What is the diagnosis based on a plain cranial result showing lacunar infarct, pon(d) (pontine) and left thalamus involvement, microvascular ischemic white matter changes, degenerative demyelination in periventricular white matter, corona radiata, and semioval centers, cerebral and cerebellar volume loss, and atherosclerotic vessel disease?

Differential Diagnosis

• Single most likely diagnosis
  • Vascular Dementia: The presence of lacunae infarct, microvascular ischemic white matter changes, and atherosclerotic vessel disease suggests a chronic vascular process affecting the brain, which is consistent with vascular dementia. The cerebral and cerebellar volume loss further supports this diagnosis.
• Other Likely diagnoses
  • Multi-Infarct Dementia: Similar to vascular dementia, the evidence of multiple infarcts (lacunae infarct) and white matter changes could also suggest multi-infarct dementia, where cognitive decline is due to multiple small strokes.
  • Small Vessel Disease: The microvascular ischemic changes and lacunae infarcts are hallmark findings of small vessel disease, which can lead to cognitive decline and dementia.
  • Normal Pressure Hydrocephalus (NPH): Although less directly supported by the findings, NPH can cause cerebral atrophy and sometimes is associated with vascular changes. The "pond" mentioned could potentially refer to a feature seen in NPH, though this is speculative without more context.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Cerebral Vasculitis: Although less common, cerebral vasculitis could present with similar vascular changes and would require urgent treatment to prevent further brain damage.
  • Moyamoya Disease: A rare condition causing stenosis or occlusion of the internal carotid artery and its branches, leading to ischemic changes. It's crucial to consider due to its potential for significant morbidity if not treated.
• Rare diagnoses
  • CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): An inherited condition leading to stroke and dementia, characterized by white matter changes and subcortical infarcts, which could fit some of the described findings.
  • Binswanger's Disease: A rare form of vascular dementia characterized by white matter changes, which could be considered given the microvascular ischemic changes and degenerative demyelination described.