Ruth Edwards

There are many imaging approaches that might be used in the
evaluation of "dementia".

Computed tomography is a good method to obtain a general
understanding of brain anatomy.   CT images can confirm or
exclude some causes of dementia such as an unsuspected tumor
or multiple small infarcts.

Magnetic resonance images can also give a good display of
anatomy and various MR techniques can be used to further
evaluate brain function.  It is also possible do relatively atraumatic
intracerebral angiography using MR.

There are nuclear medicine techniques that can be used to more
quantitatively evaluate brain physiology such as perfusion and
glucose metabolism.

These computed tomographic images, show the typical pattern of
diffuse cerebral atrophy.  The lateral ventricles are enlarged in a
symmetrical way.  The loss of cerebral cortex is shown by the

abnormally wide sulci over the brain surface.  Focal Intracerebral
calcification is present.  Can you identify the anatomic sites?

CT Scan

 

 

   

You can get some idea of the degree of cerebral atrophy by comparing the images of Ruth Edwards (above)  to the computed tomographic images below.  The evidence of cerebral atrophy is dilation of the lateral ventricles and widening of the cortical sulci.  If you compare the patients lateral ventricles with the example CT, the anterior horns of the lateral ventricles are much more rounded showing loss of brain tissue with resultant expansion of the ventricles.   Over the cerebral convexities, the cortical sulci are much wider than the sulci in the example. 

 Three (3) areas of normal intracerebral calcification are present.  The midline calcification is related to the pineal.  The symmetrical, more lateral calcifications are located in the glomera of the choriod plexus (within the lateral ventricles).  

Remember, the degree of cerebral atrophy recorded on brain images does not correlate directly with the individual’s functional ability so the presence of atrophy does not give a definitive diagnosis.

 Comparison Magnetic resonance image and a labeled cross section of the brain are also shown below.

 

 

 

 

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