuli, she moans and withdrawals to noxious stimuli in the right arm and has extensor posturing in the left arm with an extension of bilateral legs.

You plan to perform a foramen magnum decompression on the patient shown below. Which one of the following investigations may be helpful?

A 17 year old boy is brought to the emergency room following a motor vehicle collision with multiple fatalities. He is alert, awake, and oriented. He denies neck pain, has no midline tenderness, and does not have any other injuries. The neurologic exam is unremarkable. He has not used alcohol or drugs. What is the minimum radiographic study needed to clear the cervical spine?

Neurophysiological monitoring during translabrynthine resection of a vestibular schwannoma with minimal extension into the cerebellopontine angle includes which of the following?

BAER yang menghilang gelombang apa yang tidak

menimbulkan defisit secara klinis?

MRI kasus Vestibular schwannoma, grading Koos berapa?

Perusahaan trial obat, dalam populasi kecil terpilih, fase

apa? (clinical trial fase I)

Trial implantation boleh jadi permanen kalau

perbaikannya berapa persen?

Tumor metastasis yang paling radiosensitive adalah

What type of metastatic brain tumor generally is

considered radiosensitive to whole brain radiation therapy?

A 68 year old male with a history of prostate cancer presented with new-onset back pain. X-ray of the spine showed a mass in the bilateral T12 pedicles and vertebral body. He has a normal neurological examination. What is the appropriate next step in the management of this patient condition?

A 65 year old male patient undergoes craniotomy and clipping of an anterior communicating artery aneurysm. He was fully conscious and oriented on postoperative day 1. But the next day onwards, he starts refusing food, prefers to sleep throughout the day, and is not responding nicely to questions asked. A magnetic resonance imaging scan of the brain is ordered. An infarct in which of the following regions is the most likely cause of his behavioral problem?

Lateral SCIT, saat dibuka tampak lobus cerebellum apa?

Tumor di posterior ventrikel 3, akan sulit dicapai jika

menggunakan approach?

A 28 year old left handed female who is 14 weeks pregnants presented to the emergency department with worsening headache, vomiting and drowsiness. CT head scan showed a large right frontal tumor with significant edema. After 48 h of dexamethasone her headache has improved but she still has a mild left-sided arm weakness. Which one of the following would be most appropriate?

An 8 month old female child who previously fell from a changing table. She presented on referral form her pediatrician for evaluation of a left frontoparietal mass. Which on of the following management strategies is most appropriate?

A 55 year old male presents with progressive gait disturbance and impotence. Coronal Magnetic resonance angiogram and angiograms are shown in the lumbar spine. There is no evidence of hemorrhage. VHL screen is negative. Which one of the following diagnoses is most likely?

An 82 year old woman presents to the neurosurgery clinic with typical trigeminal neuralgia. She has substantial medical comorbidities and would like to avoid surgery. The patient opts for stereotactic radiosurgery. What factor would predict a favorable outcome?

What is the most common location for dural

arteriovenous fistulae to drain?

During an endonasal transsphenoidal approach, what structure limits the working space and maneuverability of the instruments?

How much of the superior sagittal sinus can be sacrificed without a high risk of inducing venous infractions?

A patient presents with a blunt cerebrovascular injury after a motor vehicle collision. The patient has no intracranial hemorrhage. CT angiogram reveals an internal carotid artery luminal irregularity with < 25% stenosis. What is the next step in the management of this patient?

A patient presents with subarachnoid hemomrrhage due to a ruptured aneurysm. What is the approximate risk of re-rupture over the next 14 days if the aneurysm is not treated?

A 58 year old right handed male presents with bifrontal headaches and a partial left opthalmoplegia. MRI results are shown. Biopsy revealed this tumor to be a chordoma. An extensive subtotal skull-based resection was performed. Which is the best choice for adjuvant therapy regimen?

Parkinsonian tremor can be diminished by high frequency stimulation of

Pasien perempuan, mata terdeviasi ke medial, tidak bisa ke lateral. Kalau berjalan kepala harus miring kekanan. Pertanyaan : lokasi MRI dimana yang tidak perlu dievaluasi?

Sebuah studi di suatu RS pada 30.000 orang pasien mengambil data dari tahun 2001 – 2008, didapatkan data. Metode penelitiannya adalah?

