Neuroimaging: mesial temporal sclerosis: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Neuroimaging: mesial temporal sclerosis

Sample item

A 28-year-old with childhood febrile seizures now has focal seizures preceded by a rising epigastric sensation and drug resistance. Which MRI finding is expected?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Unilateral hippocampal atrophy with T2/FLAIR hyperintensity

Hippocampal sclerosis is the commonest pathology in drug-resistant temporal lobe epilepsy. Coronal thin-slice FLAIR and T2 show a small, bright hippocampus, and surgical resection offers a good chance of cure.

Option by option

  • A. Diffuse leptomeningeal enhancement

    Leptomeningeal enhancement indicates meningitis or carcinomatosis.

  • B. Cortical band heterotopia (double cortex)

    Band heterotopia causes generalised epilepsy in a different pattern and is seen mostly in females.

  • C. Unilateral hippocampal atrophy with T2/FLAIR hyperintensity (correct)

    Correct. Hippocampal volume loss with signal increase is the typical finding.

  • D. Multiple calcified granulomas

    Calcified granulomas suggest neurocysticercosis and cause seizures but not this syndrome of mesial origin.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is C, Unilateral hippocampal atrophy with T2/FLAIR hyperintensity. Hippocampal sclerosis is the commonest pathology in drug-resistant temporal lobe epilepsy.

Why is "Diffuse leptomeningeal enhancement" not the answer?

Leptomeningeal enhancement indicates meningitis or carcinomatosis.

Why is "Cortical band heterotopia (double cortex)" not the answer?

Band heterotopia causes generalised epilepsy in a different pattern and is seen mostly in females.

Why is "Multiple calcified granulomas" not the answer?

Calcified granulomas suggest neurocysticercosis and cause seizures but not this syndrome of mesial origin.

What concept does this question test?

It tests Neuroimaging: mesial temporal sclerosis in Radiology. Coronal thin-slice FLAIR and T2 show a small, bright hippocampus, and surgical resection offers a good chance of cure.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuroimaging: mesial temporal sclerosis?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.