dementing illness radiology

Question 1

CT: generalised atrophy and enlarged ventricles

Answer 1

Alzheimer’s

Question 2

MRI: medial temporal lobe atrophy

Answer 2

Alzheimer’s

Question 3

SPECT: temporo-parietal hypoperfusion

Answer 3

Alzheimer’s

Question 4

CT: deep white matter lesions

Answer 4

Vascular dementia

Question 5

SPECT: multi-focal hypoperfusion

Answer 5

Vascular dementia

Question 6

CT/MRI: generalised ventricular enlargement with preservation of medial temporal lobe

Answer 6

LBD

Question 7

SPECT: posterior deficits with reduced D2 receptor density

Answer 7

LBD

Question 8

CT/MRI: frontal lobe atrophy

Answer 8

FTD

Two subtypes:
- behavioural - frontal atrophy
- language (primary progressive aphasia or primary non fluent aphasia) - atrophy of L presylvian region

In general, semantic dementias have more pronounced anterior temporal lobe atrophy compared to posterior temporal lobe.

Question 9

SPECT: anterior perfusion deficits

Answer 9

FTD

Question 10

MRI: deep white matter hyperintensities on T2 weighted brain MRI

Answer 10

late life depression; vascular depression - poorer response to treatment

Question 11

high intensity signal in thalamus- pulvinar nucleus (pulvinar sign)

Answer 11

CJD

Question 12

Mesial temporal sclerosis

Answer 12

TLE

Question 13

bilateral high T2 signal without enhancement

Answer 13

limbic encephalitis

Question 14

best test for CJD

Answer 14

structural MRI/

Question 15

best test for FTD

Answer 15

PET

Question 16

best test for small brain processes

Answer 16

MRS

Question 17

PET- cingulate island sign

Answer 17

LBD

Question 18

caudate nucleus atrophy

Answer 18

huntingtons

Question 19

SPECT: posterior deficits, reduced D2 density and dopamine transporter

Answer 19

LBD

Question 20

AD pathology

Answer 20

Amyloid plaques/neuritic plaques; neurofibrillary tangles (tau protein aggregates)
Astrocytosis
Microgliosis
Neuronal and synaptic loss
Hirano bodies

Greatest density in the medial hippocampus including the entorhinal cortex, the amygdala and the neocortex of the occipital, frontal and temporal lobes.

Question 21

LB pathology

Answer 21

Eosinophilic inclusion bodies, ubiquitin and alpha synuclein

LB found in cerebral cortex (where as in PD, LB found in brainstem nuclei, particularly the substantia nigra)

Question 22

Vascular Dementia pathology

Answer 22

Large or several infarcts, multiple small infarcts, lacuna infarcts
Cerebral amyloid angiopathy
Gliosis
Hyalinisation
Sclerosis

Question 23

Tauopathy with an accumulation of abnormal tau protein in brain

Answer 23

Pick’s disease (a type of FTD)

Question 24

Differentiating AD and FTD

Answer 24

Elevated CSF tau protein and decreased beta-amyloid 42 protein in AD

Question 25

FTD pathology

Answer 25

Three types of FTD: BvFTD (also known as Picks), PNFA and movement disorders.

Classified according to the main protein component of pathological neuronal and glial inclusions.

The most common pathological class of FTLD is associated with the TDP-43 protein (FTLD-TDP)

FTLD-Tau is considered slightly less common - Pick type pathology consists of profound gliosis, absence of spongiform change and swollen neurons with tau and ubiquitin positive inclusions.

FTLD-FUS (Fused in sarcoma protein) pathology is rare.

Hirano bodies (actin-rich paracrystalline inclusions) are found