case_images: PMC9484149_01
case_images: CT scan (February 17, 2018), with no contrast, showing a posterior parietal (1c, 1d) and temporal cortical atrophy (1a) prevalent on the right hemisphere and a moderate atrophy of the precuneus (1e) and frontal cortex (1a, 1b). The hippocampus and the mesial temporal area appeared fairly preserved.
case_images: adr-6-adr220026-g001.jpg
case_images: PMC9484149_01_adr-6-adr220026-g001.jpg
case_images: adr-6-adr220026-g001
case_images: Brain CT and MRI, performed in 2018 before the patient was referred to the TCIC, showed a posterior parietal (Figs. 1c, 1d, 2b, 2c) and temporal cortical atrophy (Fig. 1a) prevalent in the right hemisphere and a moderate atrophy of the precuneus (Figs. 1e, 2d) and frontal cortex (Figs. 1a, 1b, 2a).
case_images: The first (March 3, 2018) and the second (December 14, 2019, not showed) structural MRI T1 and T2 weighted sequences reported a posterior parietal (2b, 2c), temporal (not shown) and frontal cortex (2a) atrophy prevalent on the right hemisphere and an atrophy of the precuneus (2d).
case_images: adr-6-adr220026-g002.jpg
case_images: PMC9484149_01_adr-6-adr220026-g002.jpg
case_images: adr-6-adr220026-g002
case_images: Brain CT and MRI, performed in 2018 before the patient was referred to the TCIC, showed a posterior parietal (Figs. 1c, 1d, 2b, 2c) and temporal cortical atrophy (Fig. 1a) prevalent in the right hemisphere and a moderate atrophy of the precuneus (Figs. 1e, 2d) and frontal cortex (Figs. 1a, 1b, 2a).
case_images: The first 18F-FDG PET study (November 13, 2018) is illustrated by the images above (3a-3e axial sections; 3f sagittal section) while the second study (December 6, 2019) produced the images below (3g-3k axial sections; 3l sagittal section). The first 18F-FDG PET study showed reduced glucose metabolism in the occipital, parietal, temporal, lateral frontal cortex on the right side along with the involvement of right supplementary motor area (3a-3e), of the precuneus (3e, 3f), and partially of the primary sensory-motor area. The hypometabolism of the precuneus on the right side suggested an initial sign of the posterior cingulate island on the right (3e). The right putamen was relatively less metabolically active (not shown). The left parietal and the temporal cortex were also moderately hypometabolic. The second study produced images substantially unchanged from the previous ones.
case_images: adr-6-adr220026-g003.jpg
case_images: PMC9484149_01_adr-6-adr220026-g003.jpg
case_images: adr-6-adr220026-g003
case_images: The 123I-ioflupane SPECT (DaT-SPECT), performed on December 20, 2018. It showed a mild thinning of the posterior portion of the right putamen that did not appear to be pathological in the semi-quantitative analysis (DaTQUANT). The second study (December 12, 2019, not shown) produced images and semi-quantitative analysis essentially unchanged.
case_images: adr-6-adr220026-g004.jpg
case_images: PMC9484149_01_adr-6-adr220026-g004.jpg
case_images: adr-6-adr220026-g004
case_images: In December 2018 the patient performed a 123I-ioflupane SPECT (DaT-SPECT) which showed a mild, albeit non-pathological at DaTQUANT (see methods), thinning of the posterior portion of the right putamen (Fig. 4).