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Dr. Laser,

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this is a 63-year-old man with dementia

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and ataxia.

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He also had a component of headache,

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which we're not sure how that relates to the case.

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But an axial FLAIR,

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white matter sensitive on the left,

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and a T2 water-weighted image

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spin echo on the right.

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We're here to talk about the global cortical

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atrophic scale or the GCA scale.

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How do you gauge the degree of cortical atrophy?

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We're scrolling up and down

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in the axial projection.

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So, the first thing that I look at is the

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relationship of the sulci and the gyri.

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In the global cortical atrophy scale,

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zero being no cortical atrophy,

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one would be mild atrophy.

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So, slight opening of the sulci.

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That's how you determine that.

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Two would be increasing opening of the sulci and

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actual volume loss of the gyri.

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And then, three would be more atrophy of the gyri

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in terms of a knife blade appearance.

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Okay.

0:57

So, that would be the 0, 1, 2, 3 score.

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Although, I spelled blade wrong.

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There's only one D in blade,

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but I think we got it pretty close on the text.

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And when we go and scroll up and down

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in the axial projection,

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there clearly is loss of volume of the gyri.

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The sulci are markedly widened.

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We don't have knife blade atrophy,

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although in the temporal region,

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if we look sagittally,

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there is some knife blade atrophy in the

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temporal lobe right here.

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Right? It ends very suddenly

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along the posterior aspect of the temporal lobe.

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And then as we go back,

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one very important analysis of the brain is

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to figure out which lobes are affected.

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Correct.

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And we know that temporal parietal predilection,

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Alzheimer's,

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frontotemporal predilection,

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more pics of frontotemporal dementia

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or frontal lobar dementia.

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So, let's find the central sulcus of Rolando,

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which is easy to do.

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All you do is you find the interparietal sulcus,

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separates out the superior parietal lobule

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from the inferior parietal lobule.

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It goes into the postcentral sulcus.

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In front of the postcentral sulcus,

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must be the central sulcus of Rolando.

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So, there's the left central sulcus.

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I'm going to put a little squiggle on it.

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Here's the right central sulcus.

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So, everything in front of that is going to be frontal.

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Behind it is going to be parietal.

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Now, as we scroll down from here,

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scroll down,

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you can see the central sulcus assumes

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a much more anterior position.

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So, now, everything in front of here is frontal.

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Everything behind here is parietal.

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But the frontal lobe on the

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left is clearly affected.

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And we'll see the parietal lobes affected, too,

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in subsequent vignettes.

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So that's the GCA scale for assessing

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neurodegenerative disease.

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Shall we move on?

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Okay. Pomeranz and Laser out.