Frontotemporal lobar degeneration with caudate atrophy

Case contributed by Dr Charlie Chia-Tsong Hsu

Presentation

65 year old male. ? Dementia.

Patient Data

Age: 65
Gender: Male

Asymmetric bifrontal atrophy more  pronounced on the right with the "knife blade" appearance of the atrophic frontal gyri.

Figure 1 Image A&B depict asymmetric bifrontal atrophy more  pronounced on the right with the "knife blade" appearance of the atrophic frontal gyri (outline in red). There is sparing of the pre and post central gyrus (highlight in yellow). Image B&C show asymmetric bitemporal atrophy again with the right side more severely affected. This can also be inferred by the more dilated right temporal horn of the lateral ventricle. Sagittal images, D&E, demonstrate marked atrophy of the anterior portion of the cingulate gyrus (yellow). 

Figure 2 Axial image A&B show disproportionate enlargement of the frontal horns of the lateral ventricles with some loss of the normal lateral concavity and right frontal horn marginally more dilated. This is likely secondary to frontal lobe and caudate head atrophy. Objected measurement of the caudate-caudate and innner table dimension showed a increased CC/IT ratio. The caudate head atrophy is best appreciated on the right parasagittal image C&D.  

Figure 3 The hippocampus is relatively symmetrical. In comparison to frontotemporal atrophy, the hippocampus is relatively preserved. 

Case Discussion

Pattern and location of cerebral atrophy is a useful discriminator for subtypes of frontotemporal lobar degeneration. In the frontotemporal dementia subtype there is asymmetric bilateral frontal temporal atrophy greater on the right side 1. Frontotemporal dementia has also  been shown to have a propensity for caudate atrophy and this maybe initially inferred by the disproportionately dilated frontal horns of the lateral ventricle 2.

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Case information

rID: 20064
Case created: 1st Nov 2012
Last edited: 8th Feb 2016
Inclusion in quiz mode: Included

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