Biparietal parenchymal volume loss

Case contributed by Dr Bruno Di Muzio

Presentation

Patient under psychiatric evaluation for behavior and personality changes in the last two years.

Patient Data

Age: 57
Gender: Male
MRI

MRI Brain

There are are a few, less than 5, punctate flair hyperintensities in the cerebral white matter likely to reflect small vessel ischaemic changes. There is an old lacunar infarct in the left thalamus and a small old infarct in the superior aspect of the left cerebellar hemisphere. There is selective biparietal volume loss with the widening of the adjacent cortical sulci. There is associated decreased perfusion on ALS perfusion scan (not shown). There is preservation of the frontal and temporal parenchymal volume. There is normal calibre of the ventricles. There is also mild bilateral superior cerebellar hemispheric volume loss.

There is no diffusion restriction or pathological parenchymal susceptibility artefact. There is no intracranial mass lesion or collection. There is preservation of the major intracranial arterial flow voids.

Conclusion:

There is selective biparietal parenchymal volume loss with associated decreased perfusion on ALS perfusion scan. The appearance is non-specific but has been described in Alzheimer's disease. There is also mild superior cerebellar hemispheric volume loss.

Nuclear medicine

SPECT

RADIOPHARMACEUTICAL: 99mTc HMPAO, 808 MBq

CLINICAL INDICATION 56 year old male with cognitive decline and behaviour change.

TECHNICAL PROCEDURE AND RESULTS SPECT studies of the brain were performed. Hypoperfusion is seen in the parietal cortex bilaterally, with reduction also seen in the precuneus. The frontotemporal cortex demonstrates relatively normal perfusion.

OVERALL IMPRESSION The findings are nonspecific. Appearances may suggest early Alzheimer's disease and are not consistent with frontotemporal dementia.

Case Discussion

This case illustrates a biparietal parenchymal volume loss correlated both in MRI and SPECT. Patient is still under psychiatric consultation and Alzheimer's disease is one of the differential diagnosis to be considered.  

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Case information

rID: 38279
Case created: 13th Jul 2015
Last edited: 10th Sep 2015
Inclusion in quiz mode: Included

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