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canp2019c12

Case 12

JP Rossiter1, B Durafourt2, M Baharnoori2

1Department of Pathology & Molecular Medicine and 2Division of Neurology, Queen’s University, Kingston, ON, Canada

An 87 year old man with a history of ischemic heart disease, type 2 diabetes, and hemodialysis-dependent chronic renal disease, presented with right upper limb weakness and dysarthria. Initial MRI showed restricted diffusion centered in the right middle cerebellar peduncle, interpreted as a subacute infarct, and he was transferred to a stroke rehabilitation unit. He gradually developed increasing right sided weakness and dysphagia, complicated by aspiration pneumonia. Repeat MRI showed enlargement of the original lesion and new lesions in the pons and cerebellum. Despite multiple relevant investigations and management strategies, he continued to deteriorate neurologically. He died 11 weeks following initial presentation and a consented autopsy was performed.

Materials submitted: 

Scanned slides of left half of pons and middle cerebellar peduncle (SCR), and of paramedian right cerebellar hemisphere (axial, HPS).

Questions:

Diagnosis/es?