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.

 

FINDINGS:

 

BRAIN:

 

Parenchyma: No infarct, hemorrhage, abnormal enhancement, or restricted diffusion.

 

Abnormal T2 hyperintense signal about the quadrigeminal plate, periaqueductal gray, 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 

cisternal effacement.

 

Orbits: Normal.

 

Paranasal sinuses: Mild mucosal thickening in the paranasal sinuses 

which may be congestive or inflammatory in nature.  

 

Mastoid air cells: Clear.

 

Bones: Normal.

 

INTRACRANIAL ANGIOGRAM:

 

Anterior circulation: No flow-limiting stenosis or aneurysm.

 

Posterior circulation: No flow-limiting stenosis or aneurysm.

 

Dural venous sinuses: Patent.

 

EXTRACRANIAL ANGIOGRAM:

 

Proximal great vessels: No flow-limiting stenosis or dissection.

 

Cervical vessels: No flow-limiting stenosis or dissection.

 

PERFUSION:

Normal.

  

IMPRESSION:

 

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.