{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:14:52Z","timestamp":1789553692055,"version":"build-2803163510"},"reference-count":42,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,8,5]],"date-time":"2020-08-05T00:00:00Z","timestamp":1596585600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81871104"],"award-info":[{"award-number":["81871104"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Lesions limited to the bilateral middle cerebellar peduncles (MCPs) are uncommon. This retrospective study investigated diseases with a proclivity for the bilateral MCPs and explored the associations between their neuroimaging features and clinical findings for the differential diagnosis of such lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled 26 patients who were admitted to our department between January 2016 and March 2019 with bilateral MCP abnormalities on magnetic resonance imaging (MRI). The demographic, clinical, and neuroimaging characteristics, and the biomarkers and diagnoses were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Although all patients exhibited symmetrical bilateral MCP hypointensities on T1\u2010weighted imaging and hyperintensities on T2\u2010weighted and fluid\u2010attenuated inversion recovery imaging, they were diagnosed with different conditions. Diagnoses included acute cerebral infarction (ACI) (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a09, 34.62%), Wallerian degeneration (WD) (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a08, 30.77%), multiple system atrophy (MSA) (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a06, 23.08%), neuromyelitis optica (NMO) (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01, 3.85%), heroin\u2010induced leukoencephalopathy (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01, 3.85%), and primary central nervous system lymphoma (PCNSL) (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01, 3.85%). Patients with ACI exhibited bilateral MCP\u2010restricted diffusion hyperintensities on diffusion\u2010weighted imaging and corresponding stenosis or occlusion of the vertebrobasilar system. The initial MRI of patients with WD depicted pontine infarctions, while symmetrical MCP lesions were observed on follow\u2010up MRI. Symmetrical MCP lesions, cruciform hyperintensity, and marked atrophy in the posterior fossa were characteristic manifestations of MSA. Longitudinally extensive myelitis affecting more than three vertebral segments on cervical MRI and positive serum AQP4\u2010IgG may be indicative of NMO. Heroin\u2010induced leukoencephalopathy was characterized by extra\u2010symmetrical lesions in the posterior limbs of the internal capsules, while the anterior limbs were spared. PCNSL was indicated by a significant and characteristic \u201cfist\u201d sign on contrast\u2010enhanced MRI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Bilateral MCP lesions were most frequently observed in cerebrovascular diseases, followed by neurodegenerative diseases, inflammatory diseases, toxic encephalopathies, and lymphomas. Our findings demonstrate that bilateral MCP signal abnormalities are more common in patients with ACI and WD, with fewer degenerative processes than previously believed. The high frequency of WD may be attributed to the specific awareness of this pathology. WD can also present with stage\u2010related restricted diffusion and should not be mistaken for a new infarction. The symmetrical bilateral MCP hypointensities on T1\u2010weighted imaging and hyperintensities on T2\u2010weighted imaging often raise concern regarding a demyelinating process. Our findings emphasize that neurologists should consider the aforementioned conditions and correlate the specific neuroimaging characteristics and medical history before arriving at the final diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.1778","type":"journal-article","created":{"date-parts":[[2020,8,5]],"date-time":"2020-08-05T03:29:20Z","timestamp":1596598160000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Bilateral middle cerebellar peduncle lesions: Neuroimaging features and differential diagnoses"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5775-2754","authenticated-orcid":false,"given":"Jiwei","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Neurology The First Affiliated Hospital of China Medical University Shenyang City Liaoning Province 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