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Okay,

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so case number six is a 70-year-old with memory loss.

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This is the initial brain MRI in 2020.

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We see the DWI sequence here.

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No acute infarcts.

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The GRE sequence is significantly abnormal.

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You see multiple little foci of

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old hemosiderin staining.

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Here's one here in the left temporal lobe.

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Here's another in the left occipital region.

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There's another little punctate focus here.

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Here's a focus in the left frontal lobe.

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Here's one in the left occipital lobe,

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one in the right occipital lobe.

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And then a lot of foci here

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throughout the cerebellum.

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There's actually superficial sclerosis that we see

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here in the bilateral cerebellar hemispheres.

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So this has the appearance of cerebral amyloid

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angiopathy. If we look at the flare sequence,

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we have multiple old infarcts.

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So here's some old areas of cortical

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encephalomalacia,

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surrounding gliosis and the

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bilateral occipital lobes.

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Here is a larger old infarct in the left parietal

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lobe extending out here to the cortex.

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Here's another infarct here.

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And then we also have several

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scattered old infarcts.

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These are in the subcortical white matter.

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This one actually abuts the left primary motor

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cortex. Here's the central sulcus here.

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So this is the precentral gyrus

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of the left frontal lobe.

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Here's another cortical infarct in the postcentral gyrus

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of the left parietal lobe.

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So a lot of old infarcts here.

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In addition,

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there's moderate cerebral atrophy with

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a bilateral temporal predilection.

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And we also have, in addition,

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all these old infarcts.

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We have at least baseline moderate microvascular

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ischemic disease. Incidentally,

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there's some moderate right degenerative

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temporomandibular joint disease.

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There is some sort of subacute

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left maxillary sinusitis.

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You see a subacute appearing fluid level there.

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And that's what this initial study showed.

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That same year in 2020,

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the patient then went on to have an FDG brain

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PET CT. Here's the FDG brain PET CT.

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And this showed statistically significant

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hypometabolism in the bilateral temporal lobes

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as well as within the bilateral parietal lobes.

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There was also a little bit of focal hypometabolism

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in the left occipital lobe,

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corresponding to the location of that

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known old left occipital infarct.

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The patient then had an MRI of

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the brain three months later,

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also in 2020,

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but three months after the initial study.

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And we will take a look at that.

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So here's the prior DWI, which was negative.

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And here is the DWI sequence from

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the study three months later.

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We now have an acute infarct in the Pica territory

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of the right cerebellar hemisphere.

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Shows up as light bulb hot on DWI.

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It's actually low in signal on ADC,

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which tells us this is true.

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Restricted diffusion.

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So it is an acute infarct that likely happened

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between less than seven days in age.

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There's also an equivocal additional punctate

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focus of DWI hyperintensity here in the

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left cerebellar hemisphere as well.

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And then all the other findings were otherwise

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stable since the study three months prior.

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So this is again the 70-year-old with memory loss.

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The initial MRI had showed moderate cerebral

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atrophy with a temporal parietal predilection.

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The MRI of the brain showed all these areas of old

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infarcts. There were in the bilateral occipital,

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left parietal,

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multiple old infarcts higher up in the

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brain here on the left-hand side.

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The initial MRI was negative in the DWI sequence,

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but when the patient came back three months later,

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again we had the acute infarct in the right

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cerebellar hemisphere and another questionable

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one in the left cerebellar hemisphere.

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We also saw changes of cerebral amyloid

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angiopathy and superficial sclerosis.

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This is the FDG brain PET CT from 2020.

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And in addition to hypometabolism in the areas of

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the old infarcts, which is what you would expect,

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we also had statistically significant hypometabolism

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in the bilateral parietal lobes,

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the bilateral temporal lobes as well as

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the left posterior cingulate gyrus.

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So you see here on the PET CT,

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this area blue is all statistically significant

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cortical hypometabolism in the parietal

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and in the temporal lobe.

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This is the FDG brain PET CT here

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in a different color format.

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This is the hypometabolism in the bilateral temporal

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lobes and bilateral parietal lobes.

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This is another look at this FDG brain PET

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CT in the coronal plane.

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So anteriorly,

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the frontal lobes look okay,

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but there's hypometabolism in the bilateral

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temporal lobes and posteriorly, again,

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we see it in the bilateral parietal lobes.

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This is the PET MR.

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Fusion on the same patient.

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Hypometabolism in the bilateral temporal and parietal.

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So this patient really had a mixture

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of three different diagnoses.

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They had vascular dementia

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from all their infarcts.

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They had Alzheimer's dementia as well

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as cerebral amyloid angiopathy.