Radiology: AIIMS MAY 2014

Q-1. Puff of smoke appearance in cerebral angiography
a) Moyamoya
b) Cavernous sinus thrombosis
c) Cerebral infarction
d) Carotid artery thrombosis

Answer: Moyamoya
Moyamoya disease is a progressive, occlusive disease of the cerebral vasculature with particular involvement of the circle of Willis and the arteries that feed it.
Cerebral angiography is the criterion standard for the diagnosis of Moyamoya disease.
Important point:
Small abnormal net-like vessels proliferate giving the characteristic “puff of smoke” appearance on direct angiography.

Q-2. A child shows upward gaze palsy and severe headache. CT suggests homogenous supra-sellar mass in posterior 3rd ventricle and MRI suggests homogenous iso-intense T1 and iso-intense T2 with high contrast enhancements. Diagnosis is
a) Choroid plexus papilloma
b) Glioma
c) Dermoid
d) Teratoma

Answer: Choroid plexus papilloma
Choroid plexus papilloma:
Patients usually present with the following signs of increased intracranial pressure: headache, nausea and vomiting, drowsiness, ocular or gaze palsies (cranial nerves CN-III and VI), papilledema, visual disturbances, and, eventually, blindness.
CT scan demonstrates a homogeneously hypo-dense to slightly hyper-dense enhancing mass with cystic areas.
Choroid plexus papillomas appear homogeneous and iso-intense with respect to gray matter on T1-weighted magnetic resonance images (MRIs), hyper-intense on T2 images, and exhibit intense contrast enhancement.