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Vascular dementia — SCE Neurology MCQ

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HardCognitive NeurologyVascular dementiaSCE Neurology

A 59-year-old architect develops progressive difficulty reading plans, judging distances and locating objects in clutter despite normal ocular examination. She misreaches for visually presented targets and cannot perceive more than one element of a complex scene, while episodic memory, insight and conversation remain relatively preserved. MRI shows bilateral parieto-occipital atrophy. Which underlying disease most commonly produces this syndrome?

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Correct answer: E — Alzheimer disease presenting as posterior cortical atrophy

The progressive higher-order visual syndrome—with simultanagnosia, optic ataxia, impaired spatial judgement, preserved primary vision and relatively spared early memory and language—is posterior cortical atrophy. Posterior cortical atrophy is a clinical syndrome rather than a single pathology, but Alzheimer disease is the underlying cause in the large majority. Lewy body and corticobasal pathologies can occasionally produce posterior cortical phenotypes, yet their usual accompanying features are not present. The subacute tempo of the Heidenhain variant and the stepwise or diffuse vascular pattern would also be discordant.

Reference: Practical Neurology, suspecting dementia: canaries, chameleons and zebras: https://pn.bmj.com/content/21/4/300