Elderly gentleman presenting with a clinical diagnosis of dementia characterised by impairments of memory and language function. Past medical history includes hypertension, ischaemic heart disease and AF.
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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 basal ganglia micro hemorrhages of cerebral amyloid angiopathy.
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.
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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