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23b - Answer: 55-year-old male presents with history of memory loss

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

HISTORY: 

This 55-year-old male presents with history of memory loss over past one year, worsening over past 2-3 months.

(QUIZ ANSWER) FAVORED PRIMARY FINDING IN THIS CASE: 

Huntington'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 a frontal horn to intercaudate distance ratio of 1.6 and inner table to intercaudate ratio of 0.22. Both of these are abnormal and consistent with a degree of caudate atrophy.

Cavum septum pellucidum and cavum vergae. 

Frontoparietotemporal neurodegenerative pattern of cerebral atrophy. 

Temporal horn prominence with a degree of parahippocampal atrophy. 

No obstructive hydrocephalus. 

No extraaxial collections or hemorrhage. 

Periventricular hyperintensities may represent gliosis of microangiopathic origin. 

No vermian or hemispheric cerebellar atrophy. 

Nigral and pallidal iron stores are maintained. 

Carotid and basilar artery flow voids are intact. 

Hyperintensity within the left petrous apex could represent petrous apex fluid or a cephalocele. No other evidence of inflammatory alteration. No mass within the masticator, parapharyngeal, pharyngeal mucosal, prevertebral or parotid spaces. Venous sinuses are patent. 

Deviated nasal septum to the left. 

No Chiari malformation. 

No suprasellar masses. 

No acute parenchymal hemorrhage. 

Mammillary bodies are intact. 

CONCLUSION: 

1. Supratentorial greater than infratentorial pattern of cerebral atrophy with abnormal frontal horn to intercaudate ratio as well as abnormal intercaudate to inner table ratio which may be consistent with Huntington's disease. 

2. Hyperintensity within the left petrous apex with differential which could include epidermoid, petrous apex fluid, cephalocele. 

3. Ventricular enlargement appears to be primarily on an ex vacuo basis without obstructive hydrocephalus. 

4. No acute parenchymal or extraaxial hemorrhage. 

5. No other supportive findings of multisystem atrophy.

LESSON 3, TOPIC 39

Case Challenge: Brain MRI Cases

Case Challenge

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Content reviewed: July 23, 2021

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