PMC10201512_01
MRI brain axial T1 and FLAIR showing mild periventricular leukoencephalopathy, bilateral fronto-parietal small infarcts and central and to less extant cortical cerebral involutional changes
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Fig1
Brain MRI showed mild periventricular leukoencephalopathy, bilateral fronto-parietal small infarcts at different stages of evolution, with central and, to a lesser extent, cortical cerebral involutional changes that raised the possible diagnosis of normal pressure communicating hydrocephalus (Fig. 1).
Abnormal EEG record showing moderate diffuse cerebral slowing
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Fig2
EEG showed abnormal bilateral symmetrical and synchronous moderately diffuse cerebral slowing of 4-5 Hz; mixed delta-theta activity (Fig. 2).
Polysomnography showing severe degree of obstructive sleep apnea
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Fig3
A diagnosis of severe obstructive sleep apnea was suggested that might be attributed to COVID-19 illness (Fig. 3), yet BiPaP ventilation trail showed no significant improvement.
Conventional MRI data with diffusion images showing abnormal relative diffusion restriction with faint abnormal high signal on FLAIR, at the deep gray matter nuclei particularly caudate nuclei and anterior aspects of the putamen and thalamic nuclei
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Fig4
Multi-parametric 18F-FDG hybrid PET/MRI brain scan revealed abnormal relative diffusion restriction at the deep gray matter nuclei, particularly the caudate nuclei and the anterior aspects of the putamen and thalamic nuclei (Fig. 4).
MR perfusion images showing mild hypoperfusion status of the deep cerebral white matter and deep gray matter bilaterally but with of normal perfusion of hippocampal formations and the precuneus regions
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Fig5
The hippocampal formations and the precuneus regions are of normal perfusion for this age, which can more or less rule out Alzheimer's disease diagnosis (Fig. 5).
PET/MR data showing hypometabolic status seen regarding the cortical regions particularly at the right and left lateral prefrontal with sparing of the precuneus and posterior cingulum and occipital lobes and temporal lobes
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Fig6
The precuneus, posterior cingulum, occipital lobes and temporal lobes were spared from such hypometabolism ruling out other causes of dementia like Lewy body dementia (Figs. 6, 7).
PET/MR data showing hypometabolic status of right and left medial prefrontal regions
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Fig7
The precuneus, posterior cingulum, occipital lobes and temporal lobes were spared from such hypometabolism ruling out other causes of dementia like Lewy body dementia (Figs. 6, 7).