Dementia symptoms and depression.
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Although there is generalised cerebral volume loss, this is most pronounced in the hippocampi which are symmetrically atrophied. There are multiple white matter hyperintensities in keeping with chronic small vessel ischaemic white matter changes, in a number and distribution slightly over what is usually seen in this age group. There are no features on susceptibility-weighted imaging of cerebral amyloid angiopathy. Bilateral foci of restricted diffusion in the choroid plexus of the lateral ventricles are likely related to xanthogranulomas. The remainder the brain is unremarkable in appearance, with no intra or extra-axial masses or collections. ASL perfusion appears reduced within the parietal lobes.
While there is generalised cerebral volume loss, the presence of symmetric bilateral hippocampal volume loss in this age group and clinical setting suggests Alzheimer's disease as the most likely diagnosis.
Brain colour maps created based on the automatic segmentation values against normal ranges show marked hippocampal atrophy (red) - almost 5 standard deviations from normality.