Presentation
Cognitive impairment.
Patient Data
There are multiple focal and confluent predominantly peripheral and to lesser extent periventricular cerebral white matter T2/flair hyperintense lesions. Few of the lesions are in pericallosal locations. There is no significant interval change in the appearance of the brain lesions. There is no involvement of the corpus callosum proper, the brain stem, the cerebellar hemispheres or the imaged upper cervical spinal cord. There is a small cortical-based infarct in the superior aspect of the cerebellar vermis. The overall appearances are of moderate small vessel ischemic changes rather than demyelination.
There is no restricted diffusion or contrast enhancement. There is mild global parenchymal volume loss with biparietal predominance; such a pattern can be seen in patients with Alzheimer disease.
There is no intra or extraaxial collection or mass lesion
Case Discussion
The MRI images show some nonspecific features such as small vessel ischemic changes and mild global parenchymal volume loss with biparietal predominance, not expected for this patient age, and that corroborate to the neuropsychiatric clinical hypothesis of Alzheimer's disease.
The deep white matter component score (Fazekas) is useful in the assessment of patients with possible dementia (see neurodegenerative MRI brain (an approach)).
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