Could This Be True!?!?!?!?!?

The comedy gods read my blog! lol.....or they listen to everybody's opinions! Apparently this is all alleged, but if it's true, then SNL might not be sooooooo bad next season.

Horatio Sanz - OUT!

Kenan Thompson - OUT!

Chris Parnell - OUT!

Finesse Mitchell - OUT!

Tina Fey - OUT! (Left On Her Own)

Rachel Dratch - OUT! (Left On Her Own)

Maya Rudolph - Might Be Leaving On Her Own

Darrell Hammond - Working out terms of his contract!

Amy Poehler - Not The Weekend Update Lady Anymore!

Jason Sudeikis - The New Weekend Update Person?

Seth Myers - Promoted to Head Writer To Take Tina Fey's Place

Now, if they would just get rid of this Will Forte character!

Celebrity Duets

Do not watch Celebrity Duets....It is the most boring show ever. Even I don't like it! I'm going to continue to watch it, because I love bad television, but it's horrible.

Little Richard, Marie Osmond and David Foster are judges on the show. Little Richard looks scary! All of the judges are too nice. They praise the celebrities and tell them that they can sing well.............but they're soooooo bad.....

Anyway, Chris Jericho, the wrestler, was eliminated last night because he is freaking horrible! This show is soooooo bad!

You're Fired

It was reported today that Carolyn Kepcher, Donald Trump's top female assistant was fired recently. Ivanka Trump, Donald's daughter, will replace her next season. Don Trump, Jr. will fill in for "The Trumps" other assistant, George Ross, occasionally throughout the season.

"An article citing unnamed sources in Thursday's New York Post, which first reported the story, indicated Kepcher's lack of focus as a reason for the firing.

Trump had had trouble reaching her recently as she had been away on a trip to give a speech, the sources told the newspaper."

I always thought that Carolyn and George were really important players in the show. Sounds like a case of "BUT DADDY! I WANT TO BE ON TELEVISION!" I don't want to see Trump and his kids at a table yelling at people. How is that fun?

Waste No Time!

Ok, I'll make this a short one....

Remember that whole mine incident, the whole "12 miners found alive! No wait, it's only one!" fiasco?

Well, Randal McCloy, Jr. - the sole survivor of the tragic mine incident, who is still recovering from brain damage and is undergoing rehabilitation - and his wife are expecting their third child!

I guess the carbon monoxide only affected one brain! Awwwwww...Michael.....That's horrible!

Talent?

Well, okay, I'm going to start this off by saying that there is no chance that the movie "The Gaurdian" starring Kevin Costner and Ashton Kutcher is going to be good. The movie is about about two Coast Guard swimmers who rescue fishermen and boaters from dangerous ocean waters.


First of all, it stars Kevin Costner and Ashton Kutcher. Kevin Costner is the most boring actor in the world. He has only one emotion....I think he only smiles once during each movie, and I think it might just be because he's gassy.... Has this guy even been marketable since "Field of Dreams"?

Oh man, and Ashton Kutcher. I'll just give you a quote from a press conference today, where Mr. Kutcher addressed many "Coasties" to promote the movie: "When I first read the script, I thought it was all made up because I didn't think anyone got to be that cool."

Speaking of great acting, Kevin Federline will be appearing as a "menacing, arrogant teen who harasses investigators" in an episode of CSI that is tentatively set to air in October. Why does this man get a part on the most watched show on television!!!! I hope he gets to quote his song "America's Most Hated":

"But its okay, i got somethin for ya
I'm handin' out ass kickins' like diplomas
Who the first to get it?
Ya' know K Feds wit it, All that shit rappers talk about, I already did it.
I'm committed - to the game, The fames why I hustle
Lyrical exercise, workin' every muscle on the double
Chief and commanda
Hand ya ass to ya in a basket wrapped in plastic
I'm looney, All these model chicks wanna do me."

One movie I am looking forward to seeing is Jackass 2, coming out on September 22, 2006. Allegedly, Johnny Knoxville is even crazier in the second movie.

Happy Birthday!

What famous person turned "three-quarters of a century" old last Friday, August 25, 2006? Ok, I'm pretty sure that Colleen will be the only person interested in this trivia question.

What famous musician turns 48 today, Wednesday, August 29, 2006?

Birthday Answers After This!

Who said this? "You guys in New York can't get a hole in the ground fixed, and it's five years later. So let's be fair."

You guessed it! New Orleans Mayor Ray "Chocolate City" Nagin!

Finally, did you hear that Paul McCartney changed the locks on his house and has frozen his bank accounts to make it difficult for Heather Mills McCartney to spend a lot of money.... Well, allegedly she is now looking into getting a job at IHOP! Ha! Ha! Ha!

By the way....Regis Philbin is now 75 years old and still going strong!

Michael Jackson turns 48 today...Well, at least some of him does.

Cardiac Radiology For Medical students

Just an experiment, was wondering if it would be much easier for medical students to remember facts if we used illustrations to aid memory...

Gadolinium related to Nephrogenic Systemic Fibrosis?

Nephrogenic Systemic Fibrosis: Suspected Causative Role of Gadodiamide Used for Contrast-Enhanced Magnetic Resonance Imaging by Peter Marckmann et al in J Am Soc Nephrol 17: 2359-2362, 2006

"INTRODUCTION-Nephrogenic systemic fibrosis is a new, rare disease of unknown cause that affects patients with renal failure. Since 1997, a total of approximately 200 cases of nephrogenic systemic fibrosis (NSF), previously known as nephrogenic fibrosing dermopathy, have been reported worldwide. The appearance of this new and serious disease has triggered considerable interest as to possible causative factors, including newly introduced clinical practices. However, until now, the eliciting factor(s) has not been identified.

COURSE- The typical course begins with subacute swelling of distal parts of the extremities and is followed in subsequent weeks by severe skin induration and sometimes anatomic extension to involve thighs, antebrachium, and lower abdomen. The skin induration may be aggressive and associated with constant pain, muscle restlessness, and loss of skin flexibility. In some cases, NSF leads to serious physical disability, including wheelchair requirement. NSF initially was observed in and thought to affect solely the skin (thus the initial term nephrogenic fibrosing dermopathy), but more recent patient reports have demonstrated that several organs may be involved.

POSSIBLE MECHANISMS-Gadodiamide belongs to the group of extracellular contrast media that are used for MRI. It is a non–tissue-specific and nonionic low-osmolar (650 mOsm/kg) agent. Gadodiamide is almost exclusively excreted renally and therefore has a markedly prolonged half-life in patients with renal failure, including dialysis patients. The gadodiamide half-life of healthy volunteers is 1.3 h, of patients with end-stage renal failure is 34.3 h, of hemodialysis patients is 2.6 h, and of peritoneal dialysis patients is 52.7 h. It previously was considered a safe agent, even in patients with renal failure. The molecular structure of chelate-binding (diethylenetriaminepentaacetic acid-bis-methylamide) Gd is linear. Gadodiamide formulation differs from most other non–tissue-specific extracellular MRI agents by having an excess chelate (12 mg/ml). Whether this could have an impact on NSF development is not known. Alternatively, NSF could be a toxic reaction to free Gd that is liberated from gadodiamide. Free Gd is highly toxic, in particular in its ionic form (Gd3+). Gadodiamide leaves two to four times more Gd in the bone than gadoteridol in patients with normal renal function. Because of the longer half-life of contrast Gd-based media in patients with ESRD, authors speculate that Gd liberation might be causing NSF.

CONCLUSION-This study therefore reviewed all of the authors’ confirmed cases of nephrogenic systemic fibrosis with respect to clinical characteristics, gadodiamide exposure, and subsequent clinical course. It was found that all had been exposed to gadodiamide before the development of nephrogenic systemic fibrosis. The delay from exposure to first sign of the disease was 2 to 75 d (median 25 d). Odds ratio for acquiring the disease when gadodiamide exposed was 32. These findings indicate that gadodiamide plays a causative role in nephrogenic systemic fibrosis."

Good Stuff

CNN's Kyra Phillips was caught with her microphone on during a press conference given by George W. Bush on the one year anniversary of hurricane Katrina.

Here's the link to the video of the press conference. Watch it, it's only about a minute or so....It's very funny.

Wonkette.com provided a transcript of her audio....:

"Highlights: The clip starts with what sounds like ASSHOLES. Then Kyra talks about, presumably, a boy of some sort: No ego you don't understand., just a really passionate, compassionate human being. And they exist! They do exist. They're hard to find

COWORKER: Yep.

KYRA: But they are out there.

Thankfully, Mom seems to approve (good vibe)

Then, Kyra again: Of course brothers hafta be, you know, protective. [ZIP] Except for mine. I gotta be protective of him. Ugh, yeah. He's married, three kids, but his wife is just a control freak.

