85-year-old male with dementia without behavioral disturbance
- 85-year-old man who presents with dementia without behavioral disturbance. Abnormality of gait and mobility/fall three weeks ago – bruising right temporal area around right orbit.
- Long- and short-axis fat- and water-weighted images were performed.
- Mild periventricular ependymitis granularis and scattered patchy and confluent areas of small vessel arteriopathy and/or venopathy induced gliosis or leukoaraiosis are present and which are most often seen as a manifestation of hypertensive arteriosclerosis and/or metabolic factors such as hypercholesterolemia or hypertriglyceridemia.
- No diffusion restriction is present to suggest acute or subacute ischemia. No intra-axial or extra-axial mass hemorrhage or fluid collection is present. No blood degradation products on the susceptibility weighted imaging.
- Ventricular system cortical sulci and basilar cisterns are prominent consistent with diffuse cortical volume loss. No hydrocephalus. Slightly asymmetrical parietal and temporal volume loss. Hippocampi are markedly atrophic with an MTA score 3 on the right and 2-3 on the left.
- Meckel’s cave and the cavernous sinus region are normal.
- Foramen magnum appears normal and no evidence of intramedullary mass at the level of the medulla or anomaly of the opisthion basion or atlantodental interval. C1/C2 junction is anatomically aligned. Visualized cervical spinal canal is patent.
- Marked extensive mucosal disease of the ethmoid air cells and minimal mucosal disease of the frontal sinuses with obstruction of both frontoethmoidal recesses.
- Right orbit appears normal. Left ocular globe is irregular with hyperdense signal which may represent either hemorrhage within the globe postsurgical or developing phthisis bulbi. Given the small nature of the left globe developing phthisis bulbi is also a consideration.
- Mastoid air cells are clear.
- Visualized intracranial arterial vasculature appear patent with expected flow void signal.
- No evidence of acute intracranial abnormality such as acute ischemia mass effect hydrocephalus or intracranial hemorrhage.
- Moderate microangiopathic white matter disease consistent with chronic small vessel ischemia most often seen as a manifestation of hypertensive arteriosclerosis and/or metabolic factors such as hypercholesterolemia/hypertriglyceridemia.
- Extensive paranasal sinus disease involving the ethmoid air cells as well as the alveolar recesses of the maxillary sinuses.
- Abnormal appearance of the left ocular globe with hyperintense signal within the globe related to either developing phthisis bulbi or hemorrhage/postsurgical.
- Diffuse cortical volume loss with asymmetric parietotemporal lobe atrophy as well as marked hippocampal atrophy with an MTA score of 3 on the right and 2-3 on the left. Findings likely correlate with the patient’s stated history of dementia related to mild cognitive impairment syndrome/Alzheimer’s.
- Vague low signal on the susceptibility-weighted sequence within the left basal ganglia is likely a chronic hypertensive micro hemorrhage given the moderate microangiopathic white matter disease. Additional smaller punctate foci of susceptibility within the right temporal lobe and right superior cerebellum are likely small cavernomas.
- Additionally serpiginous low signal on the susceptibility-weighted sequence within the both high parietal lobes right greater than left appear within the sulci without corresponding abnormal signal on T2/FLAIR sequence. Findings are most consistant with the sequela of prior trauma likely coup contrecoup injury and resultant hemosiderin staining.
- Along the right temporal bone near the right orbit ovoid subcutaneous fluid collection is likely a chronic hematoma related to the patient’s history of fall.
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