Wallerian degeneration in middle cerebellar peduncles
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Symmetrical bilateral middle cerebellar peduncle T2 hyperintensities are associated with an established right paramedian pontine infarct. The lesions demonstrate minor increased DWI signal and facilitated diffusion on ADC.
This is an interesting case with the differential being essentially that of bilateral middle cerebellar peduncle T2 signal abnormality. In the context of a prior pontine infarct the main differential consideration is that of bilateral AICA infarction and Wallerian degeneration.
Wallerian degeneration is favored given the very symmetric nature of the abnormality and the presence of the pontine infarct. This is a recognized pattern 1-3,5.
Acknowledgement: Prof Stephen Stuckey
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