Differential Diagnosis for MRI Brain Findings
The patient's MRI brain findings reveal several sites of encephalomalacia, T2 signal hyperintensity, and susceptibility, suggesting remote injuries, ischemic and/or traumatic, with associated superficial siderosis. Here's a categorized differential diagnosis:
- Single most likely diagnosis
- Chronic traumatic encephalopathy (CTE) or remote traumatic brain injury: The presence of encephalomalacia and superficial siderosis, particularly in a pattern suggesting previous trauma, makes this a strong consideration. The history of syncope and collapse could be related to the sequelae of such injuries.
- Other Likely diagnoses
- Multi-infarct dementia or vascular dementia: The findings of ischemic changes and encephalomalacia could indicate a history of small vessel disease or larger territorial infarcts, contributing to cognitive decline and potentially to the episodes of syncope.
- Amyloid angiopathy: Given the patient's age and the presence of superficial siderosis, amyloid angiopathy could be a consideration, especially if there's a history of lobar hemorrhages or microbleeds.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cerebral amyloid angiopathy with associated hemorrhages: Although less likely, missing this diagnosis could be critical due to the potential for future hemorrhagic events.
- Brain tumor (e.g., glioma, metastasis): Although the description favors chronic changes, it's crucial not to overlook the possibility of a tumor, especially if any of the lesions show atypical features or enhancement on post-contrast images.
- Vasculitis (e.g., primary CNS vasculitis): This could present with a variety of imaging findings, including ischemic changes and hemorrhage, and is critical to diagnose due to its treatable nature.
- Rare diagnoses
- CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): A hereditary condition leading to stroke and dementia, characterized by white matter changes and subcortical infarcts.
- MELAS syndrome (Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes): A mitochondrial disorder that can cause stroke-like episodes and encephalopathy, though typically presents at a younger age.
- Susac syndrome: A rare condition characterized by microangiopathic changes in the brain, retina, and cochlea, leading to a variety of neurological symptoms.