Then the best part:

WOMAN: Kyra
KYRA: Yeah baby
WOMAN: Your mic is on.
ANCHOR: All right, we've been listening in to..."

Radiology Grand Rounds-III

Welcome to the Third Edition of the monthly summary of the best in the Radiology Blogsosphere known as “ Radiology Grand Rounds”. Grand Rounds is an old tradition that doctors have. Once a week, they get together and talk about one case in detail. Keeping up with this tradition this Carnival of Medical Imaging has been named “Radiology Grand Rounds”. Every physician would agree that Subspecializtion is the need of the hour in medical field, hence the concept of a specialized Radiology Grand Rounds. Radiology Grand Rounds will be hosted on last Sunday of each month, the schedule and archive will be available at- Radiology Grand Rounds. I would like to thank all the contributors for this edition of Radiology Grand Rounds.

Theme For this weeks’ Radiology Grand Rounds is a Magazine, all of us medical men are used to the Scientific Radiology Periodicals so I thought "Radiology Grand Rounds" would be more entertaining if featured like a Magazine.

CASE FILES

Col(Retd) MGK Murthy from Department of Radiology, NIMHNAS Delhi has sent a very interesting MR image.

"17 yr old boy with severe headache for some weeks duration. A solitary hyperintense structure in frontoparietal region right side probably vein of tolard is noted. This is suggestive of cortical venous thrombosis and it may or may not be bright on diffusion depending on the duration. Superior Sagittal sinus is normal. No haemorrhage is seen. It needs hypercoagulable state work up and anticoagulants. It is expected to clear in about 6 weeks post treatment MRI. Any feedback about this case is welcome here- drmgkmurthy@gmail.com"

Bhavin in his site Spot Diagnosis features a Radiological Sign “The Fallen Fragment Sign”

“One of the complications of a simple bone cyst is fracture. The fracture is often transverse and one sign that is touted is the "fallen fragment sign", due to fragments of bone that are seen in the dependent portion on erect images usually in the inferior aspect of the cyst.”


Scan Man presents describes two cases of ectopic pregnancy with detailed account of their sonographic findings.Medline Plus, the online medical encyclopedia defines an ectopic pregnancy as one that occurs when a fertilized egg implants in tissue outside of the uterus, and the placenta and fetus begin to develop there. The most common site is within a fallopian tube. In a typical ectopic pregnancy, the fertilized ovum (embryo) implants in the lining of the fallopian tube. As it grows, it stretches the fallopian tube and causes pain. If it is not detected early and treated, the growing gestational sac bursts through the fallopian tube causing massive internal bleeding and hypovolemic shock. This makes ruptured ectopic the leading cause of maternal death in the first trimester of pregnancy. Ultrasound Findings- On the abdominal ultrasound, I found what looked like an organized blood clot in the rectovaginal pouch. This was confirmed on transvaginal ultrasound. There was approximately 250 to 300 cc of clotted blood in the rectovaginal pouch. Additionally, the left adnexa showed an irregular ectopic gestational sac of about 6 weeks size with a yolk sac inside.

THOUGHT PROVOKING POSTS

Sumer’s Radiology Site points to newspaper reports on harmful effects of Ultrasound on mice brain and asks-Is Medical Imaging entirely safe?

This is somehing i read in the newspaper today morning!! I hope Tom Cruise read this too, although ultrasound is a very safe investigation too much of everything can be harmful...This study should discourage recreational ultrasound use...Ultrasound affects brain in foetus
"Ultrasound disrupts the brain development of unborn mice, researchers said in a study published on Monday that adds to growing evidence that too many ultrasound scans could also affect human foetuses. Prolonged ultrasound scans of the brains of fetal mice interfered with a process known as neuronal migration in which neurons move from one place to another, the team at Yale University in Connecticut reported.


Tales from The womb points to an article in Last week's New England Journal had a very fine manuscript demonstrating that MRI is now the best method of predicting neurodevelopmental insult in premature infants. Neonatal MRI to Predict Neurodevelopmental Outcomes in Preterm Infants.
“Fortunately or unfortunately, this has the possibility of replacing cranial ultrasound overnight as the discharge screen of choice for determining the type of developmental follow up premature infants need. Ultrasounds cost hundreds of dollars; MRIs cost triple to quadruple as much. On the one hand, if it allows us to focus diminishing out-patient resources on the ones who need it most - fantastic. On the other, if we are paying out more to screen all these infants (and remember that one in every eight infants is born premature) then just what kind of cost savings do we think we'll get out of this (versus sending a few more patients to out patient followup visits and doing serial developmental exams)?”

