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

Case 1 - 68-year-old male presents with new onset of impaired cognition

Case 2 - 63-year-old male presents with headache, memory loss, ataxia

Case 3 - 59-year-old female presents with symptoms and signs involving cognitive functions and awareness

Case 4 - 53-year-old female presents with cognitive decline with sleep inversion

Case 5 - 66-year-old male presents with decreased fine motor skills

Case 6 - 2-year-old male presents with developmental delay

Case 7 - 63-year-old male presents with headaches

Case 8 - 29-year-old female presents with several syncopal episodes

Case 9 - 15-year-old female presents with blurred vision for two weeks

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

Case 11 - 50-year-old male presents with dizziness, diplopia

Case 12 - 59-year-old female presents with hyperreflexia

Case 13 - 52-year-old female presents with olivopontocerebellar atrophy

Case 14 - 64-year-old female presents with memory loss

Case 15 - 65-year-old male presents with abnormal gait

Case 16 - 66-year-old male presents with history of Parkinson's disease

Case 17 - 76-year-old male presents with Parkinson's disease

Case 18 - 62-year-old female referred for MRI subsequent to being unable to hold still

Case 19 - 74-year-old male presents with gait disturbance, dementia

Case 20 - 52-year-old male presents with history of multiple sclerosis

Case 21 - 68-year-old male presents with history of a fall one year prior with brain trauma

Case 22 - 92-year-old female is to be evaluated for cerebral degeneration

Case 23 - 58-year-old female presents with speech disturbance

Case 24 - 51-year-old female presents with numbness and weakness in legs and arms

Case 25 - 64-year-old male presents with possibility of ALS

Course Evaluation

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

<div>HISTORY:&#160;This 66-year-old male presents with history of Parkinson's disease.(QUIZ ANSWER) IS A FINDING IN THIS CASE:&#160;Partial empty sella.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Medialized midbrain iron stores and narrowing of the zona compacta stripe may correlate with provided history of Parkinson's.Midbrain and collicular plate volume are maintained.&#160;Multiple bilateral foci of parenchymal hyperintensity may represent gliosis of microangiopathic origin. No supportive findings of acute ischemia on diffusion-weighted images.&#160;No transependymal spread of CSF or sulcal effacement.&#160;No Chiari malformation.&#160;Carotid and basilar artery flow voids are intact.&#160;&#160;Optic nerve sheath dilatation, partial empty sella.&#160;Venous sinuses are patent.&#160;No masses in the masticator, parapharyngeal or pharyngeal mucosal spaces.&#160;No focal white matter tract signal abnormality on fractional anisotropy.&#160;No callosal thinning. No white matter tract disruption on fiber tracking.&#160;No focal diffusion abnormality on arterial spin labeling.&#160;No siderosis on blood-sensitive images.&#160;No extraaxial hemorrhage.&#160;No enlargement of the extraocular muscles.&#160;No parahippocampal atrophy.&#160;Maxillary and ethmoid sinus mucosal thickening.&#160;No focal hypointensities on ADC.&#160;CONCLUSION:&#160;1. Multiple bilateral foci of parenchyma hyperintensity may represent gliosis of microangiopathic origin related to chronic hypertension and / or metabolic disease. No supportive findings of acute ischemia on diffusion-weighted images. Additional differential could include vasculitis, hypercoagulable state. If basilar inflammatory process such as sarcoidosis or Lyme are of clinical concern, contrast-enhanced examination may be considered to provide further definition.&#160;2. Medialization of midbrain iron stores with mild narrowing of the zona compacta stripe could be consistent with provided history of Parkinson's disease. Midbrain and collicular plate volume are maintained. No supportive findings of multisystem atrophy.&#160;3. No obstructive hydrocephalus. No NPH.&#160;4. No parenchymal or extraaxial hemorrhage.&#160;5. Optic nerve sheath dilatation and partial empty sella may be seen in association with intracranial hypertension. Although patient demographic is atypical, eye examination to exclude papilloedema is recommended if presentation includes headaches and/or visual disturbance.&#160;6. No siderosis. No supportive findings of amyloid angiopathy.&#160;7. No focal signal disruption of white matter tracts on fractional anisotropy or fiber tracking. No focal perfusion defect on arterial spin labeling.&#160;8. No parenchymal mass identified on noncontrast images.</div>

Case

Transependymal spread of cerebrospinal fluid

White matter tract disruption on fiber tracking

Which of the following IS a finding in this case