Frontal Lobe Syndromes Workup

Updated: Sep 20, 2017
  • Author: Stephen L Nelson, Jr, MD, PhD, FAAP; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Workup

Laboratory Studies

Choice of blood tests depends on clinical setting.

In many cases, tests of thyroid function, B-12 level, and serology for syphilis are appropriate.

In other instances, testing for HIV or connective tissue disorders is indicated.

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Imaging Studies

CT scanning is adequate to diagnose acute bleeds and ventriculomegaly (hydrocephalus).

MRI is more sensitive and specific than CT for showing tumors, focal or diffuse atrophy, subdural hematomas, or vascular and microvascular pathology.

Many behavioral neurology specialists would obtain a deoxyglucose PET scan in patients with a clinical diagnosis of frontotemporal dementia. A pattern of decreased frontal lobe glucose utilization with preserved temporal-parietal glucose utilization would favor the diagnosis of a frontotemporal dementia. The opposite pattern is characteristic of Alzheimer disease. [16]

In one study, 18-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) was able to identify nearly half of the cases of behavioral variant of frontotemporal dementia (bvFTD) that were not detected by magnetic resonance imaging. According to the authors, high specificity of 18F-FDG-PET can enable exclusion of psychiatric and other neurodegenerative disorders. The 18F-FDG-PET study was performed in 52 patients with suspected bvFTD who lacked characteristic structural neuroimaging results. [17]

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Other Tests

Neuropsychology: Many tests are described in Physical.

EEG may be exceptionally considered if evidence of subclinical seizure activity is suspected, particularly in rapidly progressive symptomatic cases.

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Procedures

Lumbar puncture may be needed to look for signs of occult infection.

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