Alzheimer's disease

Case contributed by A.Prof Frank Gaillard

Presentation

Long history of schizophrenia, with a 1 year history of cognitive decline, predominantly involving memory.

Patient Data

Age: 60
Gender: Female
CT

CT brain

Slight prominence of parietal sulci. Otherwise unremarkable study for age. 

MRI

MRI brain

 

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 ischaemic change. No susceptibility induce signal dropout to suggest micro haemorrhages. 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.

Nuclear medicine

SPECT

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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Case information

rID: 30244
Case created: 28th Jul 2014
Last edited: 28th Oct 2015
Inclusion in quiz mode: Included

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