Case Challenge

Brain

Neuro

Stephen J Pomeranz

Gain confidence interpreting Neurodegenerative Disease Cases w/ MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME. Try it free!

Case Review

Neuroradiology

Case 1 - 68-year-old male presents with new onset of impaired cognition

Case 2 - 63-year-old male presents with headache, memory loss, ataxia

Case 3 - 59-year-old female presents with symptoms and signs involving cognitive functions and awareness

Case 4 - 53-year-old female presents with cognitive decline with sleep inversion

Case 5 - 66-year-old male presents with decreased fine motor skills

Case 6 - 2-year-old male presents with developmental delay

Case 7 - 63-year-old male presents with headaches

Case 8 - 29-year-old female presents with several syncopal episodes

Case 9 - 15-year-old female presents with blurred vision for two weeks

Case 10 - 10-year-old female presents with sudden onset disconjugate gaze

Case 11 - 50-year-old male presents with dizziness, diplopia

Case 12 - 59-year-old female presents with hyperreflexia

Case 13 - 52-year-old female presents with olivopontocerebellar atrophy

Case 14 - 64-year-old female presents with memory loss

Case 15 - 65-year-old male presents with abnormal gait

Case 16 - 66-year-old male presents with history of Parkinson's disease

Case 17 - 76-year-old male presents with Parkinson's disease

Case 18 - 62-year-old female referred for MRI subsequent to being unable to hold still

Case 19 - 74-year-old male presents with gait disturbance, dementia

Case 20 - 52-year-old male presents with history of multiple sclerosis

Case 21 - 68-year-old male presents with history of a fall one year prior with brain trauma

Case 22 - 92-year-old female is to be evaluated for cerebral degeneration

Case 23 - 58-year-old female presents with speech disturbance

Case 24 - 51-year-old female presents with numbness and weakness in legs and arms

Case 25 - 64-year-old male presents with possibility of ALS

Course Evaluation

Post-Course Activities

As the average lifespan of the general population increases, neurodegenerative diseases have become more prominent and the need for imaging is expanding.

Neurodegenerative Disease Cases

<div>HISTORY:&#160;This 29-year-old female presents with several syncopal episodes over the last three weeks.(QUIZ ANSWER) DIFFERENTIALS IN THIS CASE:&#160;All of the above.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: The ventricular system and peripheral cerebrospinal fluid spaces are normal in caliber. Multiple foci of T2 / FLAIR hyperintensity are identified scattered throughout the brain within the corona radiata, centrum semiovale, the anterior forceps and the anterior limb of the internal capsules. No restricted diffusion is identified. No evidence of infarct, hemorrhage, mass effect or shift of the normally midline structures. No abnormal enhancement is seen. Differential diagnosis includes vasculopathy from migraine, vasculitis, CADASIL, occult hypertension and other causes of microangiopathy (e.g., hypercholesterolemia, hypertriglyceridemia, factor V Leiden homozygous, antithrombin III, Factor VIII anomaly and others. Demyelinating process such as ADEM, Lyme disease, multiple sclerosis (most unlikely based on distribution), are not prime considerations. Further workup recommended. Recreation drug use with stimulants may occasionally produce this picture. The posterior fossa, cerebellum and brain stem are within normal limits. No extra-axial collections or lesions noted.&#160;The optic nerves are within normal limits. The 7th / 8th cranial nerves are without abnormality.&#160;The vascular flow voids are preserved.&#160;Moderate right maxillary sinus mucosal thickening with an air-fluid level is identified. Mucosal thickening of the ethmoid air cells also noted. Findings are consistent with acute on chronic sinusitis.CONCLUSION:&#160;1. Scattered white matter disease involving the corona radiata, centrum semiovale, anterior forceps and anterior limb of the internal capsules for which the differential diagnosis includes vasculopathy from migraine, vasculitis, CADASIL, occult hypertension and other causes of microangiopathy (e.g., hypercholesterolemia, hypertriglyceridemia, factor V Leiden homozygous, antithrombin III, Factor VIII anomaly and others. Demyelinating process such as ADEM, Lyme disease, multiple sclerosis (most unlikely based on distribution), are not prime considerations. Further workup recommended. Recreation drug use with stimulants may occasionally produce this picture.2. Acute on chronic right maxillary and ethmoid air cell sinusitis.</div>

Case

In this case, we see scattered white matter disease involving the corona radiata, centrum semiovale, anterior forceps, and anterior limb of the internal capsules for which the differential diagnosis includes: