What is another name for the medial striate artery?

What midbrain anatomic structure is responsible for pain modulation?

A patient has an intractable nosebleed following transsphenoidal pituitary surgery. What artery likely is injured?

From superior to inferior (rostral to caudal), what are the correct layers, in order, of the roof of the third ventricle?

The lateral cord of the brachial plexus is formed from what structure(s)?

The vertebral artery often is divided into numbered segments. What segment exits the axial and curves posteromedially in a groove on the atlas and enters the foramen magnum?

In this spinal cord cross-sectional image, what letter corresponds to the location of the spinothalamic tract?

What blood vessel is at risk of injury during a Chiari decompression?

Number 2 in this image represents what structure?

In brain dead, what happens to the intracranial pressure (ICP) as the mean arterial pressure (MAP) rises ?

A patient has a hormone-producing pituitary microadenoma that puts him at risk (if left untreated) for peripheral neuropathies, cardiac arrhytmias, and sleep apnea. What hormone is the adenoma producing ?

What is the mechanism of action for temozolamide (Temodar) ?

What component of the blood-brain barrier is most responsible for its integrity, creation, and maintenance ?

A 52-year-old woman with a history of decompressive left hemicraniectomy for a large middle cerebral artery territory infarction presents with new-onset headache, vomiting, and lethargy. Her CT scan is shown in this image. What is the next appropriate step for her management?

What is the brain’s response to rising PCO2 with regard to cerebral blood flow (CBF) and intracranial pressure (ICP) ?

How do cytotoxic and vasogenic edema differ ?

What typically prevents axonal regeneration in the central nervous system ?

Apert syndrome is distinguished from Crouzon syndrome as individuals with Apert, and not Crouzon, syndrome tend to have:

What involuntary movement disorder typically persists during sleep?

A 49-year-old man presents with left elbow pain. His symptoms have not improved with rest, ice, splinting and analgetics. He has noticed progressive weakness in extension of his thumb and fingers without weakness of his wrist or arm. There is no sensory loss. What is the suspected diagnosis ?

A man with lethargy, confusion, and one episode of seizures underwent an MRI of the brain, shown in these images. What is the likely diagnosis?

A woman is referred to you for treatment of a cerebellopontine angle tumor. She has obvious weakness of the right side of her face. She does have some motion but has no motor contraction over her forehead, she cannot close her eye completely, and she has noticeable asymmetry of her mouth when attempting to smile. What is her House-Brackmann classification grade?

An 81-year-old man with a history of hip replacement 3 weeks ago complicated by a mild myocardial infarction is brought to the hospital with an acute-onset middle cerebral artery stroke. The patient has been maintained on warfarin, and the INR is 2,3. The platelet count is 120,000. In this patient, what is an absolute contraindication to thrombolysis ?

A 30-year-old man with a history of homocystinuria develops a headache followed by hemiparesis and focal epilepsy. He is brought to the emergency room for evaluation. What is the most sensitive imaging modality to detect this patient disease ?

What is classically described as the cause of an immediate coma in a patient after a head injury without evidence of an intracranial mass or ichemia ?

A 7-year-old boy is reffered to your office by his endocrinologist after an MRI was obtained during a workup for precocious puberty. The MRI reveals a nonenhancing T1 isointense and T2 isointense lesion within the hypothalamus. Other than precocious puberty, there are no focal findings on exam. While you are interviewing his parents, you notice that the patient occasionally has brief episodes of laughter. What is the most likely diagnosis, and what is the natural history of the described seizures ?

Following trauma to his arm, a patient is unable to abduct and oppose his thumb. He has weakness in forearm pronation and wrist and finger flexion. What other physical exam finding is this patient expected to have ?

A 69-year-old man incidentally was found to have 85% stenosis of his right internal carotid artery. According to the North American Symptomatic Carotid Endarterectomy Trial (NASCET), what management option is the most likely to prevent a future stroke in the patient ?

A 78-year-old woman presents to the emergency room after experiencing dizzinesss and syncope. A neurologic exam revealed decrease pain/temperature sensation on the right side of the body, a left facial palsy, decreased pain/temperature sensation on the left side of the face, left-sided hearing loss, ptosis, nausea, vomiting, and vertigo. An infarction in what vessel is suspected ?

A patient with a history of intravenous drug use is seen in clinic with new-onset severe back pain. An MRI is obtained that demonstrates bony erosion and collapse of the L2/L3 disk. What is the next step in the management of this patient ?

Multiple sclerosis is a contraindication to what procedural treatment for trigeminal neuralgia?

A woman with a known pituitary macroadenoma presents to the emergency room with a sudden, intense headache and a new-onset ophthalmoplegia with her chronic visual field cuts. She endorses photophobia. After imaging confirms the most likely diagnosis, what is the next step in her management?

