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So case number five is an 81-year-old with sudden onset memory loss,

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that actually did not have memory loss on their initial MRI of the brain,

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that actually came prior to their subsequent MRI.

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So let's look here first at the initial

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MRI of the brain in 2014, where there really wasn't too much memory loss.

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There was, I think, some just very minor, but nothing too prominent.

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The DWY is negative, the GRE sequence is negative.

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If we look here on the flare sequence, we do have just mild microvascular

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ischemic disease here in the cerebral white matter.

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On the T2-weighted sequence, we have some mild cerebral atrophy.

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It's actually mild to moderate with a biparietal predilection,

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and just fairly mild in the temporal lobes as well.

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The patient then came back in 2020

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and when they came back in 2020, now they had, again, sudden onset memory loss.

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Let's take a look at that MRI.

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So this is the DWY sequence from the 2020 study

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and there's nothing acute here, but you can see that there has been

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a change here, which will be easier to see on the flare and T2-weighted sequences.

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So here's the T2-weighted sequence.

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The patient has developed an infarct

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in the right PCA territory, involving the lingual gyrus of the right

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occipital lobe, as well as much of the right hippocampus.

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This was not present on the initial MRI, so again, not acute on this study,

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but it happened in the interim between these two studies and when the patients

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had this infarct, they then developed the acute memory loss symptoms.

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Atrophy has overall progressed since the prior study.

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Look here at the size of the temporal horns before and now.

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We now have moderate atrophy really throughout the brain.

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Microvascular ischemic disease had also

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progressed since the prior study. Here on the flare that had increased.

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So this is case number five.

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Again, that 2020 MRI showed this

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relatively large right PCA territory infarct.

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Infarct in here, that right hipocampus, resulting in the patient's sudden onset memory loss.

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This type of thing often occurs if you infarct the PCA on the ipsilateral side.

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So here you can see there's really lack of flow signal in the right PCA

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compared to the normal appearing contralateral side.

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The patient did have quantitative volumetric imaging.

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This is a segmentation of that imaging.

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They had that done with the 2020 MRI.

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You can see here is the infarct here.

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And then they also had quantitative imaging in 2014.

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So in 2014, everything looked completely normal.

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The hippocampal volumes were fine, the inferior lateral ventricle size was fine.

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But in 2020, we see the hippocampal volumes are now in the one percentile.

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They are statistically significant.

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The HOC is also now statistically significant.

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And we have statistically significant enlargement, the inferior lateral ventricles.

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And by the way, when you see disproportionate enlargement

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of the inferior lateral ventricles compared to the superior, this will indicate sort

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of a mesial temporal predilection to the cerebral atrophic pattern.

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So that is something to look out for when you're reviewing quantitative imaging.