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Frontotemporal lobar degeneration with caudate atrophy

Case contributed by Charlie Chia-Tsong Hsu
Diagnosis probable



Patient Data

Age: 65 years
Gender: Male

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

Figure 1 Images 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 C&D 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, E&F, 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 inner table dimension showed an 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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