Bilateral middle cerebellar peduncle lesions

Involvement of both middle cerebellar peduncles is uncommon, but has a relatively long list of differential diagnoses, including ¹:

• neurodegenerative diseases
  • multiple systemic atrophy (MSA)
    • olivopontocerebellar atrophy
    • Shy-Drager syndrome
  • spinocerebellar atrophy
• metabolic diseases 
  • adrenoleukodystrophy
  • Wilson disease
  • alcoholic liver cirrhosis
  • hypoglycemic coma
• neoplasms
  • primary CNS lymphoma
  • brainstem glioma
  • leptomeningeal carcinomatosis
• cerebrovascular disease
  • AICA infarction
  • hypertensive encephalopathy
  • pontine infarct with Wallerian degeneration (involving bilateral middle cerebellar peduncles)
• inflammatory and demyelinating diseases
  • multiple sclerosis (MS)
  • acute disseminated encephalomyelitis (ADEM)
  • Behcet disease
  • Erdheim-Chester disease ²
  • HIV encephalopathy
• Cyclosporin-A encephalopathy

See middle cerebellar peduncles for anatomy.