Wednesday, January 11, 2012

Phenytoin associated Cerebellar atrophy - MRI

28 year old female with chronic seizures on long term phenytoin therapy. MR examination of the brain showing diffuse atrophy of the both lobes of the cerebellum, vermis and the brainstem evidenced by prominent cerebellar foliae, pre pontine and CP angle cisterns.
Diffuse atrophy of the cerebellum refers to degeneration / reduction from a previously normal cerebellar volume. The term slightly differs from cerebellar hypoplasia meaning the cerebellum was not well formed to start with.
  • Diffuse atrophy can result from variety of causes
  • Normal ageing
  • Alcoholic cerebellar degeneration
  • Drugs (e.g phenytoin)
  • Multi system atrophy (MSA)
  • Ataxia telangiectasia 
  • Friedreich ataxia
  • Marinesco-Sj√∂gren syndrome (MSS)
  • Fahr disease : atrophy not specific to cerebellum
  • Paraneoplastic cerebellar degeneration (PCD)
  • Olivopontocerebellar atrophy (OPCA)
  • Cerebrotenidinous xanthomatosis

Differential diagnoses
  • Cerebellar hypoplasia
  • Mega cisterna magna

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