Board Review 1 – Case 2

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

In this case, the patient has focal midbrain atrophy. On sagittal images, this gives the midbrain the appearance of a hummingbird, with a concave upper margin to the midbrain. This is called the hummingbird sign. On axial images, the interpeduncular cistern is widened, giving the midbrain the appearance of “Mickey Mouse”

The diagnosis is: progressive supranuclear palsy, or PSP

PSP is a degenerative disease which is similar to Parkinson’s disease. Other key features include vertical gaze palsy and dementia. It does not respond well to typical Parkinson’s disease treatments.