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22b - Answer: 61-year-old male presents with memory loss

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

HISTORY: 

This 61-year-old male presents with memory loss.

(QUIZ ANSWER) FAVORED PRIMARY FINDING: 

Amyloid angiopathy.

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

FINDINGS:

Hypointense area within the left frontal lobe measuring approximately 1.9 x 1.1cm in size consistent with an old area of hemorrhage. Multiple other scattered areas of hemosiderin deposition. No surrounding vasogenic edema or mass effect. No evidence of midline shift. 

Diffuse FLAIR hyperintense structures throughout the subcortical and deep white matter consistent with gliosis of micrangiopathy origin. Confluent areas of FLAIR hyperintensity particularly within the bilateral external capsules, left greater than right, consistent with a lenticulostriate vasculopathy. 

No acute intracranial hemorrhage or abnormal extraaxial fluid collection. 

No evidence of restricted diffusion to suggest an acute ischemic event. The major proximal vascular flow voids are maintained. The venous sinuses are patent. 

Mild prominence of the temporal horns consistent with parahippocampal atrophy. 

No enhancing intracranial masses. No leptomeningeal enhancement. No evidence of a basilar inflammatory process. 

The paranasal sinuses and mastoid air cells are clear. 

IMPRESSION:

Area of old hemorrhage within the left frontal lobe measuring approximately 1.9 x 1.1cm in size. Multiple other areas of hemosiderin deposition throughout the brain for which amyloid angiopathy is favored.

Diffuse confluent areas of gliosis throughout the subcortical and deep white matter consistent with a vasculopathy likely related to hypertension. Given the extent of gliosis as well as parahippocampal atrophy, this likely contributes to the patient's memory loss. 

No acute intracranial hemorrhage. 

No acute supratentorial or infratentorial infarcts.

LESSON 3, TOPIC 36

Case Challenge: Brain MRI Cases

Case Challenge

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Content reviewed: July 23, 2021

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