Behavioral variant frontotemporal dementia

Case contributed by Charlie Chia-Tsong Hsu
Diagnosis almost certain

Patient Data

Age: 50 years
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Sagittal T1 and axial T2/FLAIR images demonstrate striking right frontal lobe atrophy with the characteristic "Knife blade" configuration of the frontal gyri. 

Coronal T2 images best demonstrate the right temporal atrophy with widening of the right Sylvian fissure and collateral sulcus and thinning of the superior/middle and inferior temporal gyri. It is also useful to compare the greater degree of frontal horn dilatation compared to the temporal horn implying greater frontal regional atrophy compared to the medial temporal lobe. 

A degree of hippocampi atrophy is present but the overwhelming pattern is the asymmetric right frontotemporal lobe atrophy. 

Axial Tc-99m HMPAO labeled WBC SPECT images demonstrate marked reduction in cerebral blood flow in the right frontal and temporal lobes. Functional HMPAO SPECT confirmed the morphological pattern of atrophy observed on the concurrent MRI examination. 

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