Infarction at this special location may lead to bilateral and symmetrical WD of the middle cerebellar peduncles
(MCPs).,, However, because bilateral lesions of the MCPs may also occur in ischemic, demyelinating, metabolic, other neurodegenerative diseases and intoxication,, misdiagnosis in clinical practice may occur; consequently, clinicians need to become more familiar with secondary lesions.
The additional findings include T1-hypointense and T2 and FLAIR hyperintense signal abnormalities in the inferior olivary nuclei, inferior cerebellar peduncles
, central tegmental tracts, reticular formation in the dorsal pons and periaqueductal gray matter in the midbrain (1,2).
However, these subtypes share common histopathological changes, characterized by neuronal loss, gliosis and the presence of glial cytoplasmic inclusions (GCI) with a-synuclein.5 In MSA-P the degenerative changes predominantly affect the basal ganglia, particularly the putamen seen as hyperintense rim at the putaminal edge, atrophy and hypointensity of putaminal body on T2WI while in MSA-C changes predominantly affect infratentorial structures like pons and cerebellum, seen as atrophy and hyperintense signals in pons, cerebellum and middle cerebellar peduncles
with pontine hyperintensity (hot cross bun sign) on axial image,4 which was seen in both of our patient's MRI.
Caption: Figure 4: Magnetic resonance imaging cerebellar peduncles
showing "molar tooth appearance"
Out of 14 SLE patients who had seizures, 9 had white matter hyperintensities; seven had isolated white matter hyperintensities, one had combination of white matter hyperintensities plus hyperintensities in corpus callosum and right middle cerebellar peduncle
, and one patient had combination of white matter hyperintensities and hyperintensities in paramedian cerebellar hemispheres with mild brain atrophy.
Magnetic resonance imaging (MRI) of the brain showed signal abnormalities in the pons and left middle cerebellar peduncle
on fluid-attenuated inversion recovery (FLAIR) sequences, with subtle contrast enhancement on T1-weighted images.
Rhombencephalosynapsis (RS) is a rare congenital posterior fossa malformation characterised by hypogenesis or agenesis of the vermis, dorsal fusion of cerebellar hemispheres, and fusion of the dentate nuclei and superior cerebellar peduncles
(1) This appearance is a result of absence or hypoplasia of the cerebellar vermis, lack of normal dorsal decussation and consequent enlargement of the superior cerebellar peduncles
which follow a more horizontal course as they extend perpendicularly to the brainstem between the midbrain and the cerebellum.
Two patients had balance problems which were likely due to involvement of inferior cerebellar peduncles
as there was no cerebellar lesion.
MR patterns in LBSL are characterized by extensive demyelination, involving corpus callosum, pyramidal fibres of corona radiata, posterior part of the internal capsules, brainstem (cerebellar peduncles
, intraparenchymal and mesencephalic trigeminal nerves).
14), and the cerebellum with the middle cerebellar peduncles
Because the cerebellum represents an inappreciable proportion of brain weight on GD21, the remainder was designated "midbrain + brainstem." For studies on PN5, PN10, PN15, and PN21, brains were dissected into three regions: blunt cuts were made through the cerebellar peduncles
, whereupon the cerebellum (including flocculi) was lifted from the underlying tissue.
An MRI of the brain showed an asymmetric abnormal signal in both cerebellar peduncles
, the cerebellar white matter, and the front area of the medulla (Figure 1).
Additional symmetrical FLAIR hyperintensities involved the cerebellar white matter extending to the middle cerebellar peduncles
Lesions can involve the substantia nigra, periaqueductal gray matter within the midbrain, inferior colliculus, inferior olivary nuclei, inferior cerebellar peduncles
, medulla, solitary tract in the medulla, central tegmental tract and reticular formation in the dorsal pons.