Scan Man Points to an extremely useful article by Dr. John R. Wilcox, M.D., titled ‘The Written Radiology Report‘ in the July edition of Applied Radiology Online. The purpose of the article is to help radiologists improve the quality of their written radiology reports by reviewing the components of a report, addressing grammar and writing style, and considering appropriate standardization.
“Part of the problem with radiology reports arises because we do not really understand how important this document has become to the nonradiologist caregiver. This lapse is more understandable when you realize that most major radiology textbooks do not address the subject of report composition. This would be equivalent to a journalism textbook without a chapter on how to write an article. But journalism and radiology have a lot in common. Both professions require spending a great deal of time gathering “facts” and “data” and then reporting that material in written form for a reader.”

Marian Pop sends us a story on a case of suspected Battered baby. Full story in Romanian is here. English translation-

"Ancuta is 1.3 years old.She is scared and stressed, especially because she doesn't know what'sgoing to happen to her.She's in for a shoulder radiography. And she doesn't want to stay there byherself. And if anyone touches her, she starts crying.Actually her name is not Ancuta. I call her that way because today names doesn't matter.When we have to "make a photo" of a small child the mother or the otherparent enters with her, receive an leaded coat and try to hold the childstill for a second, just enough for us to shoot. Otherwise we'll just irradiate the child and mother for no reason.Ancuta doesn't want to stay. Neither stories nor games won't make her staystill. When she's about to lye down she starts crying and try to get up.The mother can't hold her still.One of the nurses gets into the X-ray room. He's in the early 30's andhe's done this times and again. He ain't scared of 3 more gamma rays. Ihope. He enters and helps the mother to hold the child still. And togetherthey hardly make her stay still.Quick- exposure. And in the exact moment we exposed everyone moves, makingour efforts in vain. We caught just a small part of the humerus and thenurse's hand. We must repeat it, there's no other way. And all this whileAncuta cries her heart out, the mother is already on the edge of breaking"what are you doing to my child...?" and everyone is tensed.30 seconds later we see the image- mistery solved: clavicle fracture, witha humerus dislocation. We stay and look at the monitor with an absentmind.For a while before my eyes pass all the Caffey pages regarding the XTrauma syndrome (or how is it's name). Battered child syndrome. I'm scaredand ashamed to look in mother's eyes. I don't know what to say. Did shefell? Did she hit into something? Is it an too energetic child and someonetried an "correction"?I don't have the time to ask. Ancuta has calmed down, the mother take herout on the corridor and leaves towards the referring physician. We sendthe images thought the internal network. The next patient is alreadyundressed and positioned. In 5 minutes everything will become history..I get up and light a cigarette. I know, they're bad for my health, butthey calm me.I'm still moved by what i just saw. Maybe there will be a socialinvestigation, maybe everything was just in my imagination.I throw the cigarette, I'm already late. The patients are waiting.But, still...., how will Ancuta sleep tonight?"

INFORMATION FILES

Jon Mikel of Unbounded Medicine presents a patient handout of NEC ( Necrotizing enterociloitis) with a classic abdominal plain film. Radiographic findings in NEC-Marked abdominal distention, dilated loops, pneumatosis intestinalis (bubbles of gas in bowel’s wall) and/or free intraabdominal air.


UNUSUAL RADIOLOGY

Mikhail Serebrennik of Filmjacket.com presents an abdominal Radiograph of a 58 y.o. mentally challenged female with abdominal pain.

The Radiographs and CT images are must see, it shows needles, needles and needles everywhere!!



This one is must watch for all, this post by dogscatskidslife showing an usual finding in a Cat’s Ultrasound.
“A 2 1/2 year old neutered male cat was sent to us for an ultrasound a while back. The doctor who sent it said that the cat had FLUTD (feline lower urinary tract disease). He had been treating this cat for many months and didn't feel like any progress was being made. So he was wanting an ultrasound to see if there could be stones in the bladder that were not showing up on radiographs (x-rays).I did a complete ultrasound on the cat which was normal, until I got to the urinary bladder. I had located a foreign body that was linear in appearance. "What is that?"After a few minutes, I had determined that I had found a urinary catheter inside of the cat's bladder.”

