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Diagnosis

Reading File
analyse_media
This looks like diffuse cerebral atrophy with ventriculomegaly, but one photographed slice can't settle it. I read it myself because the image analysis tool failed on the local file. I also didn't pull textbook references.
What I see (non-contrast axial CT, level of the frontal horns, third ventricle and atria)
  • Ventricles: The frontal horns, third ventricle and atria of the lateral ventricles are enlarged. The frontal horns have a "butterfly" shape.
  • Sulci and fissures: The cortical sulci and sylvian fissures are widened, more so in the frontal and parietal regions. This is more than expected for a 42-year-old.
  • Midline: There is no midline shift.
  • Hemorrhage and mass: I see no acute hemorrhage, mass lesion or large territorial infarct.
  • Periventricular margins: They are not clearly blurred, so there is no obvious transependymal CSF seepage (an acute hydrocephalus sign).
  • Posterior midline dot: A small bright dot near the pineal/vein of Galen region is most likely physiological calcification or a normal vessel.
Impression Diffuse cerebral atrophy with proportionate ex-vacuo ventricular enlargement. This is premature for age. The main alternative is communicating hydrocephalus (including normal pressure hydrocephalus), where the ventricles are disproportionately large compared with the sulci.
Differential for atrophy at this age
  • Chronic alcohol use or other toxic/nutritional causes, such as B12 or thiamine deficiency
  • Early-onset neurodegenerative disease, such as frontotemporal dementia or early Alzheimer's
  • HIV-related encephalopathy
  • Prior hypoxic, traumatic or inflammatory injury
  • Chronic hydrocephalus, such as NPH or post-meningitic hydrocephalus
What would narrow it down
  • History: Cognitive decline, gait disturbance, urinary incontinence, alcohol or drug use, HIV status, seizures, and prior meningitis or head injury.
  • Imaging: Review the full stack for the temporal horns, fourth ventricle, callosal angle and the high-convexity sulci. These help separate atrophy from hydrocephalus. MRI brain (with FLAIR, and volumetrics if needed) is the next step.
  • Labs: B12, TSH, HIV, VDRL, liver function and glucose.
If you share the clinical history and the other slices, I can narrow this down.

Final diagnosis??

Most likely diagnosis: generalized cerebral atrophy (premature for age 42) with ex-vacuo ventricular enlargement.
Why
  • The ventricles are enlarged, and the cortical sulci and sylvian fissures are widened to a similar degree. This proportionate pattern points to loss of brain volume rather than obstructed or excess CSF.
  • There is no hemorrhage, mass, midline shift, large infarct or transependymal edema. That makes acute hydrocephalus and a space-occupying lesion unlikely.
What I can't confirm
  • This is a phone photo of a monitor showing one slice, with no clinical history. A final diagnosis needs the full scan and the patient's history.
  • Communicating hydrocephalus (including normal pressure hydrocephalus) is the main alternative. It would show ventricles out of proportion to the sulci, with tight high-convexity sulci. If the patient has gait disturbance, urinary incontinence and cognitive decline, check for this specifically.
Next steps to find the cause
  • Ask about alcohol use, HIV risk, nutritional deficiency, prior head injury or meningitis, and family history of early dementia.
  • Order B12, TSH, HIV, VDRL, liver function and glucose.
  • Get an MRI brain, with FLAIR and volumetric assessment if available.
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