CASE 26: 32 y/o male with progressive cuadriparesia

Patient started several months ago with right hand paresia and subsequently developed to ipsilateral leg and now in all 4 limbs, more present in right side.

He underwent a Cervical MR, here are the relevant slices (click to enlarge):

Differentials please..

Interamerican College of Radiology Congress!

I want to have a time to invite you all foreigners and locals to this years CIR congress wich will be taken place  in El Salvador.

Here is the ad and the webpage for more information:




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DX: Vascular Dementia possible Amiloid Angiopathy with État criblé VR spaces

Sorry for the long delay..some very big situations in my life came asn with that all of my time...anyways..

Patient is in worse condition now, MR study was conducted several months ago. Findings are inconclussive but representative of a leukoencephalopathy (white matter disease). The combination of brain atrophy, isquemic lesions (pons and cerebellum) and puntiform (petechial) hemorrage are consistent with a degenerative vascular disease. Differentials are broad but Vascular Dementia and Amyloid Angiopathy are much more likely due to age and symptoms. CADASIL is more encountered in a young population.

White matter disease manifested as hyperintensities on FLAIR and T2 WI:

État crible Virchow-Robin Spaces:

http://radiopaedia.org/articles/peri-vascular-space


Cerebral amyloid angiopathy (CAA), also known as congophilic angiopathy, is a form of angiopathy in which amyloid deposits form in the walls of the blood vessels of the central nervous system.  CAA has been identified as occurring either sporadically (generally in elderly populations).

Amyloid deposition predisposes these blood vessels to failure, increasing the risk of a hemorrhagic stroke. Since this can be caused by the same amyloid protein that is associated with Alzheimer's dementia such brain hemorrhages are more common in people who suffer from Alzheimer's, however they can also occur in those who have no history of  dementia. The hemorrhage within the brain is usually confined to a particular lobe and this is slightly different compared to brain hemorrhages which occur as a consequence of high blood pressure (hypertension)  - a more common cause of a hemorrhagic stroke.

The diagnosis of vascular dementia can be straight-forward in patients with a clear history of strokes and cognitive impairment when a temporal connection exists between stroke and cognitive decline. More often, however, it is difficult to determine whether cerebrovascular disease alone causes dementia, whether it merely contributes to the dementia, or whether it is simply a coincidental finding. Various diagnostic criteria exist to aid diagnosis.

On the Hachinski ischaemic scale vascular dementia is diagnosed when the patient is given a score of 7 or higher. Although the Hachinski scale is widely used, particularly for research purposes, it has poor interrater reliability, and modified versions have been proposed.


http://www.bmj.com/content/312/7025/227.full 

http://emedicine.medscape.com/article/1135408-overview 

http://en.wikipedia.org/wiki/Multi-infarct_dementia 

http://radiopaedia.org/articles/peri-vascular-space 

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