Over 95% of vestibular schwannomas present with progressive unilateral or asymmetric sensorineural, high-frequency hearing loss. In general, what is considered the definition of serviceable hearing ?

A 50-year-old woman presents with an acute onset of severe headache, bitemporal hemianopsia, and cranial nerve III palsy. She is alert and conversant. What is the most appropriate next step in this patient’s management ?

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 ?

A patient presents in the emergency room with a cervical spine fracture and the following radiographic findings: a triangular bone fragment fractured off the anterior inferior vertebral body, retrolisthesis of the caudal vertebrae, and disruption of the facet joints and the disk space. What type of fracture is suspected ?

A 37-year-old man presents with a sudden onset of the “worst headache of my life.” The CT shows intraventricular hemorrhage that you suspect resulted from hemorrhage entering through the lamina terminalis. You are suspicious of an aneurysm at what location ?

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 ?

A 35-year-old woman presents with spontaneous neck pain. A noncontrast head CT demonstrates subarachnoid hemorrhage, and an angiogram reveals a lesion suspicious for an intradural vertebral artery dissection. What is the appropriate treatment for this finding

What structure is indicated by the arrow in this image from an endoscopic third ventriculostomy ?

A 3-year-old boy presents with a history of spinal cord de-tethering and excision of a thoracic dermal sinus tract during infancy. What is the most likely spinal cord lesion seen on the current T2 MRI shown in this image ?

An 8-year-old child with a history of myelomeningocele repair after birth presents with progressive leg weakness and a neurogenic bladder. An MRI of lumbar spine, shown in this image, suggests:

A 3-month-old baby has an abnormal head shape. Based on the 3D reconstruction imaging of the skull, shown in this image, what syndrome is suspected ?

An 11-month-old boy presents with macrocrania and failure to thrive. An MRI of the brain, shown in this image, confirms what likely type of hydrocephalus ?

Obstructive hydrocephalus secondary
to a vein of Galen aneurysm

The MRI shown in this image suggests that the cause of the cervicothoracic syringomyelia in this child is due to:

A child presents with a second episode of middle cerebral artery stroke. The cerebral angiogram, shown in this image, suggests:

A 6-year-old boy presents with new-onset seizures. MRI of the brain, shown in this image, demonstrates an enhancing temporal mass. What is the most likely diagnosis?

An endoscope-assisted strip craniectomy procedure for an infant with sagittal craniosynostosis, shown in this image, followed by helmet therapy will have the best cosmetic outcome if it is performed at what age ?

A 24-year-old man is brought to the emergency department following a single midline gunshot wound to the forehead. On arrival, he is GCS 7T with bilateral sluggishly reactive pupils and localizing in the left upper extremity to noxious stimulus. His non-contrast head CT is depicted (Figure 1). This patient is most at risk for what acute complication of penetrating brain injury ?

A 23-year-old man presents to the emergency department after an intoxicated fall and head injury. He has a moderate occipital headache and nausea without vomiting. On exam, the patient has normal vital signs and no focal neurological deficits. His non-contrast head CT is shown (Figure 1). The volume of the hematoma is measured to be 35 cm³. What is the most appropriate treatment for this patient ?

A 5-month-old infant was a passenger in a car seat in a high-speed crash resulting in ejection. On exam, she only demonstrates right parietal scalp swelling. A head CT scan shows separation of the lambdoid suture and faint hypodensity in the subjacent brain (Figure 1). CT scanning of the cervical spine and other routine trauma investigations were negative. She was discharged in stable condition after 1 day. Which of the following is the most active concern for outpatient follow-up?

A 23-year-old male involved in a motor vehicle accident exhibits neurological decline from an initial GCS of 15 to 8, with a neurological exam notable for left hemiparesis and right dilated pupil. What is the most appropriate initial step in management of this patient ?

A 25-year-old man presents after assault with bilateral contusions and subarachnoid hemorrhage. His admission GCS is 4T, and an ICP monitor is placed. ICP steadily increases despite sedation, CSF diversion, hyperosmolar therapy, and hypothermia. What additional non-surgical intervention is most appropriate ?

A patient initially presents after closed head injury with a GCS of 14. Head CT demonstrates a small amount of pneumocephalus. Two hours later, the patient becomes unresponsive (GCS 4). A repeat head CT is obtained (Fig. 1). What is the most appropriate next step in management ?

A 17-year-old sustains a gunshot wound to the head. On examination, he has decorticate posturing on the right and he localizes on the left. His left pupil is 2 mm larger than the right but is still reactive. His non-contrast head CT (see figures) demonstrates metal and bone fragments within the left frontal region with an associated subdural hematoma with midline shift. What is the most appropriate management of this patient ?

A 22-year-old man without a significant medical history presents with progressive midthoracic pain. An MRI examination of the spine is shown in these images. What is the most likely diagnosis ?

