Loss of Brain Volume

a HIV encephalopathy b Steroid-associated volume loss a HIV encephalopathy b Steroid-associated volume loss

Pictures Alzheimer Brain

Fig. 11.43a The brain volume is diffusely reduced (left) in this 45-year-old HIV patient who was becoming increasingly disoriented. On the right you see a normal age-matched CT for comparison. b This child is treated with high-dose steroids after receiving a liver transplant. The brain volume is reduced significantly. CT after termination of steroid therapy in these patients shows a return to normal brain size.

Fig. 11.43a The brain volume is diffusely reduced (left) in this 45-year-old HIV patient who was becoming increasingly disoriented. On the right you see a normal age-matched CT for comparison. b This child is treated with high-dose steroids after receiving a liver transplant. The brain volume is reduced significantly. CT after termination of steroid therapy in these patients shows a return to normal brain size.

Do You Know about Alzheimer, Pick, and Binswanger? Alois Alzheimer was a neurologist and psychiatrist in Wroclaw (the former Breslau) around 1900. His special field of interest was brain pathology. He searched forthe substrate of the presenile dementia that was named after him. The neurologists Arnold Pick and Otto Binswanger worked on the same topic around the same time as Alzheimer, the former in Prague and the latter in Jena. Binswanger's major contribution to medicine was his research on the microangiopathy of the brain.

Normal-pressure hydrocephalus: Normal-pressure hydrocephalus may also go along with dementia and can occur after meningitis or subarachnoid hemorrhage (see p. 235), and—most often—idiopathically. The inner CSF spaces are all dilated, the outer ones remain normal in caliber. Peri-ventricular hypodensities seen on CT have been interpreted by some as a result of parenchymal stretching (Fig. 11.42d).

Brain infarction: Isolated brain infarction due to embolic occlusion of a small end-artery, for example, in the region of the thalamus, can also cause a clinical syndrome resembling dementia (see also p. 237).

• Diagnosis: Paul thinks he is looking at an SAE; Giufeng tends toward Alzheimer. Pierre drops in and asks whether this could also be Creutzfeldt-Jakob disease. Greg arrives just in time to keep Pierre from asking the unfortunate Mr. Braggbag about any beef consumption. "The poor man has got enough to worry about as it is. Leave him alone, please. Creutzfeldt-Jakob is incredibly rare! The atrophy is obvious. The most likely diagnosis is Alzheimer." Gregory sinks into a chair and grabs the cup of coffee that Giufeng has just brought along for Paul. "Brain volume loss is a tricky thing," he starts to lecture. "It doesn't always go along with dementia. Always keep the age of the patient in mind. Then look at the social background. Wanna know a secret? But don't tell anyone I told you: Check the dental status on the CT scout image for information about past oral hygiene—that will tell you a little about what type of patient you are dealing with. Alcohol- and/or drug-induced atrophy we see by the dozen in this hospital. The same is true for HIV encephalopathy, which can

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