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Click 41 yo female with history of multiple sclerosis presented with horizontal diplopia. Noncontrast enhanced axial CT slices (64 slice Somatom, Siemens Health Care, Erlangen, Germany, 3 mm axial reconstruction, 440 mA, 120 KVp) demonstrate a predominantly hypodense lesion in the left cerebellar hemisphere sparing the cerebellar peduncle with slight mass effect upon the fourth ventricle.

Click 41 yo female with history of multiple sclerosis presented with horizontal diplopia. Axial diffusion weighted imaging (B-1000, 1.5 Tesla Siemens Espree, repetition time (TR) = 4500 ms; echo time (TE) = 112 ms) demonstrates a 3 x 4 cm large, well defined area of predominantly corduroy appearing, increased signal in the left cerebellar hemisphere with sparing of the cerebellar peduncle, causing slight mass effect upon the left aspect of the 4th ventricle.

Click 41 yo female with history of multiple sclerosis presented with horizontal diplopia. Apparent diffusion coefficient (ADC) map shows increased diffusion values proving lack of diffusion restriction. This excludes acute ischemia and is typically found in LDD. Medulloblastoma that may present with diffusion restriction becomes a less likely differential diagnosis.

Click 41 yo female with history of multiple sclerosis presented with horizontal diplopia. Axial T2-weighted sequence (General Electric Signa 3.0Tesla; TR = 5200ms, TE = 101.82 ms, number of excitations (NEX), 2; flip angle FA = 90) demonstrates alternating isointense and hyperintense signals of the tumor within the left lobe of the cerebellum. This is the characteristic striated pattern of a tumor in Lhermitte-Duclos disease. The adjacent cerebellar fissures are affected from associated mass effect.

Click 41 yo female with history of multiple sclerosis presented with horizontal diplopia. Sagittal FLAIR image (1.5 Tesla Siemens Espree, TR = 9000 ms; TE = 123 ms; inversion time TI = 2500 ms; FA 180) demonstrates hyperintense lesions along the corona radiata and extending into the corpus callosum suggestive of Dawson`s fingers, which are characteristic of MS plaques. Also seen is a striated-appearing cerebellar tumor characteristic of Lhermitte-Duclos disease.

Click 41 yo female with history of multiple sclerosis presented with horizontal diplopia. Axial T1-weighted image (General Electric Signa 3.0Tesla; TR = 2607ms, TE = 9.94 ms, inversion time (TI) 1100ms, number of excitations (NEX), 2; flip angle FA = 90) demonstrates alternating isointense and hypointense signal of the tumor within the left lobe of the cerebellum. This is the characteristic striated corduroy pattern of a tumor in Lhermitte-Duclos disease.