Case Challenge

Brain

Neuro

Stephen J Pomeranz

Gain confidence interpreting Neurodegenerative Disease Cases w/ MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME. Try it free!

Case Review

Neuroradiology

Post-Course Activities

As the average lifespan of the general population increases, neurodegenerative diseases have become more prominent and the need for imaging is expanding.

Neurodegenerative Disease Cases

Case 10 - 10-year-old female presents with sudden onset disconjugate gaze

<div>HISTORY:&#160;This 10-year-old female presents with sudden onset disconjugate gaze.(QUIZ ANSWER) DIFFERENTIAL IN THIS CASE:&#160;All of the above.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: No extraaxial collections or hemorrhage.&#160;No obstructive hydrocephalus.&#160;Skull base and orbital assessment is limited by aspect ratio distortion related to dental appliance.&#160;Cerebral hemispheres and deep nuclei are without hemorrhage, mass or edema.&#160;Subtle area of nonenhancing T2 hyperintensity within the pontine tegmentum is symmetric to the right involving the medial menisci and floor of the fourth ventricle. No exophytic component. No edema or mass effect.&#160;Carotid and basilar artery flow voids are intact.&#160;7th and 8th nerve complexes are intact. Cochlea and vestibulae are intact.&#160;Brain is normally sulcated.&#160;No ectopias or migrational disturbance.&#160;No signal abnormality within the basal ganglia.&#160;Venous sinuses are patent.&#160;Craniocervical junction is without Chiari malformation.&#160;Diffusion-weighted images are without a diffusion-restrictive defect.&#160;CONCLUSION:&#160;Subtle signal abnormality within the pontine tegmentum and floor of the fourth ventricle may be relevant to the provided history of transient disconjugate gaze. Differential may include a demyelinating process such as childhood MS or ADEM. Additional differential possibilities may include Lyme disease, Wilson's disease. Six month followup examination is recommended. Pontine neoplasm is felt less likely. No other areas of parenchymal demyelination are noted. Optic nerve assessment is limited by aspect ratio distortion related to dental appliance.</div>

Case

Acute disseminated encephalomyelitis (ADEM)

In this case, we see subtle signal abnormality within the pontine tegmentum and floor of the fourth ventricle which may be relevant to the provided history of transient disconjugate gaze. Differential may include: