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Radiographic Features of Cerebellar Disease: Imaging Approach to Differential Diagnosis

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Handbook of the Cerebellum and Cerebellar Disorders

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Abstract

The cerebellum shares many neuroanatomical, histochemical and neurophysiological features with other CNS structures and many generic processes affecting the cerebellum will exhibit similar imaging features as seen in supratentorial and brainstem regions. The cerebellum also has many particular features that are reflected in its selective involvement by multiple pathological processes with characteristic imaging features. The purpose of this chapter is to provide the reader with a general overview and differential diagnosis of the pathological processes involving the cerebellum with similar imaging features as seen in other CNS structures as well as describing particular conditions more selectively involving the cerebellum with more specific radiological appearance.

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References

  • Alkan O, Kizilkilic O, Yildirim T (2009) Malformations of the midbrain and hindbrain: a retrospective study and review of the literature. Cerebellum 8:355–365

    Article  PubMed  Google Scholar 

  • Aribal ME, Gurcan F, Aslan B (1996) Chiari III malformation: MRI. Neuroradiology 38(Suppl 1):S184–S186

    Article  PubMed  Google Scholar 

  • Bland LI, Lapham LW, Ketonen L, Okawara SH (1994) Acute cerebellar hemorrhage secondary to capillary telangiectasia in an infant. A case report. Arch Neurol 51:1151–1154

    Article  PubMed  CAS  Google Scholar 

  • Blank MC, Grinberg I, Aryee E et al (2011) Multiple developmental programs are altered by loss of Zic1 and Zic4 to cause Dandy-Walker malformation cerebellar pathogenesis. Development 138:1207–1216

    Article  PubMed  CAS  Google Scholar 

  • Blaser SI (2007) Dandy Walker spectrum. In: Barkovich AJ (ed) Diagnostic imaging: pediatric neuroradiology, Amirsys, Salt Lake City, UT

    Google Scholar 

  • Boyd CA (2010) Cerebellar agenesis revisited. Brain 133:941–944

    Article  PubMed  CAS  Google Scholar 

  • Cantu C, Murillo-Bonilla L, Arauz A, Higuera J, Padilla J, Barinagarrementeria F (2005) Predictive factors for intracerebral hemorrhage in patients with cavernous angiomas. Neurol Res 27:314–318

    Article  PubMed  Google Scholar 

  • Caplan LR (2005) Cerebellar infarcts: key features. Rev Neurol Dis 2:51–60

    PubMed  Google Scholar 

  • Castillo M, Quencer RM, Dominguez R (1992) Chiari III malformation: imaging features. AJNR Am J Neuroradiol 13:107–113

    PubMed  CAS  Google Scholar 

  • Chao CP, Zaleski CG, Patton AC (2006) Neonatal hypoxic-ischemic encephalopathy: multimodality imaging findings. Radiographics 26(Suppl 1):S159–S172

    Article  PubMed  Google Scholar 

  • Chaves CJ, Caplan LR, Chung CS et al (1994) Cerebellar infarcts in the New England Medical Center posterior circulation stroke registry. Neurology 44:1385–1390

    Article  PubMed  CAS  Google Scholar 

  • Chiari H (1987) Concerning alterations in the cerebellum resulting from cerebral hydrocephalus. 1891. Pediatr Neurosci 13:3–8

    Article  PubMed  CAS  Google Scholar 

  • Connolly DJ, Widjaja E, Griffiths PD (2007) Involvement of the anterior lobe of the cerebellar vermis in perinatal profound hypoxia. AJNR Am J Neuroradiol 28:16–19

    PubMed  CAS  Google Scholar 

  • Conway RL, Pressman BD, Dobyns WB et al (2007) Neuroimaging findings in macrocephaly-capillary malformation: a longitudinal study of 17 patients. Am J Med Genet A 143A:2981–3008

    Article  PubMed  Google Scholar 

  • Costa MO, Lacerda MT, Garcia Otaduy MC, Cerri GG, Da Costa LC (2002) Proton magnetic resonance spectroscopy: normal findings in the cerebellar hemisphere in childhood. Pediatr Radiol 32:787–792

    Article  PubMed  Google Scholar 

  • D’Avella D, Cacciola F, Angileri FF et al (2001) Traumatic intracerebellar hemorrhagic contusions and hematomas. J Neurosurg Sci 45:29–37

    PubMed  Google Scholar 

  • Donmez FY, Basaran C, Kayahan Ulu EM, Yildirim M, Coskun M (2010) MRI features of posterior reversible encephalopathy syndrome in 33 patients. J Neuroimaging 20:22–28

    Article  PubMed  Google Scholar 

  • Fenzi F, Rizzuto N (2008) Ataxia and migraine-like headache in a girl with a cerebellar developmental venous anomaly. J Neurol Sci 273:127–129

    Article  PubMed  Google Scholar 

  • Fugate JE, Claassen DO, Cloft HJ, Kallmes DF, Kozak OS, Rabinstein AA (2010) Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc 85:427–432

    Article  PubMed  Google Scholar 

  • Fujita A, Nakamura M, Tamaki N, Kohmura E (2002) Haemodynamic assessment in patients with dural arteriovenous fistulae: dynamic susceptibility contrast-enhanced MRI. Neuroradiology 44:806–811

    Article  PubMed  CAS  Google Scholar 

  • Garner TB, Del Curling O Jr, Kelly DL Jr, Laster DW (1991) The natural history of intracranial venous angiomas. J Neurosurg 75:715–722

    Article  PubMed  CAS  Google Scholar 

  • Gripp KW, Hopkins E, Doyle D, Dobyns WB (2010) High incidence of progressive postnatal cerebellar enlargement in Costello syndrome: brain overgrowth associated with HRAS mutations as the likely cause of structural brain and spinal cord abnormalities. Am J Med Genet A 152A:1161–1168

    Article  PubMed  Google Scholar 

  • Guibaud L, Garel C, Annie B et al (2003) Prenatal diagnosis of capillary telangiectasia of the cerebellum–ultrasound and MRI features. Prenat Diagn 23:791–796

    Article  PubMed  Google Scholar 

  • Han DH, Kwon OK, Oh CW (1998) Clinical characteristics of vertebrobasilar artery dissection. Neurol Med Chir (Tokyo) 38(Suppl):107–113

    Article  Google Scholar 

  • Huissoud C, Rudigoz RC, Bisch C et al (2009) Complete cerebellar agenesis: a very rare abnormality of the posterior fossa. Ultrasound Obstet Gynecol 33:730–731

    Article  PubMed  CAS  Google Scholar 

  • Jacobs MA, Horska A, van Zijl PC, Barker PB (2001) Quantitative proton MR spectroscopic imaging of normal human cerebellum and brain stem. Magn Reson Med 46:699–705

    Article  PubMed  CAS  Google Scholar 

  • Jagodzinski Z, Dabrowska E, Buczek M (1990) Post-traumatic cerebellar hematomas. Neurol Neurochir Pol 24:315–321

    PubMed  CAS  Google Scholar 

  • Kirkpatrick JB (1983) Head-in-motion contusions in young adults. Acta Neurochir Suppl (Wien) 32:115–117

    CAS  Google Scholar 

  • Kondziolka D, Dempsey PK, Lunsford LD (1991) The case for conservative management of venous angiomas. Can J Neurol Sci 18:295–299

    PubMed  CAS  Google Scholar 

  • Kovacs T, Pajor P, Bodrogi L, Farsang M, Juhasz C, Szirmai I (2002) Cerebellar venous anomalies with symptomatic vascular malformations. Ideggyogy Sz 55:235–243

    PubMed  Google Scholar 

  • Kovacs T, Osztie E, Bodrogi L et al (2007) Cerebellar developmental venous anomalies with associated vascular pathology. Br J Neurosurg 21:217–223

    Article  PubMed  CAS  Google Scholar 

  • Kumral E, Kisabay A, Atac C (2005) Lesion patterns and etiology of ischemia in superior cerebellar artery territory infarcts. Cerebrovasc Dis 19:283–290

    Article  PubMed  Google Scholar 

  • Leao EK, Lima MM, Maia OO Jr, Parizotto J, Kok F (2010) Joubert syndrome: large clinical variability and a unique neuroimaging aspect. Arq Neuropsiquiatr 68:273–276

    Article  PubMed  Google Scholar 

  • Lee C, Pennington MA, Kenney CM 3rd (1996) MR evaluation of developmental venous anomalies: medullary venous anatomy of venous angiomas. AJNR Am J Neuroradiol 17:61–70

