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33b - Answer: 60-year-old male presents with numbness and weakness

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

HISTORY: 

This 60-year-old male presents with numbness and weakness. Complaining of being off balance.

(QUIZ ANSWER) PRIMARY FINDING: 

Brain stem with gliosis.

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

FINDINGS:

1.25cm spherical, cystic-appearing lesion in the left temporal bone at the temporooccipital suture which follows CSF intensity on T1, T2, and FLAIR sequences, does not enhance, and demonstrates intermediate diffusion restriction favor congenital dermoid lesion versus less likely pacchionian body.

Cerebral hemispheres, deep nuclei, brain stem and cerebellum are without hemorrhage, mass, edema, gliosis, enhancement or atrophy. 

No internal auditory canal or cerebellopontine angle masses or enhancement. 

Ventricular system is of normal size and configuration without hydrocephalus. 

No extraaxial collections or hemorrhage. 

Carotid and basilar flow voids are intact. 

Venous sinuses are patent. 

No diffusion restriction. No acute supra- or infratentorial ischemia or areas of demyelination. 

No siderosis or evidence of vascular malformation. 

Pituitary and sella turcica are unremarkable. No para- or retrosellar masses or cysts. 

Craniocervical junction is unremarkable without Chiari malformation. 

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

Mild bilateral otomastoid airspace disease, left greater than right. Ethmoid sinus demonstrates debris bilaterally without confluent disease or air-fluid levels. Remaining paranasal sinuses are clear without air-fluid levels. 

No cranial neuritis. 

No supportive findings of pseudotumor cerebri. No optic nerve sheath dilatation, globe flattening, or ventricular dilatation. 

No meningeal enhancement. No evidence of meningitis or meningoencephalitis. 

7th and 8th nerve complexes are intact. Cochleae and vestibula are intact. No cranial neuritis. 

No vestibular ductal dilatation. 

No supportive findings of vertebrobasilar insufficiency. 

CONCLUSION

1. 1.25cm spherical, cystic-appearing lesion in the left temporal bone at the temporooccipital suture which follows CSF intensity on T1, T2, and FLAIR sequences, does not enhance, and demonstrates intermediate diffusion restriction favor congenital dermoid lesion versus less likely pacchionian body.

2. Mild bilateral otomastoid airspace disease, left greater than right. Ethmoid sinus demonstrates debris bilaterally without confluent disease or air-fluid levels. Remaining paranasal sinuses are clear without air-fluid levels. 

3. Cerebral hemispheres, deep nuclei, brain stem and cerebellum are without hemorrhage, mass, edema, gliosis, enhancement or atrophy. 

4. 7th and 8th nerve complexes are intact. Cochleae and vestibula are intact. No internal auditory canal or cerebellopontine angle masses. No cranial neuritis. No vestibular ductal dilatation.

LESSON 3, TOPIC 69

Case Challenge: Brain MRI Cases

Case Challenge

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Content reviewed: July 23, 2021

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