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mri/vermian atrophy
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mri/vermian atrophy

  What is vermian atrophy?  My MRI report of Dec. 97, which with positive LP and multiple clinical problems over time and space led to MS diagnosis, has a sentence at the end which I've had trouble understanding: "Incidentally there appears to be hypoplasia or vermian atrophy.  Is there a history of alcohol abuse or has the patient been on long term dilantin?"
  Later, this is called "cerebellar vermian hypoplasia".  I've looked up combinations of these words, and have managed to turn up a variety of largely congenital problems which manifest at childhood.  I've never had dilantin, and there is no history of alcohol abuse.
  Is vermian atrophy a possible effect of MS?  What might the clinical presentation of such a thing be?
  Thanks very much for any help!
The cerebellum is divided into the central or medial part (vermis) and the hemispheres off to the sides (lateral). Atrophy is a generic term meaning shrinkage or loss of mass (usually implying loss of cells). Vermian atrophy, therefore, is shrinkage of the midline structure of the cerebellum.
Hypoplasia usually implies poor development: that is instead of active loss of cells which were there, there never were the cells which were supposed to be there.
One of the most common causes of this is sustained alcohol use (actually, it's the anterior vermis that is the most affected). Usually this means years of heavy drinking, not a drink or two here or there, or even modest abuse.
Phenytoin (Dilantin TM) is another cause of shrinkage of the cerebellum. If I recall correctly, though, it usually leads to atrophy of the entire cerebellum, not specifically the vermis.
The significance of this finding depends on your symptoms. Cerebellar damage can produce incoordination of a fairly characteristic appearance, termed ataxia. Ataxia can affect manual dexterity and/or gait.
I've seen people with cerebellar and/or cerebral atrophy with absolutely no symptoms - their MRI was done for another reason and it was found incidentally. On the other hand, if your MRI was done because you had symptoms of incoordination, then the finding may mean something.
If your cerebellum just didn't develop fully the way it should have, then you may have lived your entire life without knowing it, and it is not significant. Sometimes hypoplasia can lead to symptoms, other times the rest of the brain compensates just fine for what's missing.
There is nothing about vermian hypoplasia or atrophy which would support a diagnosis of MS. If you happen to have MS (based on other data), then this would be irrelevant data.
I hope this helps. CCF MD mdf

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