A patient presents after a motor vehicle accident (MVA) with the head CT shown in the figure. His GCS is 14. His blood alcohol level is 0.31%. What is the most appropriate initial management?

A 54-year-old man underwent an MRI of the spine. Sagittal and axial postcontrast T1-weighted images are shown in these images. What is the patient’s likely diagnosis ?

A woman underwent a head CT, shown in these images. What is the likely diagnosis ?

A 38-year-old man who sustained a gunshot wound to the head underwent an emergent CT scan, shown in this image. What finding portends the worst prognosis ?

A man is reported to have a “string of pearls” appearance on his angiogram. What is the likely diagnosis ?

A 29-year-old female presents after a motor vehicle accident with left hemiplegia, weak localization on right, and a dilated unreactive right pupil. Her head CT is shown. What is the most appropriate surgical management ?

Sagittal CT and MRI STIR sequences of the cervical spine are shown in these images. What is the injury type demonstrated?

What is true regarding the lesion shown in this CT image? ?

What is a characteristic of the injury shown on this CT scan ?

A 12-year-old boy presents complaining of left eye visual loss and occasional headache. Endocrine evaluation reveals the presence of mild diabetes inspidus and hypothyroidism. His MRI is shown in Figure 1&2. You recommend an attempt at complete tumor resection . Which of the following is the most likely surgical complication?

The spinal cord lesion in the T2-weighted MRI shown in this image is consistent with what disease process ?

The left vertebral artery usually arises from the:

A 12-year-old boy presented to the emergency department with progressive headaches, nausea, and vomiting. Axial T2 and contrast-enhanced T1-weighted imaging and apparent diffusion coefficient maps are shown in these images. What is the patient’s likely diagnosis ?

A 4-week-old was transferred to the Trauma Service from an outlying emergency department after an evaluation for a seizure that included a CT scan of the head (Figure 1). What additional diagnostic investigation is most appropriate?

A 34-year-old female presents with spontaneous proptosis and chemosis of the left eye. Cerebral angiography (left common carotid injection) is shown . What is the best management option?

A 17-year-old boy is struck on the right side of the head during a sports match. He is dazed initially and is taken off the field despite saying he feels fine. He becomes more sleepy over the subsequent 15 min and an ambulance is called. In the emergency department his GCS is E2V3M5 with a sluggish right pupil and weakness on the left side of his body. CT head is shown. Which one of the following is LEAST likely to be an indication for surgery in this type of pathology?

A 75-year-old woman presents with a 2-month history of progressive difficulty walking, headache, and memory difficulties. Magnetic resonance imaging is shown (figure). Histopathology shows nests of small blue cells amid a pink fibrillary matrix.  What is the most likely diagnosis?

A 27-year-old presents to the 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 day 3 post-injury, he developed three episodes of vomiting and became drowsy. On examination he was obtunded and lethargic, but arousable. His BP was 140/90 mmHg, heart rate 59/min, respiratory rate 20/min, and oxygen saturation 92% on room air. Examination revealed a dilated right pupil, while the rest of the neurological and systemic examination was normal. Which one of the following is the most appropriate acute management?

A physician diagnoses a 67-year-old patient with the beginning stages of Alzheimer's disease. The patient's neurologic exam is otherwise intact. A treatment plan of deep brain stimulation to minimize the rate of brain deterioration is created. Where should the surgeon place the stimulator within the brain?

A view from above into the anterior third ventricle is shown. The ideal location for performing a third ventriculostomy is indicated by which number?

A 57-year-old patient presents with head injury after falling backwards and sudden onset of agitation. Two hours later her blood pressure is 220/110 mmHg, her heart rate is 39 beats per minute, and her consciousness is fluctuating. She is intubated and ventilated. CT is shown. Regarding this type of lesion and its location, which one of the following is LEAST likely to be an indication for surgical evacuation ?

What structure does the arrow point to in the figure?

A 58 year-old right handed male presents with bifrontal headaches and a partial left ophthalmoplegia. 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?

A 41 year-old woman undergoes gross total resection for the lesion shown (Figure). Pathology confirms a grade 2 oligodendroglioma. What is the recommended course of treatment?

A 16-year-old boy presents with headaches, nausea, and blurred vision. His neurological examination is remarkable for impaired upgaze and convergence nystagmus. Contrast-enhanced MRI of the brain is shown (figure). Serum beta-HCG and alpha-fetoprotein levels are normal. What is the most likely diagnosis?

Occlusion of which artery causes the stroke shown in the figure?

A 35 year old female presents with headaches and progessive left sided hearing loss. What is the BEST treatment for the lesion depicted in the MR images?

What type of tumor harbors the histopathological structure seen in the figure?

A view of the fundus (lateral end) of the internal acoustic meatus is shown in the figure. Which number represent the location of the cochlear nerve segment?

