Presentation
Long history of schizophrenia, with a 1 year history of cognitive decline, predominantly involving memory.
Patient Data
Slight prominence of parietal sulci. Otherwise unremarkable study for age.
Atrophy of the parietal lobes bilaterally is demonstrated, associated with atrophy of both hippocampi. The remainder of the brain is within normal limits for age, with no small vessel ischemic change. No susceptibility induce signal dropout to suggest micro hemorrhages. No posterior fossa abnormality.
Conclusion:
Bilateral parietal lobe atrophy with hippocampal volume loss is suggestive of Alzheimer's disease, especially in the setting of an amnestic syndrome, although parietal involving schizophrenia is also reported.
RADIOPHARMACEUTICAL: 99mTc ECD, 790 MBq
TECHNICAL PROCEDURE AND RESULTS
SPECT studies of the brain were performed.
Mild hypoperfusion is seen in the parietal and temporal lobes. Perfusion is preserved to the occipital cortex and basal ganglia. The cerebellum demonstrates mild bilateral hypoperfusion. No other significant abnormalities are seen.
OVERALL IMPRESSION
The findings of mild global cortical hypoperfusion are non-specific. The changes could be related to schizophrenia.Alzheimer's type dementia could also produce this appearance.
Case Discussion
Imaging of neurodegenerative conditions is difficult and often frustrating as a definitive diagnosis if often not available; certainly histology is rare, and even when obtained not necessarily diagnostic. As such one must get used to at most pushing clinicians towards or away from certain diagnoses being entertained on clinical grounds.
In this case the diagnosis of Alzheimer's disease is strengthened by imaging.
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