Alzheimer disease

Case contributed by Dr Bruno Di Muzio

Presentation

Dementia symptoms and depression.

Patient Data

Age: 80 years
Gender: Female
MRI

MRI Brain

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 the usually seen at 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. 

Case Discussion

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. 

Considering the limitations of arterial spin labelling (ASL) MR perfusion, this cases shows the typical Alzheimer dementia hypometabolism in both parietal regions,

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Case information

rID: 57096
Case created: 7th Dec 2017
Last edited: 7th Dec 2017
Inclusion in quiz mode: Excluded

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