    PubMed  CAS  Google Scholar 

  • Lee SK, Willinsky RA, Montanera W, terBrugge KG (2003) MR imaging of dural arteriovenous fistulas draining into cerebellar cortical veins. AJNR Am J Neuroradiol 24:1602–1606

    PubMed  Google Scholar 

  • Lee CE, Danielian LE, Thomasson D, Baker EH (2009) Normal regional fractional anisotropy and apparent diffusion coefficient of the brain measured on a 3T MR scanner. Neuroradiology 51:3–9

    Article  PubMed  Google Scholar 

  • Lew SM, Morgan JN, Psaty E, Lefton DR, Allen JC, Abbott R (2006) Cumulative incidence of radiation-induced cavernomas in long-term survivors of medulloblastoma. J Neurosurg 104:103–107

    PubMed  Google Scholar 

  • Lin L, Huang Y, Zhang W (2008) Acute basilar artery occlusion: topographic study of infarcts. Neurol Res 30:341–343

    Article  PubMed  Google Scholar 

  • Marinkovic S, Kovacevic M, Gibo H, Milisavljevic M, Bumbasirevic L (1995) The anatomical basis for the cerebellar infarcts. Surg Neurol 44:450–460; discussion 460–451

    Article  PubMed  CAS  Google Scholar 

  • Martinez-Glez V, Romanelli V, Mori MA et al (2010) Macrocephaly-capillary malformation: analysis of 13 patients and review of the diagnostic criteria. Am J Med Genet A 152A:3101–3106

    Article  PubMed  Google Scholar 

  • Mascalchi M, Bianchi MC, Mangiafico S et al (1997) MRI and MR angiography of vertebral artery dissection. Neuroradiology 39:329–340

    Article  PubMed  CAS  Google Scholar 

  • Mascalchi M, Brugnoli R, Guerrini L et al (2002) Single-voxel long TE 1H-MR spectroscopy of the normal brainstem and cerebellum. J Magn Reson Imaging 16:532–537

    Article  PubMed  Google Scholar 

  • McCormick PW, Spetzler RF, Johnson PC, Drayer BP (1993) Cerebellar hemorrhage associated with capillary telangiectasia and venous angioma: a case report. Surg Neurol 39:451–457

    Article  PubMed  CAS  Google Scholar 

  • McKinney AM, Short J, Truwit CL et al (2007) Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. AJR Am J Roentgenol 189:904–912

    Article  PubMed  Google Scholar 

  • McLean CA, Gonzales MF, Dowling JP (1993) Systemic giant cell arteritis and cerebellar infarction. Stroke 24:899–902

    Article  PubMed  CAS  Google Scholar 

  • Milhorat TH, Bolognese PA, Nishikawa M, McDonnell NB, Francomano CA (2007) Syndrome of occipitoatlantoaxial hypermobility, cranial settling, and chiari malformation type I in patients with hereditary disorders of connective tissue. J Neurosurg Spine 7:601–609

    Article  PubMed  Google Scholar 

  • Milhorat TH, Nishikawa M, Kula RW, Dlugacz YD (2010) Mechanisms of cerebellar tonsil herniation in patients with Chiari malformations as guide to clinical management. Acta Neurochir (Wien) 152:1117–1127

    Article  Google Scholar 

  • Min WK, Kim YS, Kim JY, Park SP, Suh CK (1999) Atherothrombotic cerebellar infarction: vascular lesion-MRI correlation of 31 cases. Stroke 30:2376–2381

    Article  PubMed  CAS  Google Scholar 

  • Minati L, Aquino D, Bruzzone MG, Erbetta A (2010) Quantitation of normal metabolite concentrations in six brain regions by in-vivoH-MR spectroscopy. J Med Phys 35:154–163

    Article  PubMed  Google Scholar 

  • Miyazawa N, Toyama K, Arbab AS, Koizumi K, Arai T, Nukui H (2001) Evaluation of crossed cerebellar diaschisis in 30 patients with major cerebral artery occlusion by means of quantitative I-123 IMP SPECT. Ann Nucl Med 15:513–519

    Article  PubMed  CAS  Google Scholar 

  • Murakami M, Ikeda Y, Haraoka J (2010) Cerebellar infarction caused by primary central nervous system angiitis of childhood: case report. J Stroke Cerebrovasc Dis 19:77–80