RADIOLOGICAL QUIZ

Aleksandr Kavokin MD, PhD of RDoctor Medical Portal presents a RADIOLOGY QUIZ. So, click here to-
Test your knowledge of Radiology.


Mikhail Serebrennik of Filmjacket.com presents a 57 y.o. male, no history provided. Can you make a diagnosis?



That wraps up this month's highlights of the Radiology blogosphere. Hope the readers enjoyed the third edition of the Radiology Grand Rounds. If you liked any of these blogs, keep visiting them. Please email me at sumerdoc@yahoo.com if you are interested in hosting future Radiology Grand Rounds. Archive for the Radiology Grand Rounds here-Radiology Grand Rounds.
For More updates on Radiology Grand Rounds A new discussion Group
has been created here, send me a mail to be invited to the group.
Group name: Radiology Grand Rounds
Group home page: http://groups.google.co.in/group/radgrandrounds
Group email address radgrandrounds@googlegroups.comBe sure to tune in Next Month Last Sunday 24th September, when Grand Rounds
will be hosted at- ScanMan’s Notes A site by an Indian Radiologist. Send the Submissions to-
dr.scanman@yahoo.co.in

A Slice of Daily Life in Farmer's Cubao

Kindly click on the picture to enlarge the image. Canon 350D 50mm F2.8 1/13s Aperture Priority, ISO 100.

Subependymoma

Findings


Noncontrast CT images show dilation of the lateral ventricles (Figure 1 and Figure 3) secondary to a large hypodense heterogeneous mass within the right lateral ventricle (Figure 2).
MRI brain with and without contrast. Images show a heterogeneous mass in the right lateral ventricle that causes obstruction of the foramen of Monroe and mild hydrocephalus. The mass is isointense to gray matter on T1 sequences (Figure 6), hyperintense on T2 (Figure 4), shows little if any enhancement on post contrast T1 (Figure 7), and is hyperintense with multiple cystic spaces on FLAIR images (Figure 5).

Differential diagnoses: Intraventricular tumors
- Meningioma
- Choroid plexus papilloma or carcinoma
- Ependymoma
- Subependymoma
- Central neurocytoma
- Metastasis
- Subependymal giant cell astrocytoma


Diagnosis: Subependymoma


Subependymomas are benign intraventricular tumors that arise from cells of the subependymal plate, including subependymal glia, astrocytes and ependymal cells. They are rare, accounting for less than 1% of all intracranial neoplasms. They can occur with ependymomas, which can worsen prognosis. They occur in either the lateral or fourth ventricles, being attached to either septum pellucidum or wall of lateral ventricle, or the ventricular floor, respectively. The larger the lesion, the more likely cystic change and calcification are encountered; however, the calcification is more often punctate and fine rather than coarse, as seen in other intraventricular tumors. Mean age of presentation is 60 years in asymptomatic patients, but only 40 years if symptomatic. There is a male predominance. Surgical resection is often curative, although fourth ventricular subependymomas pose a challenge at total resection.

On CT, an iso- to hypodense intraventricular mass will be seen with cystic change and calcification in larger lesions, and associated hydrocephalus if obstructing. Mild to no enhancement after contrast is typical. On MR, subependymomas are T2/FLAIR hyperintense and T1 isointense with mild to no enhancement with contrast. Because fourth ventricular subependymomas can have calcification and contrast enhancement more typical of ependymomas, diagnostic imaging is more challenging.

Another diagnostic challenge on imaging is the central neurocytoma, a recently described tumor that was routinely mistaken for an intraventricular oligodendroglioma on histologic analysis. These intraventricular tumors have a striking resemblance to a subependymoma on CT and MR images. Neurocytomas, however, more reliably enhance after contrast administration, and have a more heterogeneous cystic appearance. They also are usually found in younger patients.

MVEMJSNU

Here's an interesting question....I've been thinking about the television "Saved By The Bell" recently, and I ran across this tid bit of information. On "Saved By The Bell", who achieved the highest SAT score? Was it Screech Powers? Zack Morris? Kelly Kapowski? Lisa Turtle? AC Slater? Jessie Spano?

Here's another fun question....What does AC stand for in AC Slater? By the way, AC Slater does rank very high in my Mullet Masterpiece poll.

Albert Clifford

Somewhere Clyde Tombaugh (the guy who discovered Pluto) is rolling over in his grave. Pluto, the only planet to be discovered by an American and the only planet discovered in the 20th century, has been demoted...and then there were eight.


