Wk 10, Case 5 - Review

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Report

Patient History
Diabetes. Gait problems leaning to the right. Hypertension.

Findings
These images demonstrate a tiny area of restricted diffusion in the posterior lateral right medulla. No other areas of restricted diffusion are evident. The signal intensity of the remainder of the brain shows a few punctate foci of high signal intensity in the subcortical white matter. Susceptibility weighted scans show no evidence of hemorrhage. Post gadolinium enhanced scans show no evidence of pathologic enhancement in the internal auditory canal cochlea or vestibule.

Both vertebral arteries show good flow voids as does the basilar artery.A small mucous retention cyst is seen in the inferior left maxillary antrum with minimal mucosal thickening in the ethmoid sinuses.

Impressions
Tiny right posterior lateral medulla acute infarction.Small vessel ischemic change of the white matter, chronic in age. No evidence of temporal bone pathology.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Joshua P Nickerson, MD

Associate Professor of Neuroradiology

Oregon Health & Science University

Francis Deng, MD

Assistant Professor of Radiology and Radiological Science

Johns Hopkins University School of Medicine

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Wk 10, Case 5 - Review