Differential Diagnosis for Cerebral Volume Loss with Frontal Predominance and Age-Commensurate Mild Left Hippocampal Atrophy
Single Most Likely Diagnosis
- Frontotemporal Dementia (FTD): Given the frontal predominance of cerebral volume loss, FTD is a strong consideration. It is a group of brain disorders caused by cellular degeneration that affects the brain's frontal and temporal lobes, leading to prominent changes in personality, behavior, and language.
Other Likely Diagnoses
- Alzheimer's Disease (AD): Although the hippocampal atrophy is described as mild and age-commensurate, Alzheimer's disease cannot be ruled out, especially in the context of cerebral volume loss. AD often presents with temporal lobe atrophy, but frontal involvement can also occur, particularly in later stages.
- Vascular Dementia: This condition, resulting from reduced blood flow to the brain, can cause a variety of cognitive impairments. The pattern of atrophy can be variable but may include frontal predominance, especially if small vessel disease is prominent.
- Chronic Traumatic Encephalopathy (CTE): A condition associated with repeated blows to the head, leading to brain damage, particularly in the frontal and temporal lobes. It's more likely in individuals with a history of significant head trauma.
Do Not Miss Diagnoses
- Normal Pressure Hydrocephalus (NPH): Characterized by the triad of gait disturbance, dementia, and urinary incontinence, NPH can cause cerebral volume loss and ventricular enlargement. It's crucial to consider NPH because it is potentially treatable with shunting.
- Prion Diseases (e.g., Creutzfeldt-Jakob Disease): Although rare, these diseases are fatal and can present with rapidly progressive dementia and various neurological signs. They can cause cerebral volume loss and must be considered to avoid missing a diagnosis with significant public health implications.
Rare Diagnoses
- Huntington's Disease: An inherited disorder that causes progressive damage to the brain, leading to cognitive, motor, and psychiatric disturbances. It typically presents with caudate nucleus atrophy but can also involve the frontal lobes.
- Inherited Frontotemporal Dementia: Certain genetic mutations can lead to FTD, and while these are less common, they should be considered, especially in younger patients or those with a significant family history.
- Leukoencephalopathy with Brainstem and Spinal Cord Involvement and Lactate Elevation (LBSL): A rare hereditary condition affecting the brain's white matter, which could potentially present with cerebral volume loss, though it's less likely given the specific pattern described.