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18b - Answer: 63-year-old female presents with ataxia and memory disorder

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

HISTORY: 

This 63-year-old female presents with ataxia and memory disorder.

(QUIZ ANSWER) NOT A LIKELY DIFFERENTIAL: 

Alzheimer's dementia.

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

FINDINGS:

The caudate heads and putamen are atrophic. The inter-caudate to frontal horn distance of 1.5cm is below the normal range. 

Mild vermian and cerebellar atrophy. 

Frontoparietotemporal pattern of cerebral atrophy with relative preservation of hippocampal volume. 

Diffusion-weighted images are without a diffusion restrictive defect. 

No obstructive hydrocephalus. 

Nigral and pallidal iron stores are maintained. 

Mild midbrain volume loss. 

Pontine volume is maintained. 

No extraaxial collections or hemorrhage. 

Cerebral hemispheres and deep nuclei are without hemorrhage, mass or edema. Partial empty sella. No extraocular muscle enlargement. No suprasellar masses or chiasmal compression. No masses in the masticator, parapharyngeal or pharyngeal mucosal spaces. 

IMPRESSION:

Atrophy of the putamen and caudate heads with cerebellar trophy may represent a neurodegenerative process. Differential could include frontal lobar atrophy, corticobasal degeneration, multisystem atrophy, Wilson's disease. Distribution of findings which spares the hippocampi, is atypical for Alzheimer's. 

No obstructive hydrocephalus, no NPH. 

Midbrain iron stores are preserved. No supportive findings of idiopathic Parkinson's. 

No evidence of acute supra- or infratentorial ischemia.

LESSON 3, TOPIC 24

Case Challenge: Brain MRI Cases

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Content reviewed: July 23, 2021

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