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19b - Answer: 50-year-old female presents with post mitral valve operation

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 50-year-old female presents with post mitral valve operation, and episode of diplopia.

(QUIZ ANSWER) NOT A FINDING: 

Neurodegenerative pattern of cerebral atrophy.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

The calvarium is intact. 

Persistent trigeminal artery on the right exhibiting a tau sign. 

Midbasilar is nonvisualized. Upper basilar is small. 

Posterior communicating arteries are robust with filling of posterior cerebral arteries via the anterior circulation. 

Venous sinuses are patent. 

Bilateral maxillary sinus mucous retention cysts. 

No extraaxial collections or hemorrhage. 

No obstructive hydrocephalus. 

Nigral and pallidal iron stores are maintained. 

Diffusion-weighted images are without a diffusion-restrictive defect. 

No parahippocampal atrophy. 

No obstructive hydrocephalus. 

Scattered subcortical hyperintensities may represent gliosis of microangiopathic origin without evidence of acute ischemia on diffusion-weighted images. 

No internal auditory canal or cerebellopontine angle masses. No confluent otomastoid airspace disease. 

No Chiari malformation. 

No suprasellar masses or chiasmal compression. 

IMPRESSION:

Multiple anomalies of the intracranial circulation. Posterior fossa circulation anomalies including hypoplastic basilar and nonvisualization of anterior-inferior cerebellar arteries. Findings result in tonus flow to the mid brainstem and may be relevant to the provided history of diplopia. 

Scattered subcortical hyperintensities may represent gliosis of microangiopathic origin without evidence of acute ischemia on diffusion-weighted images. 

Maxillary sinus mucous retention cysts. 

No neurodegenerative pattern of cerebral atrophy.

LESSON 3, TOPIC 27

Case Challenge: Brain MRI Cases

Case Challenge

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Content reviewed: July 23, 2021

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