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 64-year-old female presents with memory loss.&#160;A lot of motion due to AMS.&#160;No cancer, surgery or followup.&#160;Memory loss for one year.(QUIZ ANSWER) PRIMARY FINDING IN THIS CASE:&#160;Creutzfeldt-Jakob disease (CJD).Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS:&#160;Marked symmetric restricted diffusion involving the caudate nuclei, putamen, and thalami with associated subtle gyriform restricted diffusion involving the frontal cerebral cortex (cortical ribbon sign).&#160;Corresponding abnormal T2 / FLAIR hyperintensity symmetrically involves the caudate nuclei, putamen, and thalami.In addition, bilateral symmetric hyperintensity of the pulvinar nuclei of the thalamus as well as the dorsomedial thalamic nuclear region compatible with the hockey stick sign.Given the patient's history of memory loss over the past year and altered mental status, findings are most consistent with Creutzfeldt-Jakob Disease.Basilar cisterns, ventricles, and sulci are normal in size and configuration.Foramen magnum is normal without intramedullary mass at the level of the medulla or anomaly of the opisthion, basion, or atlantodental interval.C1 / C2 junction is anatomically aligned. Visualized cervical spinal canal is patent.Pituitary gland is normal in size.Minimal mucosal disease of the ethmoid air cells; otherwise, paranasal sinuses are well aerated.Orbits are normal.Mastoid air cells are clear.Visualized intracranial arterial flow voids appear normal.CONCLUSION:Restricted diffusion and abnormal T2 / FLAIR hyperintensity involving the caudate nuclei, putamen, and thalami with subtle gyriform restricted diffusion involving the frontal cerebral cortex (cortical ribbon sign).&#160;In addition, bilateral symmetric hyperintensity of the dorsomedial thalami and pulvinar compatible with the hockey stick sign.&#160;Given the patient's history of memory loss over the past year and altered mental status, findings are most consistent with Creutzfeldt-Jakob Disease, likely the sporadic variant given the pulvinar involvement.</div>

Case

What is the primary finding in this case?