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17b - Answer: 83-year-old male presents with cognitive impairment

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 83-year-old male presents with cognitive impairment.

(QUIZ ANSWER) NOT A LIKELY DIAGNOSIS: 

Alzheimer's disease.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

There is generalized cerebral atrophy. There are a few small focal areas of increased T2 signal seen within the white matter of both hemispheres compatible with mild chronic ischemic changes in the small vessel distribution/arteriopathic leukoaraiosis secondary to underlying microvascular disease, in keeping with the patient's age. The remainder of the brain parenchyma, ventricular system, and subarachnoid space are normal. 

No acute intracranial hemorrhage or acute evolving infarcts are identified. 

The posterior fossa and craniocervical junction are normal. 

The cavernous sinuses and sella are normal. 

Normal flow voids are seen within the circle of Willis and dural sinuses. 

No abnormal contrast enhancement identified. There is minimal inflammatory mucosal thickening involving the paranasal sinuses. 

CONCLUSION

1. No acute intracranial abnormality identified. 

2. Generalized cerebral atrophy and associated mild chronic ischemic changes in the small vessel distribution/arteriopathic leukoaraiosis secondary to underlying microvascular disease, in keeping with the patient's age, with no evidence of multiinfarction.

3. Pattern of atrophy spares the entorhinal cortex but is frontal predominant and raises the possibility of frontolobar dementia, formerly known as Pick's disease, MSA, or Lewy body dementia. 

4. Extrapyramidal increased iron deposition.

LESSON 3, TOPIC 21

Case Challenge: Brain MRI Cases

Case Challenge

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Content reviewed: July 23, 2021

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