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 59-year-old female presents with hyperreflexia.(QUIZ ANSWER) LEAST LIKELY DIFFERENTIAL IN THIS CASE:&#160;Friedreich's ataxia.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Status post antrostomies.&#160;Calvarium is intact. No Chiari malformation.&#160;Marked superior cerebellar atrophy involving the culmen, declive, folium and tuber of the cerebellar vermis with relative sparing of the uvula pyramis. The inferior vermis is intact. Atrophy extends into the quadrangular lobes of the cerebellum bilaterally. Nigral and pallidal iron stores are maintained. Midbrain and collicular plate volume are maintained.&#160;Diffusion-weighted images are without a diffusion-restrictive defect.&#160;Maxillary sinus mucosal thickening.&#160;No masses within the masticator, parapharyngeal or pharyngeal mucosal spaces.&#160;No internal auditory canal or cerebellopontine angle masses.&#160;No extraaxial collections or hemorrhage.&#160;No obstructive hydrocephalus.&#160;Mild left otomastoid airspace disease.&#160;No abnormal meningeal enhancement.&#160;No atrophy of the olive or medulla.&#160;Diameter of the middle cerebellar peduncle of 1.6cm.&#160;No supratentorial atrophy.&#160;Partial empty sella with pituitary stalk slightly deviated to the right. No macroadenoma.&#160;No orbital or retroorbital masses.&#160;CONCLUSION:&#160;1. Marked superior vermian greater than hemispheric cerebellar atrophy involving the culmen, declive, folium and tuber, and to a lesser degree the quadrangular lobes of the more lateral cerebellar hemispheres. Midbrain and collicular plate volume are preserved. Nigral and pallidal iron stores are maintained. Differential may include hereditary cerebellar atrophy, MSA-C, toxic metabolic, thyroiditis,paraneoplastic. Hereditary olivopontocerebellar atrophy, Friedreich's ataxia may also be within the differential but appear less likely given the morphologic pattern of volume loss.&#160;2. No other supportive findings of corticobasal degeneration.&#160;3. No other supportive findings of idiopathic Parkinson's.&#160;4. No obstructive hydrocephalus.&#160;5. Status post antrostomies.</div>

Case

Multiple system atrophy, cerebellar (MSA-C)

Which of the following is the LEAST LIKELY differential in this case?