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Short case...Progressive supranuclear palsy
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Short case...Progressive supranuclear palsy

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Short case...Progressive supranuclear palsy …

Short case...Progressive supranuclear palsy
http://yassermetwally.net
http://yassermetwally.com

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  • 1. Short case publication... Version 4.3 | Edited by professor Yasser Metwally | November 2010 Short case Edited by Professor Yasser Metwally Professor of neurology Ain Shams university school of medicine Cairo, Egypt Visit my web site at: http://yassermetwally.com A 50 years old female patient presented clinically with postural instability with frequent falling, and Vertical gave palsy with preserved oculocephalic reflex. Clinical examination revealed mild parkinsonian features. DIAGNOSIS:PROGRESSIVE SUPRANUCLEAR PALSy (PSP)
  • 2. Figure 2. MRI FLAIR images. On axial views, the selective atrophy of the midbrain tegmentum with relative preservation of the tectum and cerebral peduncles produces the “Mickey mouse” sign. Sometimes, the concavity of the lateral margin of the midbrain tegmentum is referred to as the “morning glory” sign and has high specificity but rather low sensitivity for PSP. Notice the periaqueductal signal changes representing astrogliosis. Also notice the dilatation of the aqueduct of Sylvius. Also notice evidence of central and cortical atrophy. Figure 1. Precontrast MRI T1 images. The characteristic MR imaging feature is selective atrophy of the midbrain in association with preservation of the pons. The resulting atrophy of the midbrain tegmentum gives a distinctive concavity with the appearance of the beak of a hummingbird or king penguin, and is termed the “hummingbird” or “penguin” sign. Notice dilatation of the aqueduct of Sylvius and the superior cerebellar peduncle.
  • 3. Figure 3. On axial views, the selective atrophy of the midbrain tegmentum with relative preservation of the tectum and cerebral peduncles produces the “Mickey mouse” sign (see Fig. 1B). Sometimes, the concavity of the lateral margin of the midbrain tegmentum is referred to as the “morning glory” sign and has high specificity but rather low sensitivity for PSP. Notice the periaqueductal signal changes representing astrogliosis. Also notice the dilatation of the aqueduct of Sylvius. Also notice evidence of central and cortical atrophy. References 1. Metwally, MYM: Textbook of neurimaging, A CD-ROM publication, (Metwally, MYM editor) WEB-CD agency for electronic publishing, version 11.4a October 2010 Figure 4. MRI T2 images showing Vircho Robin spaces scsttered in the region of the midbrain. (Type III VR spaces)
  • 4. Addendum A new version of short case is uploaded in my web site every week (every Saturday and remains available till Friday.) To download the current version follow the link "http://pdf.yassermetwally.com/short.pdf". You can download the long case version of this short case during the same week from: http://pdf.yassermetwally.com/case.pdf or visit web site: http://pdf.yassermetwally.com To download the software version of the publication (crow.exe) follow the link: http://neurology.yassermetwally.com/crow.zip At the end of each year, all the publications are compiled on a single CD-ROM, please contact the author to know more details. Also to view a list of the previously published case records follow the following link: (http://wordpress.com/tag/case-record/) or click on it if it appears as a link in your PDF reader To inspect the patient's full radiological study, click on the attachment icon (the paper clip icon in the left pane) of the acrobat reader then double click on the attached file Click here to download the long case version of this short case in PDF format