Concluded Case

Acute infarctions Both PICA territories.

69 yr ,M ,Presented with acute onset of vertigo,vomiting and unsteadiness developed on 14th of this month at 02 hrs.Denied having head ache or alteration in sensorium.Arrived the hospital at 12 noon. History Known Duabetic 20 yrs ,on insulin ,on regular follow up Physical Examination Vitals stable. BP 140/ 90 mmhg. Normal pupils.Dysarthria with explosive quality , gaze evoked nystagmus on all directions.Other cranial nerves normal. Motor system gr 5/5 power. DTRs equal bilaterally with flexor plantars.Bilateral cerebellar signs in both upper and lower limbs with gait ataxia . Investigations All blood work up including lipids Normal Marginal elevation in uric acid noted. Cardiac evaluation reported as normal. Diagnosis Diagnosisis very clear I'm MRI brain ,keeping for discussion. Management Started on appropriate medicine. What abnormality in the MRI brain ?

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Concluded answer

Thanks Curofy and all others answeres. MRI brain with MRA : Acute infarct with hemorrhagic transformation involving bilateral posterior inferior cerebellar hemisphere's and left inferior cerebellar vermis,corresponding to PICA territories. Mass effect with compression and narrowing of 4th ventricle causing mild upstream hydrocephalus. MRA shows attenuated caliber of proximal Rt PICA.Left PICA is not visualized. Rept CT brain done to check the hydrocephalus.Remaining static. On medical management as per stroke protocol. Getting physio. Pt is better ,improving,still in the hospital.

All Answers

Thanks Curofy and all others answeres. MRI brain with MRA : Acute infarct with hemorrhagic transformation involving bilateral posterior inferior cerebellar hemisphere's and left inferior cerebellar vermis,corresponding to PICA territories. Mass effect with compression and narrowing of 4th ventricle causing mild upstream hydrocephalus. MRA shows attenuated caliber of proximal Rt PICA.Left PICA is not visualized. Rept CT brain done to check the hydrocephalus.Remaining static. On medical management as per stroke protocol. Getting physio. Pt is better ,improving,still in the hospital.

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