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Case 351.

Surrin Shazam Deen1, Bobak Khalili2, Kapil Semalti1

  • 1Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612.

Radiology
|June 30, 2026
PubMed
Summary
This summary is machine-generated.

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A 76-year-old man experienced progressive confusion, falls, and incontinence. Advanced imaging revealed a rare cerebrovascular condition, highlighting the importance of comprehensive diagnostic workups for neurological decline.

Area of Science:

  • Neurology
  • Radiology
  • Vascular Medicine

Background:

  • A 76-year-old male with diabetes, hypertension, and dilated cardiomyopathy presented with subacute onset of confusion, falls, and urinary incontinence.
  • Symptoms progressed over 3-4 months, worsening significantly in the 2 weeks prior to presentation, with new memory lapses and functional cognitive deficits.

Purpose of the Study:

  • To investigate the cause of rapidly progressive neurological decline in an elderly patient with multiple comorbidities.
  • To illustrate the diagnostic challenges and imaging findings associated with rare cerebrovascular pathologies.

Main Methods:

  • Initial evaluation included noncontrast head CT, followed by multiphasic CT angiography with parenchymal phase imaging.
  • Serial noncontrast CT scans and noncontrast MRI of the brain were performed due to symptom worsening.

Related Experiment Videos

  • Digital subtraction angiography with selective carotid artery injections was utilized for definitive vascular assessment.

    • Main Results:

    • Initial CT scans were unremarkable for acute intracranial processes, prompting further vascular imaging.
    • Despite normal initial laboratory findings and neurological examination, the patient developed seizure episodes and increased drowsiness.
    • Advanced imaging, including digital subtraction angiography, was crucial in identifying the underlying cerebrovascular abnormality.

    Conclusions:

    • This case underscores the importance of considering rare cerebrovascular diseases in the differential diagnosis of acute or subacute neurological deterioration, especially in patients with cardiovascular risk factors.
    • Multimodal imaging, progressing from CT to MRI and angiography, is essential for accurate diagnosis and management planning.
    • Prompt recognition and diagnosis of such conditions are critical for appropriate therapeutic interventions and patient outcomes.