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Case Challenge: Brain MRI Cases


Case Review Power Pack – Brain Pre-Course Activities
1 topic
Brain Pack, Vol. 1
20 topics | 10 quizzes
Brain Pack, Vol. 2
50 topics | 25 quizzes
Course Evaluation
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29b - Answer: 44-year-old female presents with multiple sclerosis

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

HISTORY: 

This 44-year-old female presents with multiple sclerosis. Numbness and tingling in the legs. Forgetful for seven months.

(QUIZ ANSWER) A FINDING IN THIS CASE: 

Xanthogranulomas within the ventricular atria.

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

FINDINGS:

Calvarium is intact. 

No Chiari malformation. 

No extraaxial collections or hemorrhage. 

Multiple foci of parenchymal hyperintensity most conspicuous left centrum semiovale may represent gliosis of microangiopathic origin without evidence of acute ischemia on diffusion-weighted images. 

No obstructive hydrocephalus. 

No air-fluid levels within the paranasal sinuses. 

Masticator, parapharyngeal, pharyngeal mucosal, prevertebral and parotid spaces are without masses or adenopathy. 

Partial empty sella without optic nerve sheath dilatation, globe flattening or ventricular compression. 

Maxillary, ethmoid and frontal sinus mucosal thickening. 

Venous sinuses are patent. 

No falcine ossification. No siderosis. 

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

No meningeal enhancement or evidence of basilar meningitis. 

2mm of tonsillar ectopia without platybasia, Klippel-Feil and basilar assimilation. 

Optic nerves are symmetric without enlargement or enhancement. 

No neurodegenerative pattern of cerebral atrophy. Nigral and palatal iron stores are maintained. Midbrain and collicular plate volumes are maintained. 

No parahippocampal atrophy. 

Xanthogranulomas within the ventricular atria. 

IMPRESSION:

Scattered subcortical hyperintensities without evidence of acute ischemia on diffusion-weighted images most conspicuous in the left centrum semiovale. Septal callosal region is relatively spared. No supportive findings of optic neuritis. No diffusion restriction or lesional enhancement. Differential may include gliosis of microangiopathic origin, migraine and, in the described clinical setting, demyelinating process. Further considerations could include vasculitis. No other supportive findings of basilar inflammatory process. 

No intracranial hemorrhage, neoplasm or obstructive hydrocephalus. 

2mm of tonsillar ectopia without other supportive findings of Chiari malformation. 

Maxillary, ethmoid and frontal sinus mucosal thickening. 

No neurodegenerative pattern of cerebral atrophy. No supportive findings of multisystem atrophy. 

No obstructive hydrocephalus.

LESSON 3, TOPIC 57

Case Challenge: Brain MRI Cases

Case Challenge

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Content reviewed: July 23, 2021

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