Pasien wanita post tindakan fusi L4-S1 10 minggu lalu datang dengan keluhan nyeri punggung. 1 minggu pasca operasi keluhan nyeri post fusi membaik 85%. Pemeriksaan apa yang perlu dilakukan pada pasien?

N VII terdorong oleh schwannoma vestibular ke arah?

Gambar MRI non kontras dan kontras potongan sagittal dan coronal. Tampak lesi di sella, ditanya mendorong pituitary ke arah mana?

Gambar sama dengan no 39, yang ditanya struktur yang ditunjuk panah

A 45 year old woman with intractable structural epilepsy who had experienced partial compex and secondarily generalize seizures form the age of 8 years. Coronal FLAIR MRI is shown. Which one of the following is most likely?

In the STASCIS trial (early versus delayed decompression for traumatic cervical spinal cord injury), 30% of patients were lost to follow-up at 6 months. Although this is typical for a trauma study, what type of bias could this represent?

A 17 year old female with a history of intravenous drug abuse presents with fever, back pain, and inability to ambulate. She has been experiencing back pain for the past 3 days. She reports that the weakness has been progressively worsening for the past 6 hours, and she is now unable to walk. On exam, the patient has reduced sensation on her umbilicus and 2/5 strength in her lower extremities bilaterally. Her temperature is 101 F (38.3 C), her respiratory rate is 17/min, and her pulse is 89 bpm. An MRI is obtained, and a contrast-enhancing lesion is note at T10-L1, which confirmed the diagnosis. Which of the following is the next best step in the management of this patient?

A 53 year old male had a left acoustic neuroma resected 5 months ago and has had severe, throbbing left-sided headaches that began the week of the resection. He rarely had headaches before surgery. His headaches are without associated symptoms and are not positional. The only relief he gets is from opioid analgesics. What is the next best step in management?

A 21 year old man presents with a brachial plexus avulsion type injury. What is the recommended treatment option?

According to the Food and Drug Administration (FDA), vagal nerve stimulation is indicated for use in partial-onset seizures refractory to medical therapy in patients of what age?

Which one of the following statements regarding fluorescein sodium is LEAST accurate?

Which one of the following statements regarding history of spine trauma is LEAST accurate?

Which one of the following is not a normal variant seen in

the pediatric cervical spine?

Axial noncontrast CT and T2-weighted MRI are shown in these images. What is the likely diagnosis?

Which one of the following condition is most likely?

What cistern contains the anterior choroidal artery, posterior cerebral artery, medial posterior choroidal artery, and basal vein of Rosenthal?

A 42 year old male presents with a 5 year history of Parkinson disease (PD) with severe motor fluctuations. What would be his expected benefit from deep brain stimulation?

Which form of systemic cancer therapy is associated with an increased risk of radiation necrosis after stereotactic radiosurgery for cerebral metastases?

During surgery, additional exposure is needed to access the upper petroclival region for tumor resection. Which maneuver may assist the surgeon in accomplishing this task?

What are the borders of Kawase's triangle?

Following surgical resection of glioblastoma, standard therapy includes radiotherapy with concomitant temozolimide. What is the standard radiation dose given over 30 fractions?

Which one of the following is most accurate regarding placement of thoracic pedicle screws?

A 74 year old woman presents to the emergency room complaining of vertigo and nausea increasing in severity over the past several hours. CT and MRI studies were performed, and representative image are shown here. This lesion likely represents a(n):

What imaging feature favors a pilocytic astrocytoma over a hemangioblastoma?

What is a contraindication for posterior cervical foraminotomy as a treatment for cervical radiculopathy due to disc herniation?

A 19-year-old man presents following a motor vehicle collision complaining of lower extremity weakness. He is found to have a thoracic spine Chance fracture. He has full strength in his upper extremities. He has sensation in his lower extremities and perineum, and his motor strength in his lower extremities ranges from 4-/5 to 4/5. What is his American Spinal Injury Association (ASIA) impairment scale score?

During resection of a WHO grade II insular glioma, what white matter language tracts run through the tumor and under the insula?

Pasien perempuan 52 tahun dengan keluhan sakit kepala, dan hemiparesis sejak 4 jam yang lalu. CT scan dilakukan 2 jam pasca onset . Penatalaksaan pada pasien tersebut?