You are performing surgery on a patient with a suspected nerve entrapment, and discover that the nerve is severely narrowed (>50%) along the point of entrapment. What is the most appropriate treatment for this condition?

What is the first clinically important branch given off by the upper trunk of the brachial plexus?

Based on the cerebral angiogram, which vessel is the PRIMARY arterial blood supply for this tumor?

What extent of surgical resection of low grade gliomas contributes to a survival benefit?

The figure is a cadaveric dissection of the anterior portion of the left cavernous sinus. What deficit would be seen with damage to this structure?

A 24-year-old woman presents with a history of menstrual irregularity and headache. Magnetic resonance (MR) imaging reveals a nonenhancing 1.6-cm tumor of the sellar/suprasellar region with displacement of the optic chiasm.  If the patient was noted to have a prolactin level of 265, which of the following is the most appropriate management strategy?

On which chromosome is the gene mutation associated with the syndrome depicted by the MRI shown (figure)?

What imaging finding of a sphenoid wing meningioma significantly diminishes the possibility of safe gross-total resection?

What recess is indicated by the arrow in this image?

During a far lateral approach, exposure of what anatomic structure first indicates that more than the posterior one-third of the occipital condyle has been removed?

What is the most common location for the “pearly” tumor shown in this image

Which one of the following PET tracers is LEAST appropriate for detection of de novo low-grade glioma?

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 55-year-old woman presents to the clinic with the complaint of increasingly blurry vision over the past several weeks. Besides, she notes a persistent headache that is worst in the morning and occasionally awakens her from sleep. On physical exam, extraocular movements are impaired. The patient is unable to intort and extort her eye. It is also noted that there is a diminished pupillary light reflex. MRI reveals an intracranial mass. Which of the following locations is most likely affected?

What structure is indicated by the arrow in this image from an endoscopic third ventriculostomy?

A 43-year-old female presents to the clinic with chronic headaches worsening over the past three months. Imaging identifies a colloid cyst in the third ventricle. Which of the following findings best indicates a transcortical open craniotomy for treatment of the colloid cyst compared to other possible treatment modalities?

A child presents with a second episode of middle cerebral artery stroke. The cerebral angiogram, shown in this image, suggests

During lateral osteophyte removal in an anterior decompressive discectomy, you encounter brisk bleeding in the region of the nerve root. What is the best next step?

A 54-year-old female was taken to an emergency room after collapsing at work. She was alert and communi­cative, with a severe headache, photophobia, nuchal rigidity, and blurry vision. Computed tomography (CT) of the brain revealed diffuse subarachnoid blood in the basal cisterns, mild hydrocephalus, and no intraparenchymal hematoma. Her angiogram is depicted below. What is the clinical Hunt and Hess grade of this patient?

You are seeing a patient with multiple stab wounds to the upper extremity.  The patient has isolated deficits in finger extension and ulnar wrist extension.  What is the most likely level of injury?

Which one of the following is most likely given the image below?

You have diagnosed your patient with a nerve entrapment and have decided to decompress the entrapped nerve. Which of the following procedures would be most appropriate for the majority of nerve entrapments?

A 45-year-old man presents with sudden onsent headache, nausea, vomiting and visual disturbance. On examination he is apyrexial, hypotensive, and tachycardic but does not have neck stiffness or photophobia. Visual fields appear to be constricted on confrontation. CT head is abnormal therefore MRI is done. Which one of the following is appropriate acute management?

A 40-year-old ex-IV drug abuser presents to the emergency room with a seizure. CT head with contrast shows 3 cm diameter ring enhancing lesion periventricular location. MRI is performed and the lesion is bright on DWI and dark on ADC map. Which one of the following would be the appropri- ate next step in management?

Which one of the following is most likely based on the MRI shown ?

A 9-year-old is brought into the emergency room lethargic with a stiff neck and fever. Despite aggressive therapy in the ITU the child dies. Postmortem evaluation reveals that the child had primary amoebic meningoen- cephalitis. This condition is usually acquired through which one of the following means?

A 55-year-old man presents to your office with difficulty ambulating and buttoning his shirt. It started 2 years ago but has worsened significantly over the last year. On physical exam he is unable to perform a tandem gait and has a positive Hoffman's sign bilaterally, however he has no ankle clonus and flexor plantars bilaterally. He has 4/5 strength in his hands, but 5/5 strength in all other muscle groups. Sagittal MRI is shown. Which one of the following is the most appropriate next step in management?

A 27-year-old man presents to his primary care doctor with a low-grade fever, headache, and neck stiffness, which have become more both- ersome over the past 1-2 weeks. Serum is pos- itive for Borrelia burgdorferi IgM. CSF polymerase chain reaction (PCR) is also positive for this organism. The cranial nerve most commonly affected in this disease is most likely?

