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Purpose: To report a case of neurovascular compression in a patient presenting with ophthalmic evidence of aberrant reinnervation. Observation: A 68-year-old woman diagnosed with right partial third nerve palsy with aberrant regeneration. Suspicion was based on isolated clinical features of the right eye, including ptosis, upper eyelid elevation on adduction, mydriasis, exotropia, and hypotropia. Magnetic resonance imaging revealed atrophy of the right oculomotor nerve secondary to neurovascular compression from a prominent right superior cerebellar artery. Conclusion and importance: This case highlights the importance of utilizing Fast Imaging Employing Steady-state Acquisition (FIESTA) for the diagnosis of oculomotor nerve palsy presenting with evidence of aberrant reinnervation.

A growing body of evidence has shown that a relationship between age-related hearing loss and structural brain changes exists. However, a method to measure brain atrophy associated with hearing loss from a single MRI study (i.e. without an interval study) that produces an independently interpretable output does not. Such a method would be beneficial for studying patterns of structural brain changes on a large scale. Here, we introduce our method for this.Audiometric evaluations and mini-mental state exams were obtained in 34 subjects over the age of 80 who have had brain MRIs in the past 6years. CSF and parenchymal brain volumes (whole brain and by lobe) were obtained through a novel, fully automated algorithm. Atrophy was calculated by taking the ratio of CSF to parenchyma. High frequency hearing loss was associated with disproportional temporal lobe atrophy relative to whole brain atrophy independent of age (r=0.471, p=0.005). Mental state was associated with frontoparietal atrophy but not to temporal lobe atrophy, which is consistent with known results. Our method demonstrates that hearing loss is associated with temporal lobe atrophy and generalized whole brain atrophy. Our algorithm is efficient, fully automated, and able to detect significant associations in a small cohort. Keywords: Presbycusis, Age-related hearing loss, Temporal lobe atrophy, Brain atrophy

A 78-year-old woman complained of gradual, painless onset of horizontal binocular diplopia associated with progressive axial weakness. Physical examination revealed esotropia that was greater at distance than at near vision, bilateral levator dehiscence, and normal abducting saccadic speeds. Given the age of the patient and compatible clinical findings, the diagnosis of Sagging Eye Syndrome (SES) was made. However, further work-up with a muscle biopsy suggested Sporadic Late-Onset Nemaline Myopathy (SLONM) as the cause of her progressive muscle weakness. Although rare, external ophthalmoplegia has been described in the literature as a presenting symptom in SLONM. To elucidate the pathological mechanism for the patient’s diplopia, an MRI of the orbits was performed, which revealed findings consistent with SES. This case aims to highlight the importance of integrating clinical findings during the diagnostic process and serves as a reminder that diplopia can be a common symptom for an uncommon diagnosis.

Acute ischemic stroke imaging is one of the leading causes of death and disability worldwide. Neuroimaging plays a crucial role in early diagnosis and yields essential information regarding tissue integrity, a factor that remains a key therapeutic determinant. Given the widespread public health implications of stroke and central role of neuroimaging in overall management, acute stroke imaging remains a heavily debated, extensively researched, and rapidly evolving subject. There has been recent debate in the scientific community due to divided opinions on the use of CT perfusion and access-related limitations of MRI. In this paper we review and summarize recent updates relevant to acute stroke imaging and propose an imaging paradigm based on the recently available evidence.