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Age: 67

Sex: Male

Indication: Right-sided weakness

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Case #9


Findings

  • Small area of restricted diffusion and corresponding T2/FLAIR signal hyperintensity in the posterior limb of the left internal capsule extending into the left caudate tail and left corona radiata
  • Remote small vessel infarcts involving the right caudate nucleus and right cerebellar hemisphere
  • Patchy T2/FLAIR signal hyperintensity in the subcortical and periventricular white matter, which although nonspecific likely relates to chronic small vessel disease
  • Generalized cerebral and cerebellar volume loss with ex vacuo ventricular enlargement
  • Greater than expected susceptibility artifact involving the basal ganglia (particularly the lateral putamina), substantia nigra, red nuclei, and dentate nuclei with linear T2/FLAIR signal hyperintensity along the lateral putaminal margins/subinsular regions
  • Mucous retention cyst in the left maxillary sinus with mucosal thickening of bilateral ethmoid air cells
  • Small right mastoid effusion
  • Bilateral pseudophakia


Diagnosis

Parkinson-type multiple system atrophy (MSA-P)

Sample Report

Acute/early subacute infarct involving the posterior limb of the left internal capsule extending into the left caudate tail and left corona radiata. No hemorrhagic transformation or significant corresponding mass effect.

Remote small vessel infarcts in the right caudate nucleus and right cerebellar hemisphere on a background of generalized volume loss and chronic small vessel disease.

Greater than expected susceptibility artifact involving the basal ganglia (particularly the lateral putamina), substantia nigra, red nuclei, and dentate nuclei with linear T2/FLAIR signal hyperintensity along the lateral putaminal margins/subinsular regions which can be seen with Parkinson-type multiple system atrophy (MSA-P) or neurodegeneration with brain iron accumulation (NBIA).


Discussion



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Images

Abnormal hypointense signal in the putamina on susceptibility-weighted imaging (red arrows) and linear T2 hyperintense signal along the periphery of the putamina (yellow arrows) in this patient with MSA-P.



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