AJNR Am J Neuroradiol. 2003 Nov-Dec;24(10):1946-54
Okamoto K, Tokiguchi S, Furusawa T, Ishikawa K, Quardery AF, Shinbo S, Sasai K.
Department of Radiology, Niigata University Faculty of Medicine, Niigata City, Japan, Department of Neurology, Ojiya General Hospital, Ojiya City, Japan, and Department of Neurology, Kawase Neurology Clinic, Sanjo City, Japan.
BACKGROUND AND PURPOSE:
Distribution of lesions or involvement of specific anatomic sites can suggest the diagnosis of disease.
The purpose of this study was to investigate what diseases affect both middle cerebellar peduncles (MCPs) and to evaluate other MR features for differential diagnosis.
MR findings of 27 patients (14 male and 13 female; age range, 4-77 years [mean, 48.5 years]) with bilateral MCP lesions were retrospectively studied.
Neurodegenerative diseases were the most frequent diagnoses (n = 11 [41%]: sporadic olivopontocerebellar atrophy, eight; Shy-Drager syndrome, one; spinocerebellar ataxia, two).
Also included were metabolic diseases (n = 6 [22%]: adrenoleukodystrophy, two; Wilson disease, two; cirrhosis of the liver, one; and hypoglycemia, one); cerebrovascular diseases, including posterior reversible encephalopathy syndrome (n = 3 [11%]: infarction, one; hypertensive encephalopathy, one; cyclosporin-A encephalopathy, one), demyelinating and inflammatory diseases (n = 4 [15%]: multiple sclerosis, one; acute disseminated encephalomyelitis, one; Behcet disease, one; and HIV encephalopathy, one), and neoplasms (n = 3 [11%]: lymphoma, one; glioma, one; meningeal carcinomatosis, one).
All patients showed symmetrical T2 hyperintensity in both MCPs, except for one with malignant lymphoma.
Marked atrophy in the posterior fossa was characteristically seen in neurodegenerative diseases.
Enlargement of the pons was observed in hypertensive encephalopathy and neoplasms but absent in meningeal carcinomatosis.
Lesions were restricted in the posterior fossa in eight patients with neurodegenerative diseases and one with brain stem glioma.
Other patients had supratentorial lesions.
Symmetricity of MCP lesions, morphologic change of the posterior fossa structures, and distribution of other lesions are helpful in the differential diagnosis.