L12 Dementia neuroimaging DD

Question 1

what is the routine MRI protocol

Answer 1

no contrast material injection
-3d t1 w image - evaluation of the medial temporal love
-axial FLAIR and t2 TSE - hypoxic/ischemic (wm) pathology
- axial t2* gradient echo or SWI –> detection of microbleeds and calcification
DWI for creutzfeld-jacob

Question 2

what does MRI show in reporting

Answer 2

sweliing - infection, paraneoplastic
primary GM loss - AD, FTD, Parkinsonian
vascular pathology - infarcts, lacunes, WMC
Primary WM disease - leukodystrophies, MS, FXTAS

Question 3

what is structured reporting tell us in primary WM and what diseases could there be

Answer 3

• infectious = HIV, Whipple, syphilis
• inflammatory = MS, sarcoid, coeliac disease
• leukodystrophy = mitochondrial, peroxisomal, FXTAS, vanishing WM, adult polyglucogan body disease
• toxic/metabolic = CO, vitamin B, heroin , delayed post-hypoxic demyelination
• trauma

Question 4

what dementias are affected by the primary GM

Answer 4

alzheimer - mediotemporal, posterior varient
FTD = semantic, aphasic, frontal, right temporal
Parkinsonian = DLB, PSP, MSA
Prion = CJD, FFI, GSS
other movement disorders = huntingdon, NBIA, Wilson

Question 5

what are medio-temporal patterns of atrophy in AD

Answer 5

hippocampus, parahippocampus

APOE-4 positive, senile age, memory

Question 6

what are posterior patterns in AD

Answer 6

posterior cingulate, interparietal sulcus

APOE-4 negative, presenile, visuo-spatial

Question 7

what are atypical patterns of atrophy in AD

Answer 7

frontal or occipital predominance
behavioural or visual symptoms
-DD with FTLD and DLB

Question 8

what is the structured reporting in vascular - in smell vessel disease, large vessel pathology, systemic causes of ischemia

Answer 8

small vessel disease - extensive WML, multiple lacunes
specific diseases: CADASIL, CAA
large vessel pathology - strategic infarcts, dominant hemisphere
systemic causes of ischemia - vasculitis, mitochondrial, post-hypoxic demyelination