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Differential Diagnosis of Nervous System Disorders

Cerebral Atrophy!!navigator!!

= irreversible loss of brain substance + subsequent enlargement of intra- and extracerebral CSF-containing spaces (hydrocephalus ex vacuo = ventriculomegaly)

  1. DIFFUSE BRAIN ATROPHY
    Cause:
    1. Trauma, radiation therapy
    2. Drugs: dilantin, steroids, methotrexate, marijuana, hard drugs, chemotherapy, alcohol, hypoxia
    3. Demyelinating disease: multiple sclerosis, encephalitis
    4. Degenerative disease: eg, Alzheimer disease, Pick disease, Jakob-Creutzfeldt disease
    5. Cerebrovascular disease + multiple infarcts
    6. Advancing age, anorexia, renal failure
    • enlarged ventricles + sulci
  2. FOCAL BRAIN ATROPHY
    Cause: vascular / chemical / metabolic / traumatic / idiopathic (Dyke-Davidoff-Mason syndrome)
  3. REVERSIBLE PROCESS SIMULATING ATROPHY
    (in younger people)
    Cause: anorexia nervosa, alcoholism, catabolic steroid treatment, pediatric malignancy
    • prominent sulci
    • ipsilateral dilatation of basal cisterns + ventricles
    • ex vacuo dilatation of ventricles
    • thinning of gyri
    • focal areas of periventricular high signal intensity
    • increased iron deposition in putamen approaching the concentration in globus pallidus
    • dilatation of Virchow-Robin perivascular space

Cerebellar Atrophy!!navigator!!

  1. WITH CEREBRAL ATROPHY
    = generalized senile brain atrophy
  2. WITHOUT CEREBRAL ATROPHY
    1. Olivopontocerebellar degeneration / Marie ataxia / Friedreich ataxia
      • onset of ataxia in young adulthood
    2. Ataxia-telangiectasia
    3. Ethanol toxicity: predominantly affecting midline (vermis)
    4. Phenytoin toxicity: predominantly affecting cerebellar hemispheres
    5. Idiopathic degeneration 2° to carcinoma (= paraneoplastic), usually oat cell carcinoma of lung
    6. Radiotherapy
    7. Focal cerebellar atrophy:
      1. infarction
      2. traumatic injury

Hippocampal Atrophy!!navigator!!

  1. Alzheimer Disease
  2. Mesial temporal sclerosis
    • complex partial seizures
  3. Normal in octogenarians

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