A 30-year-old woman presents with progressive difficulty using her hands and gait dysfunction. She has pain in the back of her neck that radiates into her head. She notes pain and paraesthesias in both arms that are refractory to neuropathic pain medication. Her imaging is shown in the figures. What is the most appropriate initial surgical management ?

A 19-year-old female is involved in a high-speed motor vehicle accident and sustained facial injuries from hitting the dashboard. She was GCS 4/15 at the scene and was intubated for transfer. Her pupils are reactive to light. CT head was performed as part of the trauma protocol but did not show any mass lesions or fractures. As this was an isolated head injury, a decision was made to wean sedation and assess neurology, but she remained unresponsive. CT is shown below. These are most likely indicative of which one of the following ?

A 32-year-old recent immigrant from Southeast Asia presents with back pain and a new kyphotic deformity after tripping up in his flat. T1and T2 WMRI are shown. Which one of the following is most likely diagnosis?

A 62-year-old with known metastatic renal cell cancer presents with unbearable back pain and lower extremity myelopathy after a fall. Her imaging is displayed in the accompanying figures. The best management strategy of this lesion would be:

The  pathology  sample  shown  here  was  taken  from  a 30 year-old  woman  with  an  incidental  mass  found on headache  evaluation.  Which  of  the  following  pathological  hallmarks  is  demonstrated  in  the  photomicrograph?

An 8-year-old child with Down syndrome presents to the emergency department with decreased neck movements three days following an adenoidectomy and tonsillectomy. On examination, he is not in distress. He is afebrile and able to speak normally. His oral intake has been limited to small amounts of clear liquids. He is uncooperative, and so Kernig and Brudzinski signs cannot be assessed. What is the most likely diagnosis?

A 47-year-old diabetic woman presents with pain across her buttocks and bilateral lower extremities with ambulation, improved by leaning forward. She reports transient response to epidural injections and no response to NSAIDs and neuropathic pain medication. She has no neurologic deficit. Imaging is shown (figures). What intervention is most likely to best reduce her disability over 4 years ?

A 72-year-old male develops a worsening headache over the course of 3 weeks. There is no relevant past medical history, except for a minor head injury 6 weeks ago. On examination there is no focal deficit. CT head is shown. In the UK, which one of the following is the appropriate next management?

A 55-year-old female with obesity presents for a right breast mass removal. She is considered for an erector spinae plane block that could potentially reduce her pain during and after surgery. The block is technically difficult to perform due to the patient's body habitus, but the proceduralist finally able to successfully place an ESP catheter. Which adverse effect is most likely to occur in this patient as a result of the ESP catheter placement?

Which of the following conditions is depicted in the magnetic resonance image (MRI) shown?

A 45-year-old man is involved in a high-speed road traffic accident and was GCS E2V3M4 at the scene. He was intubated and ventilated and transferred to a trauma center. En route, his left pupil became sluggish and mannitol was administered. CT head scan is shown. Given the scenario and type of injury shown, which one of the following is the LEAST appropriate indication for surgery according to current guidelines?

A 36-year-old restrained driver presented after a motor vehicle collision. What is the classification of the spinal injury illustrated in the figure ?

Which one of the following statements regarding the lesion shown is LEAST accurate ?

A sagittal, upright long-cassette radiograph is shown (figure) for a 54-year-old woman with a history of T12-L5 instrumented fusion 2 months ago who now presents with back and thigh pain. Which of the following diagnoses is most likely based on her history and imaging ?

A 16-year-old male presented to his primary care provider with right earache and pus discharge for the past four days. He had flu one week ago after which his current symptoms developed. He was started on oral antibiotic therapy. After one week, he presents to the emergency department with neck rigidity and projectile vomiting for the past 2 hours. Computed tomography (CT) of the head reveals partial opacification of the mastoid air cells and leptomeningeal enhancement. What is the most likely diagnosis of this patient?

A 29-year-old is assaulted and is GCS E3V4M5 at the scene. On examination there is significant bruising to the right side of his head with a 5-cm laceration and does not appear to have any focal neurological deficit. He is awaiting a CT scan when you are told he is less responsive. On examination, he is GCS E2V3M4, his right pupil is dilated and on application of painful stimulus appears to only be moving his left side. Which one of the following is most likely to be responsible for these findings?

You are asked to see a 6-month-old infant who sustained a skull fracture after his older brother accidentally pulled down the flat screen TV that landed on the infant’s head. Follow-up CT scan is demonstrated below. What is the diagnosis?

According to randomized control trials of hemicraniectomy for malignant MCA infarction, what is the time frame for the performance of hemicraniectomy associated with reduced mortality?

Which one of the following pathologies is most likely to give the appearances shown ?

A 60-year-old male with type 2 diabetes presents with fever, back pain, and < 24 hours of acute onset 2/5 motor weakness in the lower extremities. Thoracic MRI (Figure 1) and CT (Figure 2) imaging is performed. What is the most appropriate management for this patient’s acute neurologic deficits ?

