0:00

Dr. Laser, 77-year-old man.

0:02

Cognitive decline. Rule out MS.

0:03

Rule out ALS. Clearly not MS.

0:06

There's no periventricular disease in the temporal region.

0:09

Just too big, too confluent.

0:11

All one hyperintensity,

0:14

as opposed to patchy areas or round fried egg areas.

0:17

Very inconsistent with MS.

0:19

As is the age in his 70s.

0:20

As is the gender. He's a man.

0:22

More common in women.

0:24

But as we scroll through,

0:25

look at the left corticospinal tract.

0:28

You can see how it's a little thick,

0:30

a little lumpy, bumpy.

0:31

And the patient's motor dysfunction,

0:33

probably attributable to this.

0:35

And what caused this?

0:37

Here it is on the left side on the axial.

0:39

So the most likely cause for this

0:41

would be Wallerian degeneration,

0:43

given the extensive confluent periventricular

0:46

white matter.

0:47

Well, I've just outlined both corticospinal tracts,

0:50

and now I'm going to put a little cursor over the

0:54

corticospinal tract area and look at the asymmetry

0:58

that is seen on fiber tract imaging.

1:00

And that is really what fiber tract imaging

1:02

in somebody like this is for.

1:05

Also,

1:05

as we get up high into the centrum semiovale,

1:08

look at how we've lost the normal white matter

1:11

fiber tract arborization in the periventricular distribution.

1:14

It's completely gone.

1:16

It also demonstrates the color blue,

1:18

which represents this area of gliosis

1:21

that is commensurate with these foci.

1:23

So it is pretty symmetric up high,

1:25

but the corticospinal tracts

1:27

very symmetric down low,

1:28

likely explaining this patient's

1:31

hemimotor abnormality.

1:32

Any other comments about this

1:34

case before we move on

1:35

in this individual who has severe confluent

1:38

Binswanger's disease?

1:40

Nope.

1:40

Okay.

1:41

Laser and P out.

1:42

All right.