Asymptomatic severe global atrophy

Case contributed by Dr Gabrielle Matta

Presentation

60-year-old man, former successful business owner and musician, with a 15 year history of partially treated depression, referred for assessment of his cognition.

Patient Data

Age: 60 years old
Gender: Male

MRI brain non contrast

MRI

No focal mass, collection of hemorrhage. There is severe global atrophy with marked prominence of the sulci, cisterns and ventricles. Very minor high T2 signal is in keeping with mild small vessel ischemic change. There is prominence of the choroid fissures, and the temporal horns of the lateral ventricles, along with hippocampal atrophy, but this in in proportion to the degree of atrophy seen elsehwere. No mass lesion is identified.

Neuropsychiatry Unit Cognitive Screening Tool

Photo

NUCOG results demonstrate performance consistent with people in a normal group, or less than one standard deviation from this group.

Case Discussion

The scan shows severe global atrophy with widening of extra-axial CSF spaces. The hippocampi are small but in keeping with the volume loss elsewhere. Other findings of note are calcified falx with bone marrow in it.

The patient scored a  94.5/100 on the NUCOG however, and went on to have a neuropsychological assessment in which he performed at an excellent level. This shows that the degree of brain atrophy does not always correlate with clinical presentation and that cognition can be well-preserved even with pronounced brain volume loss.

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