A 21-year-old female presented to the emergency department after a new-onset seizure. Before this, she was complaining of a severe headache with blurred vision for the last 2 days. Physical examination demonstrates a somnolent female with normal vitial signs and bilateral papilledema. She has mild weakness of her right face, arm, and leg. Computed tomographic (CT) imaging of the head without contrast and CT angiography of the brain with contrast are shown. Which of the following is the most appropriate treatment?

A 33-year-old man presents with spontaneous tinnitus and nausea. Which one of the following is most likely based on the imaging shown ?

What is the Fisher score in a patient with a 2 mm thick subarachnoid hemorrhage with no intraventricular or parenchymal extension?

A 75-year-old man with a history of recent memory impairment is admitted with headache, confusion, and a left homonymous hemianopsia. There is no history of hypertension or malignancy. Non-contrast CT scan and GRE MRI are shown. Which one of the following is the most likely cause of this patient’s symptoms and signs

Which one of the following is most likely given the image below ?

The North American Symptomatic Carotid Endarterectomy Trial (NASCET) reported the surgical results in patients who underwent carotid endarterectomy (CEA). According to the trial, what is the rate of perioperative permanent disabling stroke and death related to CEA?

A 37-year-old man presents with seizures. Which one of the following is NOT thought to increase risk of hemorrhage in this type of lesion ?

A 27-year-old presents with a generalized tonic-clonic seizure. On examination there is no residual neurological deficit or speech disturbance. Some spots of calcification are seen on CT therefore MRI is performed. Which one of the following statements regarding this type of tumor is LEAST accurate?

What factor is most predictive of postoperative intracerebral hemorhage after carotid endarterectomy?

Which one of the following pathologies is most likely demonstrated by the angiogram ?

Which one of the following clinical findings would you look for in this patient ?

You are evaluating a 45-year-old man who experienced a first-time seizure; subsequent MRI was performed and is demonstrated below. What would be useful during surgical resection of this mass?

Which one of the following mechanisms is most likely responsible for the finding in the angiogram ?

A 26-year-old male presents after a motor vehicle crash with absent right and partially preserved left lower extremity motor function (more than half of left leg muscles have less than antigravity strength). Sensation to pain and temperature is markedly diminished in the left leg. Proprioception is markedly diminished in the right leg. Neuroimaging studies are obtained and depicted in Figures 1 and 2. Which spinal cord syndrome BEST describes the injury?

A 44 year old man with a history of blunt head trauma 4 days earlier presents with a progressively pulsatile exophthalmus, headache, and double vision. A CT head performed after his initial trauma was normal. What is the most appropriate treatment for this condition?

A 66-year-old woman presents to your clinic with a first-time seizure and an MRI was performed which is demonstrated below. What is the next best step?

The following appearances are seen during endovascular treatment of an anterior communicating artery aneurysm. What is the next appropriate management step ?

What are the standard radiographic criteria for ventriculomegaly in order to diagnose hydrocephalus?

Placement of lumbar pedicle screws at L3 and L4 level should use which one of the following entry points ?

You are evaluating a 33-year-old man who experienced a first-time seizure; subsequent MRI was performed and is demonstrated below. If you decided to operate on this patient, what operative adjunct would be useful in this case?

After invasive grid monitoring and mapping of eloquent cortex, surgical resection is recommended for a 19-year-old man with drug-resistant epilepsy. The patient’s seizures involve speech arrest with tonic posturing of the upper extremities in a “fencing posture.” Where is the likely seizure focus ?

The primary goal of dynamic stabilization techniques in the spine is best described as which one of the following ?

A patient presented to your clinic for treatment of a low-flow indirect carotid cavernous fistula. You are performing the exposure for a direct cannulation of the superior ophthalmic vein. You have made your superior sulcus incision and opened the orbicularis oculi and orbital septum. You are unable to identify the superior ophthalmic vein, even after tracing back the supraorbital vein. What is the next best operative step?

A 55-year-old man presents with a 3-month history of progressive right hemiparesis. A contrast-enhanced magnetic resonance  image of the brain was obtained in the emergency room and  is shown  here. What is the most likely diagnosis for the lesion shown?

The spinal construct shown below would most likely have been used for which one of the following ?

When counseling a patient regarding temporal lobectomy for temporal lobe epilepsy, what is the most consistent and important predictor of a very favorable outcome after surgery ?

Site of entry for thoracic pedicle screw is best described as which one of the following ?

A 14-year-old male presents with a 9 cm, highly vascular mass centered in the posterior nasal cavity and sphenopalatine foramen invading the infratemporal fossa (ITF), middle cranial fossa, and cavernous sinus. Staged surgical resection is being planned. Which of the following is the best imaging modality to evaluate this patient's vascular anatomy for preoperative planning?

