Fig. 3

Images from three patients, highlighting some of the difficulties of differential diagnostics. The top row shows a patient with vascular dementia, but also disproportionately widened Sylvian fissures (asterisks) and compression of high-convexity sulci (arrows). The white matter changes are predominantly in deep white matter. The middle row shows another patient with a clinical diagnosis of vascular dementia. This patient has a callosal angle of 77.9°, widespread compression of high-convexity sulci (arrows) and white matter changes that are mostly periventricular. Vascular dementia and idiopathic normal pressure hydrocephalus (iNPH) can hardly be distinguished in this situation. The bottom row shows a patient with progressive supranuclear palsy with general atrophy and wide cerebrospinal fluid spaces, including the Sylvian fissures (asterisks). Parenchymal defects after previous trauma (wide arrows) clouded the neurological assessment. Although decreased mesencephalic area is a common finding in iNPH, severe atrophy (circle) would imply progressive supranuclear palsy. All three patients had 9 points on the iNPH Radscale