case_images: PMC10894606_01
case_images: a) Florbetapir PET (age 79): amyloid presence in the brain. b) Brain MRI on T2 FLAIR WI (age 80): small hyperintensity in the right precentral lesion. c) Brain MRI on T2* WI (age 80): hemosiderin deposition along with the right Rolandic fissure. d) FDG-PET imaging (age 77): absence of AD-like pattern. e) Brain MRI on T2* WI (age 82): lobar hemorrhage in the left temporopolar region, cortical superficial siderosis in the left temporal sulcus. f) Brain MRI on T2 FLAIR WI (age 82): white matter hyperintensity. g) Brain MRI on T2*WI (age 82): cortical superficial siderosis in the right superior frontal sulcus. h, i) Brain CT (age 82): large hemorrhage on the right fronto-parietal region, small amount of subarachnoid hemorrhage. (Permission to share imaging was granted by the patient before death).
case_images: adr-8-adr230183-g001.jpg
case_images: PMC10894606_01_adr-8-adr230183-g001.jpg
case_images: adr-8-adr230183-g001
case_images: Among investigations performed, neurological examination was unremarkable; neuropsychological examination confirmed memory and attention deficits (Mini-Mental State Examination (MMSE) score 25/30), a picture compatible with mild cognitive impairment (MCI); Apolipoprotein E genotype was e2/3; a brain CT scan showed chronic microvascular ischemic disease; an FDG-PET scan was apparently within the normal range whereas an Amy-PET with Florbetapir, performed two years later, was positive (Fig. 1a), the last finding supporting a diagnosis of MCI due to AD. A brain MRI on T2 FLAIR WI showed a small hyperintensity near the right precentral sulcus (Fig. 1b); on T2* weighted imaging (WI) an abnormal hypointense signal was evident (Fig. 1c) and it was indicative of hemosiderin deposition along with the right Rolandic fissure. An FDG-PET scan carried out at the time of cognitive symptom onset has been not suggestive of a typical AD-like pattern (Fig. 1d). An MRI scan revealed the occurrence of a lobar hemorrhage in the left temporo-polar region (Fig. 1e), siderosis in the left temporal sulcus (Fig. 1e), white matter hyperintensity (Fig. 1f), and CSS in the right superior frontal sulcus (Fig. 1g). Eight months later the patient became suddenly symptomatic for left hemiplegia and a CT scan revealed the presence of a large hemorrhage in the right fronto-parietal region, with small amount of subarachnoid hemorrhage (Fig. 1h, i).
case_images: Z-SCORE images are shown with a dedicated color table at the bottom of the figure (from 0 to 8), a threshold of 2 SD applied to the images; cerebellum whole as reference region in the ROI analysis performed with CortexID software; higher Z-score and standardized uptake value ratio (SUVR) for the occipital regions. a) right lateral view; b) left lateral view; c) right medial view; d) left medial view; e) anterior view; f) posterior view; g) superior view; h) inferior view.
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case_images: PMC10894606_01_adr-8-adr230183-g002.jpg
case_images: adr-8-adr230183-g002
case_images: To support this hypothesis, a quantitative region-of-interest (ROI) analysis of Amy-PET imaging was performed using CortexID software (GE Healthcare, Waukesha, WI, USA), assuming the cerebellum (whole) as reference region, and it revealed a significant SUVR in the occipital cortices (SUVR/Z SCORE 1.6/6.5, 1.7/7.8 on the right and left, respectively) (Table 1 and Fig. 2).