A 65-year-old presents with difficulty initiating movements, rigidity, and a mild resting tremor. Which of the following neurotransmitters is likely deficient in this patient ?

EMG abnormalities in which one of the following muscles is LEAST specific for C5 radiculopathy?

Which one of the following is most likely based on the MRI shown ?

A 6-year-old boy is brought to the emergency  department by his parents  for 3 weeks of headache, 2 weeks of increasing ataxia, and 2 days of headache and vomiting. A magnetic resonance image is obtained, and postcontrast T1 sagittal imaging is shown. Based on the most likely diagnosis, which of the following is the best first treatment?

MRI shows the appearances below, and the lesion is bright on T2WI and dark on fat suppression sequences and does not show any contrast enhancement. Which one of the following is most likely ?

Which one of the following is most likely based on the MRI shown ?

Which one of the following is most likely based on the MRI shown?

A child undergoes MRI scan as part of epilepsy evaluation after two seizures unrelated to febrile episodes. There are no symptoms of hydrocephalus. MRI appearances are shown, and there is no diffusion restriction. Which one of the following is most likely ?

Which one of the following is most likely based on the imaging shown below ?

A 24-year-old man has refractory complex partial seizures localized to the left temporal lobe with EEG. MRI is consistent with left mesial temporal sclerosis. What is the most appropriate next step in his management ?

Which one of the following is most likely based on the imaging shown below ?

A newborn infant has an apneic event with cyanosis and he was brought to the hospital. His evaluation was remarkable for developmental delay, bilateral lower-extremity frog-leg flaccid paralysis, with a large open defect in his lower back. At birth, the defect was covered by a transparent membrane, which subsequently ruptured and drained clear fluid for several weeks. Based on the imaging below, what is the cause of the infant’s apneic events ?

A 63-year-old woman with Parkinson disease undergoes unilateral deep brain stimulator (DBS) electrode implantation. Three months later, she returns to the office with redness, pain, swelling, and purulence from the cranial incision. Culture grows methicillin-sensitive Staphylococcus aureus. What is the most appropriate management ?

A 4 year-old boy with a history of congenital hydrocephalus and VP shunt placement near birthpresented one week following proximal shunt revision with lethargy, fevers to 38.4 C and erythema along the shunt tract. He underwent complete removal of the VP shunt system and placement of an external ventricular drain. CSF cultures grow MSSA and the patient is started on intravenous oxacillin, when should the shunt be replaced?

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

A 36-year-old man presents with a 1-year history of  gradual bilateral hearing loss, a sense of aural fullness, and progressively impaired balance. He has a history of juvenile cataracts, and his  brother and father have similar difficulties with their hearing. A brain magnetic resonance image (MRI) with contrast is shown. Which of the following is the most likely cause of his symptoms?

A 6-month-old girl with a lipomyelomeningocele is undergoing surgical detethering of their lumbar lipoma, filum sectioning, arachnoid adhesion lysis, and aggressive debulking of the intradural lipoma to the margins of the neural placode. What is the next surgical step?

What is the most common side effect of vagus nerve stimulation ?

A 54-year-old male had a good result from left-sided thalamotomy for essential tremor 10 years ago. He now wishes to have his other side treated. What is the MOST appropriate surgical procedure for his contralateral side ?

A 56-year-old female presents with neck pain worsened by activity over the last 6 months. On examination, she has full power bilaterally in the upper and lower extremities. She has a normal gait and no difficulties with manual dexterity. Which one of the following is the most appropriate next step in management?

An 8-year-old boy with cerebral palsy and spastic quadriparesis presents to the emergency room with excessive somnolence. His baclofen pump was adjusted earlier today and his mother notes that he has remarkably little tone now. What is the best pharmacological treatment option ?

During a pterional exposure of the sylvian fissure, you encounter significant brain swelling. In order to achieve rapid brain relaxation, identify the most appropriate point on the associated figure through which to place a ventriculosotomy and access the frontal horn of the lateral ventricle.

An ultrasound of a 29-year-old pregnant woman reveals a lumbar myelomeningocele in the fetus. What is the primary difference in outcome for fetal myelomeningocele repair as opposed to post-natal repair?

A 33-year-old woman with no neurological history complains of subtle left upper extremity weakness without headache or other symptoms. She is noted to have a mild left hemiparesis and otherwise normal neurological examination. EEG is normal. The MR scan is shown (figure). A stereotactic biopsy yields no evidence of glioma. What is the most likely diagnosis ?

A 37-year-old man presents with worsening low back pain and right L5 radicular pain and a normal examination. Lumbar spine MRI (Figure 1) and CT (Figure 2) are shown. Work-up revealed this solitary lesion. What is the most appropriate next step in management ?

Histopathology of a cerebellopontine angle tumor is shown in the figures below. The findings are most consistent with what type of pathology ?

