Clinical question: Mass or infarct? Signs and symptoms: Right side decreased sensation, weakness and ataxia. Pre-and post contrast brain MRI:No detectable acute intracranial process and no evidence of acute ischemic stroke.Examination demonstrates a very prominent cerebellar and vermian folia for patient's stated age of 41 consistent with significant parenchymal volume loss. There is also resultant mild expansion of the fourth ventricle. There is no convincing evidence of any signal abnormality abdominal aortogram is. There is also suggestion of subtle pontine and medullary parenchymal volume loss. Correlate with history and risk factors.The anatomical morphology and the signal intensity of the cerebral hemispheres remains within normal on all MRI sequences. The cerebral cortex, cortical sulci, ventricular system and the CSF spaces as well as the brain myelination is unremarkable. Post enhanced images demonstrate no abnormal parenchymal, leptomeningeal, calvarial or retropatellar enhancement.Signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are beginning normal with normal pattern of enhancement.Unremarkable orbits, paranasal sinuses and mastoid air cells.
1.Parenchymal volume loss of cerebellum, vermis and suspected volume loss of pons / medulla without associated signal abnormality or enhancement.2.Unremarkable pre-and post enhanced brain MRI on.