Brain Tumors, Intra-Axial and Extra-Axial Intracranial Neoplasms — WACS Viva & Clinical Scenarios (Neuroradiology and Head and Neck Imaging)

Exam-style brain tumors, intra-axial and extra-axial intracranial neoplasms viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: A 58-year-old male presents with progressive morning headaches, expressive dysphasia, and right hemiparesis. Non-contrast and contrast-enhanced multi-parametric MRI brain series (axial T1, T2, FLAIR, GRE, DWI/ADC, and post-gadolinium T1) are provided. Interpret the imaging findings, describe the lesion morphology, signal behavior, and perilesional changes, provide a prioritized differential diagnosis, and identify any critical mass-effect features requiring immediate communication with the neurosurgical team.
• SCENARIO 2: A 42-year-old female presents with progressive left-sided sensorineural hearing loss, tinnitus, and mild facial numbness. Axial and coronal T1 pre- and post-contrast, T2-weighted, and high-resolution CISS/FIESTA MR images alongside bone-window CT slices through the petrous temporal bone are presented. Evaluate the imaging features, localize the tumor compartment, differentiate the two leading neoplastic etiologies, and outline key anatomical relations necessary for surgical approach planning.
• SCENARIO 3: A 35-year-old female presents with secondary amenorrhea, galactorrhea, and bitemporal hemianopia. Sagittal and coronal contrast-enhanced T1, T2, and axial non-contrast head CT images are provided. Analyze the sella turcica, suprasellar cistern, cavernous sinuses, and visual pathway. Distinguish between pituitary macroadenoma, craniopharyngioma, and Rathke cleft cyst, and document cavernous sinus invasion according to standard radiological classification systems.
• SCENARIO 4: A 6-year-old boy presents with progressive morning vomiting, ataxia, and lethargy. Non-contrast brain CT and pre- and post-contrast MRI examinations of the brain and spine are displayed. Formulate a structured diagnostic evaluation of the infratentorial mass, differentiate medulloblastoma, pilocytic astrocytoma, and ependymoma based on signal characteristics, tumor epicenter, diffusion restriction, and calcification patterns, and describe the radiological requirements for staging neuraxis drop metastases.
• SCENARIO 5: A 46-year-old HIV-positive male presents with altered mental status, executive dysfunction, and new-onset focal seizures. Non-contrast CT and pre- and post-contrast multi-sequence MRI brain images including diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps are presented. Provide a differential diagnosis characterizing primary central nervous system lymphoma, glioblastoma, cerebral toxoplasmosis, and tuberculoma, highlighting specific diffusion, enhancement, and periventricular distribution traits.