Concluded Case

Tumefactive demyelination Rt cerebellar peduncle

28 yr ,F, presented with vertigo followed by rt sided unstediness and defective clarity of speech of 2 days duration. Two days ago she developed subjective vertigo vomited once .Evaluated locally and received inj Prochlorpirazine and then tab for 3 days. The next day she developed defective clarity of speech with unstediness of rt upper limb with mild difficulty to walk. Denied having any head ache ,visual symptoms,bladder or bowel symptoms.Denied having any fatigue,loss of wt, appetite or fever or arthralgia .No recent travel or Covid contact.Not on any hormonal med. No previous history of any medical or neurological complaints. Examination : No external markers for vasculitis.BP110/ 70 mmhg. Scanning dysarthria noted.. Normal optic fundi. Intact cranial nerves. Motor system gr5/ 5 power with intact DTRs. Rt upper limb incordination with gait ataxia with tendency to sway to rt side.Intact sensations. Routein blood work up biochemistry,vasculitis screening,Covid screening ,CSF study all with in the normal limits. Evoked potentials were normal. MRI brain with contrast & MRS done Opinion of the case.

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Concluded answer

Thanks Curofy & others who answered the case. MRI brain - A fairly well defind T2/ FLAIR hyperintense expanding the Rt middle cerebellar peduncle with mild peripheral diffusion restriction. No blooming/ enhancement. Mildly raised Choline/ creatine ration with normal NAA levels.Another similar lesion in the left thalamocapsular region with extension to ipsilateral cerebral peduncle. Tumefactive demyelination in theRt cerebellar peduncle with another demyelinating lesion in the Lt thalamocapsular extending to left cerebral peduncle Received a course of Methyl predisposition. plan - Follow up MRI after 6 weeks

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Thanks Curofy & others who answered the case. MRI brain - A fairly well defind T2/ FLAIR hyperintense expanding the Rt middle cerebellar peduncle with mild peripheral diffusion restriction. No blooming/ enhancement. Mildly raised Choline/ creatine ration with normal NAA levels.Another similar lesion in the left thalamocapsular region with extension to ipsilateral cerebral peduncle. Tumefactive demyelination in theRt cerebellar peduncle with another demyelinating lesion in the Lt thalamocapsular extending to left cerebral peduncle Received a course of Methyl predisposition. plan - Follow up MRI after 6 weeks

Rt cerebellum and and it's peduncle there is T2 hyperintensity and T1 Hypo without any contrast enhancement Rest of brain appears normal In view of history, examination and this imaging finding 1st possibility is demyelination.. Multiple sclerosis Also need to rule out other causes of secondary demyelination

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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