A 74-year-old man with a history of invasive right parotid gland adenocarcinoma presented with acute onset left hemiparesis. CT angiography showed abnormal cervical and intracranial vascular reflux with enhancement of right middle cerebral artery territory (figure 1). Vascular anomalies were suspected but digital subtraction angiography was normal. There was spontaneous resolution of the symptoms and a follow-up CT showed normalization of the imaging findings (figure 2). Pseudopathological brain parenchymal enhancement has been described rarely, usually as an Figure 1 CT angiography Coronal (A) and axial (B, C) CT angiography done by right side antecubital vein injection reveals jugular and cervical veins reflux (blue arrows) reaching the parotid tumor (orange arrow), with opacification of carotid and vertebral arteries (red arrows) and enhancement of intracranial compartment (yellow arrow). Also note hemithyroid contrast reflux (green arrow).
We present the case of a 17-year-old male with oblique unilateral hand and forearm amyotrophy, paresthesia and paresis. Tremor was present on finger extension. Hirayama disease was suspected, which led to dynamic cervical MRI. Hirayama disease affects predominantly young Asian males 1,2 , with few cases reported in the Americas 3 .
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