A 45-year-old male presents with several months of progressive headaches and an intracranial lesion (figure). Following surgical resection, histopathological analysis demonstrates a well-circumscribed, uniformly cellular tumor with no atypia and numerous ectatic, thin-walled branching vessels in staghorn configurations. Which of the following is a possible associated clinical development ?

A 34-year-old male presents with a several month history of neck pain, with intermittent episodes of arm and leg numbness. MRI is shown. Which one of the following is most likely?

A 54-year-old man presents with biopsy-proven esthesioneuroblastoma and has a normal neurological exam. MRI shows involvement of the right nasal cavity with minimal intracranial extension through the cribriform plate (Figure 1). There is no cervical adenopathy or evidence of metastatic disease. Which of the following is the best management strategy for this patient ?

A 75-year-old healthy woman suffered a fall 3 months ago and immediately noticed neck pain. She has been treating her pain with over-the-counter medications, but the pain continues to worsen over time. On exam, she has no focal deficits. X-ray (Figure 1) and CT (Figure 2) are depicted. What is the optimal management for this patient ?

Which of the following answers most appropriately pairs a sign or symptom of hydrocephalus (or shunt malfunction in the setting of a patient with a shunt) and an appropriate age or patient population?

A 47-year-old woman presented with a first seizure and underwent magnetic resonance imaging of the brain with multi-voxel spectroscopy. The spectroscopy shown in Figure 1 is most consistent with what diagnosis ?

What is the most likely craniosynostosis adepicted in this image?

A 16-year-old boy presents with headaches, nausea, and blurred vision. His neurological examination is remarkable for impaired upgaze and convergence nystagmus. Contrast-enhanced MRI of the brain is shown (figure). Serum beta-HCG and alpha-fetoprotein levels are normal. What is the most likely diagnosis ?

A 12-year-old male presents to the emergency department with a new-onset headache and blurry vision for 6 hours. The patient denies a history of prior seizures. Past medical history includes a right-hand corrective surgery for polydactyly at eight months of age. The neurological examination reveals no abnormalities. CT head without contrast shows a mass in the suprasellar region. MRI of the brain further confirms the presence of a hypothalamic hamartoma. A rare genetic disorder is suspected. Which of the following best describes the patient's clinical syndrome?

A 58-year-old right-handed male presents with bifrontal headaches and a partial left ophthalmoplegia. 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 ?

A 12-year-old boy presents complaining of left eye visual loss and occasional headache. Endocrine evaluation reveals the presence of mild diabetes insipidus and hypothyroidism. His MRI is shown in Figure 1 & 2. You recommend an attempt at complete tumor resection. Which of the following is the most likely surgical complication ?

Which one of the following is most likely based on the imaging shown?

A 10-year-old boy presents with headache and imbalance. Examination discloses mild papilledema, right-sided dysmetria, and ataxia. MRI with contrast is shown in the figure. What is the most important prognostic factor for this patient ?

A 9-year-old girl presents with headache and vomiting. On examination there is bilateral papilledema but she is otherwise neurologically stable. MRI is performed. Which one of the following is the next appropriate step?

A 76 year-old undergoes a craniotomy for evacuation of a subdural hematoma. Three days later, the patient is noted to have increased confusion and a heart rate of 102 bpm. His blood pressure is 83/52, and his respiratory rate is 31 breaths per minute. The nurse measures a temperature of 38.5 degrees C. He has coarse breath sounds and his urine output was 15cc/hr over the prior 6 hours. His symptoms do not respond to a saline bolus. What is the most appropriate next step?

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

A 30-year-old male is brought to the emergency department after a motor vehicle crash. His Glasgow Coma Scale score is 13. He begins to have seizure activity in the emergency department and the seizure is continuing after several minutes. What is the pharmacologic treatment of choice for the seizure?

A 58-year-old male who sustained traumatic fractures to the upper cervical spine following a motor vehicle accident. After a detailed evaluation of the fracture characteristics and imaging studies, you recommend posterior instrumentation and fusion from the occiput to C2. The patient asks you how would this affect his range of motion. You should inform him that he would probably experience which one of the following?

A 47 year old man presents with confusion, agitation, fatigue, fever (104F), hyponatremia, hypoglycemia, and hypotension after resection of a right frontal metastasis lesion 3 weeks ago. Phenytoin and steroids were discontinued at 2.5 weeks post-operatively. Head CT reveals no acute abnormality. What is the most appropriate management of this patient?

The lesion marked by the arrows in the following MRI will most likely cause

A 78-year-old man with a 10-year history of intermittent chronic neck pain has cervical spine X-rays (Figure 1) and MRI (Figure 2). The patient denies any current neck pain, radiculopathy, or subjective symptoms of myelopathy. His exam is normal. What is the recommended management for this patient?