Small Brainstem
Karen L. Salzman, MD
DIFFERENTIAL DIAGNOSIS
Common
Cerebral Infarction, Chronic
Wallerian Degeneration
Less Common
Multiple Sclerosis, Chronic
Multiple System Atrophy
Olivopontocerebellar Degeneration
Striatonigral Degeneration
Rare but Important
Friedreich Ataxia (Spinocerebellar Ataxia)
Progressive Supranuclear Palsy
Congenital
Prematurity-Related Atrophy
Congenital Muscular Dystrophy
Pontocerebellar Hypoplasias
ESSENTIAL INFORMATION
Helpful Clues for Common Diagnoses
Cerebral Infarction, Chronic
May be lacunar, territorial, related to small vessel disease, or hypertensive hemorrhage
Brainstem supplied primarily by cerebellar arteries & vertebrobasilar perforators
Brainstem T2 hyperintensity & atrophy
Wallerian Degeneration
Chronic infarct along corticospinal tract leads to volume loss of cerebral peduncle, ventral pons, & medullary pyramid
Typically T2 hyperintense
Helpful Clues for Less Common Diagnoses
Multiple Sclerosis, Chronic
Brainstem atrophy ± T2 hyperintensity
Multiple System Atrophy
Includes olivopontocerebellar atrophy, striatonigral degeneration, & Shy-Drager
MR features overlap
Brainstem & cerebellar atrophy
Pons, middle cerebellar peduncle ↑ T2
Putamen: T2 hypointensity
MSA-C: Cerebellar signs predominate
MSA-P: Parkinsonism predominates
Olivopontocerebellar Degeneration
Pons T2 cruciform hyperintensity
Pons, olives, & cerebellar vermis atrophy
Striatonigral DegenerationRelated posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
