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34b - Answer: 58-year-old female presents with problems walking

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

HISTORY: 

This 58-year-old female presents with problems walking, loss of hearing bilaterally, getting worse.

(QUIZ ANSWER) NOT A DIFFERENTIAL TO CONSIDER: 

Chronic hypotension.

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

FINDINGS:

Diffusion-weighted images are without evidence for active diffusion restriction to suggest acute ischemic event. 

Focal high signal on T1 and T2 lesion in the posterior fossa in the area of the junction of the right sigmoid sinus and transverse sinus abutting the right cerebellar hemisphere. Differential considerations include focal sinus thrombosis versus dermoid cyst and MRV is recommended for further evaluation. There is no evidence for venous infarction or additional flow-related abnormalities. 

Ventricular system is normal in size and configuration. No intraaxial or extraaxial fluid collections or mass lesions. No acute intracranial hemorrhage or midline shift. 

Scattered T2 and FLAIR white matter hyperintensities in a subcortical, centrum semiovale, and corona radiata distribution advanced for the patient's age. Differential considerations include chronic hypertension, vasculitis, diabetes, or metabolic diseases. 

Orbits and globes are unremarkable. Paranasal sinuses and mastoid air cells are clear. Focal irregularity within the anterior maxilla with overlying soft tissue edema concerning for a complex odontogenic cyst versus remote trauma. 

IMPRESSION:

Focal high T1 and T2 signal lesion abutting the right cerebellar hemisphere concerning for sinus thrombosis at the junction of the sigmoid and transverse sinuses versus dermoid cyst. MRV is recommended for further evaluation. No evidence for venous infarct or additional flow-related abnormalities. 

Scattered white matter microvascular ischemic changes and gliosis. Differential considerations include chronic hypertension, vasculitis, metabolic diseases, and diabetes. 

Focal defect in the anterior maxilla indicating either remote trauma or a complex odontogenic cyst.

LESSON 3, TOPIC 72

Case Challenge: Brain MRI Cases

Case Challenge

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Content reviewed: July 23, 2021

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