Neuroimaging: intracranial hypotension: 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: intracranial hypotension

Sample item

After an epidural procedure, a woman has a headache that is worse upright and relieved lying flat. Post-gadolinium MRI shows diffuse smooth pachymeningeal enhancement, downward sagging of the brainstem and engorged venous sinuses. What is the diagnosis?

AIdiopathic intracranial hypertensionBMeningeal carcinomatosisCTuberculous meningitisDIntracranial hypotension from a CSF leak

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

The answer and the reasoning

D. Intracranial hypotension from a CSF leak

Loss of CSF volume causes the brain to sag, the dural veins to engorge and the pachymeninges to enhance diffusely. Postural headache and a recent dural puncture clinch the diagnosis, and an epidural blood patch is the treatment.

Option by option

A. Idiopathic intracranial hypertension
IIH shows an empty sella, flattened globes and distended optic sheaths, with headache worse lying down.
B. Meningeal carcinomatosis
Carcinomatosis shows nodular leptomeningeal enhancement rather than smooth dural thickening.
C. Tuberculous meningitis
Tuberculous meningitis enhances the basal leptomeninges with hydrocephalus and infarcts.
D. Intracranial hypotension from a CSF leak (correct)
Correct. Diffuse smooth dural enhancement, brain sagging and venous engorgement with postural headache fit a CSF leak.

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.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, Intracranial hypotension from a CSF leak. Loss of CSF volume causes the brain to sag, the dural veins to engorge and the pachymeninges to enhance diffusely.

Why is "Idiopathic intracranial hypertension" not the answer?

IIH shows an empty sella, flattened globes and distended optic sheaths, with headache worse lying down.

Why is "Meningeal carcinomatosis" not the answer?

Carcinomatosis shows nodular leptomeningeal enhancement rather than smooth dural thickening.

Why is "Tuberculous meningitis" not the answer?

Tuberculous meningitis enhances the basal leptomeninges with hydrocephalus and infarcts.

What concept does this question test?

It tests Neuroimaging: intracranial hypotension in Radiology. Postural headache and a recent dural puncture clinch the diagnosis, and an epidural blood patch is the treatment.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: intracranial hypotension?

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.