Neuro_MR_Brain: 43 M, acute nausea/vomiting, internuclear ophthalmoplegia
MRI BRAIN STROKE PROTOCOL:
MR CEREBRAL ANGIOGRAM HEAD AND NECK WITH CONTRAST
MR CEREBRAL VENOGRAM
HISTORY: 43-year-old male with acute nausea, vomiting, internuclear ophthalmoplegia, and upward gaze palsy.
Parenchyma: No infarct, hemorrhage, abnormal enhancement, or restricted diffusion.
Abnormal T2 hyperintense signal about the quadrigeminal plate,
left middle cerebellar peduncle
, lateral medulla, subependymal third ventricle, and bilateral medial thalami.
It is difficult to assess involvement of the mamillary bodies or fornices on this exam which was optimized to evaluate for stroke, arterial anomaly, and venous anomaly rather than white matter
changes. Cerebral white matter T2/FLAIR hyperintense foci on the
left, as well as the body of the corpus callosum.
Ventricles and extra-axial spaces: No ventricular, sulcal, or
Paranasal sinuses: Mild mucosal thickening in the paranasal sinuses
which may be congestive or inflammatory in nature.
Mastoid air cells: Clear.
Anterior circulation: No flow-limiting stenosis or aneurysm.
Posterior circulation: No flow-limiting stenosis or aneurysm.
Dural venous sinuses: Patent.
Proximal great vessels: No flow-limiting stenosis or dissection.
Cervical vessels: No flow-limiting stenosis or dissection.
1. Abnormal deep gray and white matter signal within both thalami,
the brainstem notably in the periaqueductal gray, and periventricular
regions. Favor thiamine deficiency (Wernicke's encephalopathy) over
demyelination/neuromyelitis optica. Correlation with serum thymin
levels and CSF anti Aquaporin 4 immunoglobulins would be helpful.
2. No infarct, hemorrhage, perfusion anomaly, flow-limiting stenosis,
or dural venous sinus thrombosis.
Study description: MR DIAGNOSIS STROKE PROTOCOL