    Article  PubMed  Google Scholar 

  • Naidich TP, McLone DG, Fulling KH (1983) The Chiari II malformation: Part IV. The hindbrain deformity. Neuroradiology 25:179–197

    Article  PubMed  CAS  Google Scholar 

  • Niesen CE (2002) Malformations of the posterior fossa: current perspectives. Semin Pediatr Neurol 9:320–334

    Article  PubMed  Google Scholar 

  • Parisi MA (2009) Clinical and molecular features of Joubert syndrome and related disorders. Am J Med Genet C Semin Med Genet 151C:326–340

    Article  PubMed  CAS  Google Scholar 

  • Pillay PK, Awad IA, Little JR, Hahn JF (1991) Symptomatic Chiari malformation in adults: a new classification based on magnetic resonance imaging with clinical and prognostic significance. Neurosurgery 28:639–645

    Article  PubMed  CAS  Google Scholar 

  • Provenzale JM, Allen NB (1996) Neuroradiologic findings in polyarteritis nodosa. AJNR Am J Neuroradiol 17:1119–1126

    PubMed  CAS  Google Scholar 

  • Roda JM, Gimenez D, Perez-Higueras A, Blazquez MG, Perez-Alvarez M (1983) Posterior fossa epidural hematomas: a review and synthesis. Surg Neurol 19:419–424

    Article  PubMed  CAS  Google Scholar 

  • Ruiz-Sandoval JL, Chiquete E, Navarro-Bonnet J et al (2010) Isolated vein thrombosis of the posterior fossa presenting as localized cerebellar venous infarctions or hemorrhages. Stroke 41:2358–2361

    Article  PubMed  Google Scholar 

  • Safriel Y, Pol-Rodriguez M, Novotny EJ, Rothman DL, Fulbright RK (2005) Reference values for long echo time MR spectroscopy in healthy adults. AJNR Am J Neuroradiol 26:1439–1445

    PubMed  Google Scholar 

  • Sargent MA, Poskitt KJ, Roland EH, Hill A, Hendson G (2004) Cerebellar vermian atrophy after neonatal hypoxic-ischemic encephalopathy. AJNR Am J Neuroradiol 25:1008–1015

    PubMed  Google Scholar 

  • Sato K, Hinokuma K, Matsuzawa Y et al (1987) Clinical study of traumatic cerebellar contusion. No Shinkei Geka 15:1285–1289

    PubMed  CAS  Google Scholar 

  • Satoh K, Satomi J, Nakajima N, Matsubara S, Nagahiro S (2001) Cerebellar hemorrhage caused by dural arteriovenous fistula: a review of five cases. J Neurosurg 94:422–426

    Article  PubMed  CAS  Google Scholar 

  • Schiffmann R, van der Knaap MS (2009) Invited article: an MRI-based approach to the diagnosis of white matter disorders. Neurology 72:750–759

    Article  PubMed  Google Scholar 

  • Sedat J, Chau Y, Mahagne MH, Bourg V, Lonjon M, Paquis P (2007) Dissection of the posteroinferior cerebellar artery: clinical characteristics and long-term follow-up in five cases. Cerebrovasc Dis 24:183–190

    Article  PubMed  CAS  Google Scholar 

  • Senegor M, Dohrmann GJ, Wollmann RL (1983) Venous angiomas of the posterior fossa should be considered as anomalous venous drainage. Surg Neurol 19:26–32

    Article  PubMed  CAS  Google Scholar 

  • Sirikci A, Bayazit YA, Bayram M (2001) The Chiari III malformation: an unusual and asymptomatic variant in an 11-year old child. Eur J Radiol 39:147–150

    Article  PubMed  CAS  Google Scholar 

  • Srinivasan A, Miller W, Stys P, Goyal M (2004) Crossed cerebellar diaschisis in stroke. Neurology 62:2130

    Article  PubMed  Google Scholar 

  • Ten Donkelaar HJ, Lammens M (2009) Development of the human cerebellum and its disorders. Clin Perinatol 36:513–530

    Article  PubMed  Google Scholar 

  • Terao S, Miura N, Osano Y et al (2005) Multiple cerebellar infarcts: clinical and pathophysiologic features. J Stroke Cerebrovasc Dis 14:193–198

    Article  PubMed  Google Scholar 

  • Tubbs RS, Cohen-Gadol AA (2010) Hans Chiari (1851–1916). J Neurol 257:1218–1220

