The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

The Importance of Neuro-Imaging in 
Patients with Symptomatic Presentation of 
Both Cortical and Subcortical Dementia 
S Chinnam, DO1*, P Patel, DO1, J Creech, DO1 

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 

*Corresponding author: Sahithi.Chinnam@utoledo.edu

Published: 05 May 2023 

A 45-year-old male presented to the emergency department with a 6 month decline in cognitive function, 
confusion, gait disturbance, dizziness, and personality change that started after release from immigration 
jail. His family initially believed that he was acting to get out of jail. However, his symptoms continued 
to worsen. Upon presentation, he was unaware of place or time, had difficulty answering questions, and 
could not follow directions. He was hypertensive, complained of nausea with episodes of non-bloody 
vomiting, and had migraines that would awaken him from sleep. Family history included the death of his 
father at a young age due to unknown causes, and an unknown mental health disorder in his mother. 
Negative urine drug screen, blood alcohol level, ammonia levels, and blood culture combined with the 
progressive nature of his memory loss and cognitive slowing originally led physicians to suspect Early 
Onset Alzheimer’s Disease. However, further neuroimaging was conducted due to unknown family 
history and possible head trauma while in jail. Imaging included a head CT that revealed nonspecific 
white matter hypodensities in the high frontal lobes. Carotid ultrasound revealed no significant plaque 
buildup. Brain MRI revealed innumerable scattered punctate foci raising suspicion for subcortical 
vascular dementia. Binswanger Disease and Cerebral Autosomal Dominant Arteriopathy with 
Subcortical Infarcts and Leukoencephalopathy (CADASIL) are both forms of subcortical vascular 
dementia that are being explored as causes for this patient's decline. 

https://dx.doi.org/10.46570/utjms.vol11-2023-694 

https://dx.doi.org/10.46570/utjms.vol11-2023-694
mailto:Sahithi.Chinnam@utoledo.edu