Vascular dementia

Case contributed by Assoc Prof Frank Gaillard

Presentation

Elderly gentleman presenting with a clinical diagnosis of dementia characterized by impairments of memory and language function. Past medical history includes hypertension, ischemic heart disease and AF.

Patient Data

Age: 75 years
Gender: Male

MRI brain

MRI

Very extensive white matter T2 hyperintensity seen throughout both cerebral hemispheres, which is non-specific, but suggests chronic small vessel ischemia, particularly in a patient with hypertension. No punctate regions of susceptibility induce signal dropout to suggest microhemorrhages of cerebral amyloid angiopathy or hypertension. 

The corpus callosum is thinned particularly anteriorly, associated with quite pronounced cerebral volume loss, which is perhaps marginally more noticeable in the frontal and anterior temporal regions. There is little left/right asymmetry, especially when coronal images are corrected for slight tilt of the patient. The hippocampal heads are volume depleted, as are the parahippocampal gyri and inferior temporal gyri, also more marked anteriorly.

Cerebral blood volume (CBV) appears reduced throughout both cerebral hemispheres.

Case Discussion

Extensive chronic small vessel ischemic changes is the most striking finding.

Mild parietal volume loss and quite striking anterior hippocampal and temporal lobe atrophy may also suggest co-existing AD. 

Frontal and anterior temporal lobe atrophy raises the possibility of language variant frontotemporal dementia, however, the age and absence of left/right asymmetry makes this unlikely. 

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