    Article  PubMed  Google Scholar 

  • Tubbs RS, Oakes WJ (2003) Costello syndrome and Chiari I malformation: apropos of a case with a review of the literature regarding a potential association. J Child Neurol 18:496–498

    Article  PubMed  Google Scholar 

  • Tubbs RS, Iskandar BJ, Bartolucci AA, Oakes WJ (2004) A critical analysis of the Chiari 1.5 malformation. J Neurosurg 101:179–183

    Article  PubMed  Google Scholar 

  • Umashankar G, Gupta V, Harik SI (2004) Acute bilateral inferior cerebellar infarction in a patient with neurosyphilis. Arch Neurol 61:953–956

    Article  PubMed  Google Scholar 

  • van Dijk JM, Willinsky RA (2003) Venous congestive encephalopathy related to cranial dural arteriovenous fistulas. Neuroimaging Clin N Am 13:55–72

    Article  PubMed  Google Scholar 

  • Vannemreddy P, Nourbakhsh A, Willis B, Guthikonda B (2010) Congenital Chiari malformations. Neurol India 58:6–14

    Article  PubMed  Google Scholar 

  • Wilkins RH (1985) Natural history of intracranial vascular malformations: a review. Neurosurgery 16:421–430

    Article  PubMed  CAS  Google Scholar 

  • Wilms G, Marchal G, Van Hecke P, Van Fraeyenhoven L, Decrop E, Baert AL (1990) Cerebral venous angiomas. MR imaging at 1.5 tesla. Neuroradiology 32:81–85

    Article  PubMed  CAS  Google Scholar 

  • Wilms G, Demaerel P, Marchal G, Baert AL, Plets C (1991) Gadolinium-enhanced MR imaging of cerebral venous angiomas with emphasis on their drainage. J Comput Assist Tomogr 15:199–206

    Article  PubMed  CAS  Google Scholar 

  • Wong SK, Barkovich AJ, Callen AL, Filly RA (2009) Supratentorial abnormalities in the Chiari II malformation, III: the interhemispheric cyst. J Ultrasound Med 28:999–1006

    PubMed  Google Scholar 

  • Wong AM, Bilaniuk LT, Zimmerman RA, Liu PL (2012) Prenatal MR imaging of Dandy-Walker complex: midline sagittal area analysis. Eur J Radiol 81(1):e26–e30

    Article  PubMed  Google Scholar 

  • Yildiz H, Yazici Z, Hakyemez B, Erdogan C, Parlak M (2006) Evaluation of CSF flow patterns of posterior fossa cystic malformations using CSF flow MR imaging. Neuroradiology 48:595–605

    Article  PubMed  Google Scholar 

  • Yoon B, Kim JS, Lee KS, Kim BS, Chung SR, Kim YI (2006) Early pathological changes in the cerebellum of patients with pure cerebellar syndrome demonstrated by diffusion-tensor imaging. Eur Neurol 56:166–171

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neuroradiology Division, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, 02114, Boston, MA, USA

    Dr. O. Rapalino & R. G. Gonzalez

  2. Emergency Imaging Division, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, 02114, Boston, MA, USA

    Dr. Robert Chen

Authors
  1. Dr. O. Rapalino
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  2. Dr. Robert Chen
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  3. R. G. Gonzalez
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Correspondence to O. Rapalino .

Editor information

Editors and Affiliations

  1. Unité d'Etude du Mouvement (UEM), FNRS, Neurologie ULB Erasme, Bruxelles, Belgium

    Mario Manto

  2. Ataxia Unit, Cognitive and Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Jeremy D. Schmahmann

  3. Neuroscience Institute of the Cavalieri-Ottolenghi Foundation (NICO), University of Turin, Orbassano, Turin, Italy

    Ferdinando Rossi

  4. Molecular and Integrative Neuroscience Department (MIND), The Scripps Research Institute, California, CA, USA

    Donna L. Gruol

  5. Department of Integrative Physiolgy, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan

    Noriyuki Koibuchi

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Rapalino, O., Chen, R., Gonzalez, R.G. (2013). Radiographic Features of Cerebellar Disease: Imaging Approach to Differential Diagnosis. In: Manto, M., Schmahmann, J.D., Rossi, F., Gruol, D.L., Koibuchi, N. (eds) Handbook of the Cerebellum and Cerebellar Disorders. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-1333-8_27

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