#POV
Answer: B – Huntington’s Disease.
This patient most likely has Huntington’s Disease, a genetic movement disorder that causes a host of movement and mood changes. On MRI, you’ll see wasting of the caudate nucleus (part of the brain that helps regulate movement) that leads to large ventricles (black circles in the center of the image)1. Early on, patients may show jerky, purposeless movements known as chorea (sometimes described as “dance-like”)2. Later, patients may also show cognitive decline (dementia, personality changes, and namely depression/suicidality). It’s important to keep in mind Huntington’s is both inherited and demonstrates anticipation, meaning those with the disease may show a worse degree of symptoms (and often sooner) than their parents.
In Alzheimer’s, cognitive decline is more evident later (65+), and chorea movements would not be present. You’d also see more hippocampal atrophy compared to caudate atrophy on an MRI (Answer A). Parkinson’s movement will usually have subtle tremors at rest with rigidity making it hard for those patients to stand or walk at all (Answer C).
*A note: While there are meds to help manage Huntington’s symptoms, there is no definitive treatment. These patients unfortunately have a poor prognosis, and it’s crucial to watch for signs of depression/suicidality.
References:
https://radiopaedia.org/cases/hunting...
Zoghbi HY, Orr HT. Huntington disease: Genetics and pathogenesis. UpToDate .Waltham. https://www.uptodate.com/contents/hun.... Updated March 27, 2016
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