Here are the SAT scores of our favorite high school kids. That's right! Zack Morris is smarter than you!

1. Zack (1502)
2. Screech (1220)
3. Jessie (1205)
4. Lisa (1140)
5. Kelly (1100)
6. Slater (1050)

Survivor

I have never been a huge fan of the show "Survivor", but now I think I may have to watch it this season... There's going to be a new mix of contestants that are going to be put on teams according to their RACE! Yes!

Blacks vs. Whites vs. Asians vs. Latinos!

Are you a racist if you pick one team as your favorite?

You know what would be great! If they played on all the racial stereotypes.....And I wonder what kind of challenges they are going to have.....I hope there are no math test challenges, because the Asians would kick everyone's ass in that challenge. It's ok though, all of the other teams would make up round in the driving challenge! Come on guys, they're just stereotypes....laugh out loud....it's ok....it's good for your heart.

Ok fine.....since I'm expecting backlash from you oversensitive people......They should have a competition to see who's the best at watching cars drive around an oval for five hours!

And you know what's more fun! The contestants include heavy-metal guitarist, a female police officer who has been shot in the line of duty, a Vietnam War refugee who manages a nail salon and a gay fashion director for a denim company!!!!!!!

Oh man, the more and more I think about this.....pitting races against each other on one of the more watched shows in television history......this can't be good....

Interesting Information

He's previously worked as a coffin polisher and a milkman. In 1953, he finished third in his division in the Mr. Universe pageant. He turned down the role of Gandalf in "The Lord of The Rings" trilogy because he couldn't understand the novels and didn't want to film in New Zealand for 18 months. Here's the biggest hint: He once to Barbara Walters in an interview that it was "ok to hit a woman if they deserved it or needed it to keep them in line". He became one of the most famous actors in the world.....Who is the man in the white speedo? Answer after this.

I was looking at news stories this morning, and being the father of a one-year old, I naturally gravitated toward the story about Elmo. The headline read: "Elmo is a Brother!" I was thinking that a new character is going to be joining Sesame Street, Elmo is going to get a baby brother. Nope.... Elmo is voiced by a black guy. Now read the headline again...."Elmo is a Brother!" Oh!!!!!!! A brother!

Speaking of brothers. If you didn't see Kevin Federline's performance on Sunday. Here are some lyrics from his mad rhymes.

"Let me take you back to five o'clock, when I roll my Lamborghini down the block.

But not before I make them chop the top, and throw some 22's. Oh, that's hot.

As I roll to a restaurant for a bite to eat, no tuxedo 'cause they recognize me.

A lifestyle of rich living and fast cars, don't hate me 'cause I'm a superstar."

Ok, I know you are all biting your nails and dying to know the identity of that muscled man pictured above. The gentleman is Sir Sean Connery. Seven-time James Bond and Indiana Jones' Father.

Pick's disease

Findings

Figure 1, Figure 2, Figure 3, and Figure 4: MR images demonstrate marked atrophy involving the frontal and temporal lobes on T1, T2, and FLAIR.
Figure 5: Selected axial SPECT images after the intravenous administration of Tc-99m Neurolite demonstrate decreased uptake in the frontal and temporal lobes, right slightly greater that left.


Diagnosis: Pick's disease


Pick's disease is described as a rare, progressive, degenerative disease, mostly involving the frontal and temporal lobes. This was first described by Arnold Pick in 1892. It is not thought to be inherited. Women are more affected than men. There is no cure.

This disease is more common in a younger age group (40 to 60) with an average of 54. Alzheimer's disease would be more likely in older patients, over 70.

Behavioral and physical changes include repetitive or compulsive behaviors, mood changes, apathy, echolalia, aphasia, apraxia, rigidity, and a multitude of other behaviors that range from not speaking or moving to rapid pacing. It will always progress to a vegetative state.

MRI will demonstrate atrophy of the frontal and temporal lobes with preservation of the pre- and postcentral gyrus on all sequences. There is no abnormal enhancement associated with this disease.

SPECT imaging will demonstrate decreased radiotracer uptake in the frontal and temporal lobes.

Histologic evaluation, which is usually postmortem, demonstrates a "ballooned" appearance of the neurons related to swelling. These are called Pick bodies. This is different than Alzheimer's type dementia, which demonstrates amyloid plaques and neurofibrillary tangles. In multi-infarct dementia, there is myelin and axonal loss with associated astrocytosis and generalized necrosis.