After being struck in the head, a 12 year old boy presents with a scalp laceration over a palpable skull deformity. A CT scan is obtained (Figure 1). His GCS 14. What is the most appropriate management for this injury?

Pasien anak laki-laki, lahir secara pervaginam, didapatkan klinis seperti pada gambar. Bagaimana kemungkinan ambulasi pasien?

When undertaking a trans-callosal approach for resection of a colloid cyst of the third ventricle, which of the following structures is the most useful landmark?

If the tumor demonstrated in this MRI is a functioning

tumor, what is the most likely hormone being produced:

A 30-year-old woman presents for her 1 month follow up after bilateral optic nerve sheath fenestration for malignant pseudotumor cerebri syndrome. Her incisions are healing well, and her orbital edema is resolving, and her eye movements are full. However, her visual fields appear to be worsening despite the apparent improvement of her optic nerve edema clinically and by optical coherence tomography. She continues on 500 mg of PO acetazolamide twice a day but continues to have headaches with pulsatile tinnitus. What is the most likely cause of her symptoms despite the improvement of her edema?

A 25 year old male is brought to the emergency department after a motor vehicle crash. His blood pressure is low, requiring pressors. His Glasgow Coma Scale score is 5. A ventriculostomy is inserted and his intracranial pressure is found to be 35 mmHg. What is the most appropriate immediate treatment for lowering his ICP?

Postoperatively, the patient has decreased lacrimation on the ipsilateral side. What is the most likely etiology of this problem?

MRI sequence specific for IDH-mutant 1p/19q non-

codeleted gliomas (diffuse astrocytomas).

A 27 year old present to ED after an assault. His GCS is 15/15 but he has evidence of facial fractures involving the frontal sinus and evidence of some CSF rhinorrhea. He is admitted for observation and initial conservative management of CSF leak. On D3 post injury, he developed three episodes of vomiting and become drowsy. On examination he was obtuned and lethargic, but arousable. His BP was 140/90 mmHg, heart rate 59/min, and respiratory rate 20/min and maintained a saturation of 92% on room air. Examination revealed a dilated right pupil whereas the rest of neurological and systemic examination was normal. CT head was repeated (shown). Which one of the following is most appropriate acute management?

A 76-year-old female is undergoing microsurgical clipping of anterior communicating artery (ACOM) aneurysm. Intraoperatively, there is an inadvertent injury to the recurrent artery of Huebner (RAH). However, other perforators are well preserved. The postoperative CT image, however, shows hypodensities involving the caudate head, anterior limb of the internal capsule as well as putamen. What is the most likely cause of the radiological findings?

Gambaran MRI fibrous dysplasia os frontal udh operasi. Tumbuh lagi. Tatalaksananya, kecuali

Pemberian antibiotik intratekal gentamycin untuk

ventrikulitis appropriate jika?

Disajikan gambar PA tanpa keterangan klinis

(Gambar intraoperasi ETV, tampak lamina terminalis

sudah jebol). Struktur yang ditunjuk panah kuning?

CT Scan SAH, ditanya grading Fischer (SAH agak tebal, tidak ada IVH)

Gambar DSA AP/LAT (sepertinya CCF TAPI TIDAK KHAS) Gambaran klinis yang mungkin terjadi pada pasien dengan gambar DSA diatas adalah

Gambar MRI potongan sagittal. Tatalaksana pada pasien?

Pasien dilakukan injeksi di spinal, lalu tonik klonik keempat extremitas. Apakah yang terjadi?

Dibawah ini benar mengenai Shaken-Baby-Syndrome, kecuali

Seorang ibu post trauma, mengeluh nyeri lengan, absence of radial pulse saat dia nengok. Diagnosis?

AVM dikasih DSA, drainage kemana?

Gambar MRI dan MRA Choroid plexus papiloma,

darimana sumber vaskularisasinya?

Numbness digiti I and II, tinnel test (+) in forearm, forearm pain. Diagnosis?

Intrathecal morfin boleh diberikan pada pasien dengan harapan hidup lebih dari ... bulan atau minimal ... bulan

Foto gambaran tension pneumocephalus, apa tindakan yang salah?

Nyeri pada anterolateral thigh, beberapa soal kasus yang pilihan opsinya ada