Differential Diagnosis for 90y Male with Brain MRI Findings
- Single most likely diagnosis
- Alzheimer's disease: The presence of atrophy on the brain MRI, particularly in a 90-year-old male, suggests a degenerative condition. Alzheimer's disease is a common cause of atrophy in this age group and is often associated with microangiopathy.
- Other Likely diagnoses
- Vascular dementia: Given the association with microangiopathy, vascular dementia is a plausible diagnosis. It is caused by reduced blood flow to the brain, often due to small vessel disease.
- Chronic subcortical vascular encephalopathy (CSVE): This condition is characterized by damage to the small blood vessels in the brain, leading to atrophy and cognitive decline.
- Normal pressure hydrocephalus (NPH): Although less common, NPH could be considered, especially if there are symptoms such as gait disturbance, dementia, and urinary incontinence.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Creutzfeldt-Jakob disease: A rare but fatal neurodegenerative disorder that can present with rapid cognitive decline and atrophy on imaging.
- CNS lymphoma: A type of cancer that can cause atrophy and cognitive decline, particularly in immunocompromised individuals.
- Chronic meningitis: Infection or inflammation of the meninges can cause atrophy and cognitive decline if left untreated.
- Rare diagnoses
- Frontotemporal dementia (FTD): A group of rare brain disorders characterized by the progressive degeneration of the frontal and temporal lobes.
- Progressive supranuclear palsy (PSP): A rare brain disorder that causes serious problems with walking, balance, and eye movements.
- Corticobasal degeneration (CBD): A rare, progressive neurological disorder characterized by degeneration of the cerebral cortex and basal ganglia.