Small vessel disease

Case contributed by Dr Derek Smith

Presentation

Admitted with falls and cerebellar signs (reduced co-ordination, right lateral nystagmus). Known small vessel disease and previous TIAs, last imaged 5 years ago.

Patient Data

Age: 85
Gender: Female
Modality: CT

Moderate atrophy.

Marked periventricular and deep white matter ischaemic changes.

No acute infarct or haemorrhage. No extra-axial collections or hydrocephalus.

7mm hyperdense cystic structure over Foramen of Monro unchanged from previous imaging - likely colloid cyst.

Small aneurysms of proximal basilar artery and left MCA bifurcation.

Case Discussion

This is an example of chronic small vessel disease, which also includes small unruptured aneurysms and a colloid cyst.

The colloid cyst has remained unchanged on serial CTs over a decade. MPR views in this case were degraded but show it in a position above the foramen of Monro.

Although MRI would be a better modality to determine if there have been any new lesions, particularly in the posterior fossa, the patient was already on stroke preventative medication and this was all attributed to pre-existant small vessel disease.

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Case Information

rID: 37554
Case created: 12th Jun 2015
Last edited: 4th Oct 2015
Inclusion in quiz mode: Included

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