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 59-year-old female presents with symptoms and signs involving cognitive functions and awareness.(QUIZ ANSWER) FINDINGS IN THIS CASE MAY BE MOST CONSISTENT WITH:&#160;Frontopolar (Pick's type) neurodegeneration.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Frontotemporal greater than parietal pattern of cerebral atrophy with marked perisylvian atrophy and "knife-blade" type atrophy most conspicuous left middle frontal gyrus.&#160;Parahippocampal atrophy with temporal horn prominence.&#160;Left ventricular enlargement appears to be primarily on an ex vacuo basis.&#160;Periventricular and white matter hyperintensities may represent gliosis of microangiopathic origin.&#160;No siderosis. No supportive findings of amyloid angiopathy.&#160;Nigral and pallidal iron stores are maintained.&#160;Midbrain and collicular plate volume is maintained.&#160;No transependymal spread of CSF or sulcal effacement.&#160;No abnormal meningeal enhancement.&#160;No enhancing parenchymal masses.&#160;No filling defects within the venous sinuses.&#160;No enhancing masses within the internal auditory canals.&#160;No enlargement of the extraocular muscles.&#160;No parenchymal or extraaxial hemorrhage.&#160;Brainstem and cerebellum are without hemorrhage, mass or edema. Carotid and basilar artery flow voids are intact.&#160;No air-fluid levels in the paranasal sinuses.&#160;No extraaxial hemorrhage.&#160;Diffusion-weighted images are without a diffusion restrictive defect.&#160;No temporal tip encephalomalacia.&#160;No orbitofrontal encephalomalacia.&#160;Multiple foci of parenchymal hyperintensities may represent gliosis of microangiopathic origin.&#160;CONCLUSION:&#160;1. Frontotemporal greater than parietal pattern of cerebral atrophy with relative sparing of the posterior fossa including "knife-blade" frontal atrophy. Findings may be most consistent with frontopolar (Pick's type) neurodegeneration. Pattern is slightly less characteristic of Alzheimer's type neurodegeneration which could remain within the differential in an appropriate clinical setting. Lewy body dementia could be an additional consideration if presentation includes visual hallucinations.&#160;2. No other supportive findings of multisystem atrophy.&#160;3. Nigral and pallidal iron stores are maintained. No supportive findings of idiopathic Parkinson's.&#160;4. Periventricular and white matter hyperintensities may represent gliosis of microangiopathic origin. No supportive findings of acute ischemia on diffusion-weighted images. Vascular mechanisms may be an additional contributor to provided history of cognitive disturbance.&#160;5. Ventricular prominence appears to be primarily on an ex vacuo basis. No transependymal spread of CSF or sulcal effacement. NPH appears less likely.&#160;6. No intracranial hemorrhage or neoplasm.</div>

Case

Frontopolar (Pick's type) neurodegeneration

In this case, the frontotemporal cerebral atrophy is greater than parietal pattern, with relative sparing of the posterior fossa including "knife-blade" frontal atrophy. The findings may be MOST consistent with: