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 65-year-old male presents with abnormal gait. Classic clinical findings in normal pressure hydrocephalus are described in the Hakim triad consisting of gait apraxia, dementia and incontinence.(QUIZ ANSWER) THE HAKIM TRIAD CONSISTS OF:&#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 MRI of the brain in this patient is classic for normal pressure hydrocephalus. Basilar cisterns are enlarged. Third ventricle is enlarged with a prominent infundibular recess. There is clear hyperdynamic CSF flow within the aqueduct of Sylvius. Recently described finding present in this patient is that of focal bulging of the roof of the lateral ventricle seen in the sagittal plane.&#160;&#160;Thinning of the corpus callosum has been described and is present in this patient as well.&#160;Clear hyperdynamic CSF flow void extends into the fourth ventricle causing dephasing of protons and hypointense signal or signal void.&#160;&#160;Rounded lateral ventricles as classically described in normal pressure hydrocephalus are present.&#160;Dilated temporal horns.&#160;Probable small right thalamic lacune versus dilated perivascular space.&#160;Relatively little in the way of deep white matter microvascular ischemic change. Relatively little in the way of atrophy (ventricular dilatation out of proportion to the degree of atrophy) which is also a classical finding in normal pressure hydrocephalus.&#160;Accompanying CSF flow study demonstrates hyperdynamic circulation within the cerebral aqueduct consistent with so-called "water hammer pulse" and normal pressure hydrocephalus.&#160;CONCLUSION:&#160;The study is quite classical for normal pressure hydrocephalus. If this patient has gait apraxia, shunting or large volume diagnostic CSF flow tap might be expected to be supportive of the imaging diagnosis. Classic clinical findings in normal pressure hydrocephalus are described in the Hakim triad consisting of gait apraxia, dementia and incontinence.</div>

Case

Classic clinical findings in normal pressure hydrocephalus are described in the Hakim triad consisting of: