Cerebral Atrophy: Difference between revisions


Cerebral atrophy or Brain atrophy is a condition associated with a reduction of cerebrum volume by loss of neurons and their connections so it might seem like it’s a common feature of brain diseases .[1]

Brain atrophy is common in elderly due to aging process; known as senile degeneration. However, brain atrophy can also be observed in the pediatric age group, where it carries forward the small volume of the brain into middle age. It is important to note that some atrophic changes may be reversed during childhood.

In the normal aging, brain atrophy tends to be accelerated by the presence of other risk factors such as high blood pressure, cardiac disease, diabetes mellitus, smoking practice, and regular alcohol intake. It’s been observed that glycated hemoglobin (HbA1c) was the most significant risk factor for accelerating of brain atrophy, which is average blood sugar levels over a period of weeks/months.

Cerebral atrophy is classified into two categories. According to the affected brain area, it’s global and focal. And according to volume loss distributed zone, it’s central or cortical.

In central atrophy, it’s found that white matter volume loss is more than grey matter, and the opposite is seen in cortical atrophy.

There’s also brain hemiatrophy in which volume loss involves one hemisphere.

There are many factors cause atrophy;[1]

  • Aging
  • Infections of central nervous system (CNS)
  • Nutritional deficiency
  • Metabolic and endocrine causes
  • Traumatic causes
  • Drug induced brain atrophy
  • Radiation induced brain atrophy
  • Increased intracranial pressure
  • Perinatal and birth injury induced atrophy
  • Neurodegenerative diseases causing brain atrophy
  • Other causes

There are various clinical features of cerebral atrophy like poor levels of intelligence especially in growing children. Memory loss is common among elderly individuals. Elderly patients with brain atrophy often experience acute confusional state.

Brain atrophy can result in loss of functional recovery following an infarct, which may also lead to death due to poor brain functioning.

Brain atrophy does not always occur in isolation; unlike some other conditions such as leukoaraiosis and stroke are known to accompany brain atrophy.[1]

Some conditions that featured with cerebral atrophy are; Alzheimer’s disease, Cerebral Palsy , Multiple sclerosis, Epilepsy, Pick’s Disease, Dementia, ALS, Prion disease, Encephalitis, AIDS, Neurosyphilis.

The features appear in imaging may include the following;

  • Widening of cortical sulci
  • Enlargement of ventricles
  • Thinning of cortex
  • Shrinking of hippocampus

Brain CT with different atrophy grades. Medial temporal lobe atrophy (MTA) – Posterior atrophy (PA) – Frontal cortical atrophy (fGCA)

As we mentioned before, cerebral atrophy can be a feature for many conditions, although, There isn’t no cure for cerebral atrophy. However, it can de treated according to the condition itself.

For example, in the case of acute ischemic stroke (AIS), Endovascular therapy (EVT), which is a minimally invasive surgical procedure to remove a blood clot from an artery -thrombectomy- [2], benefit is well-known for AIS and it’s larger in the higher range of atrophy compared to the lower one [3].

Although there is no cure for cerebral atrophy, Studies show good outcome in nutritional related brain atrophy especially that related to protein-energy and vitamin related malnutrition. The use of vitamin B12 has shown significant improvement from brain volume loss especially in children.[1]

Table 1 shows Brain atrophy types and their clinical implication.[1]

Brain atrophy type Common differential determinants Clinical presentation Current treatment options
Global brain atrophy Advanced form degenerative atrophy

Infection such as encephalitis
Malnutrition

Headache

Tremors
Loss of memory
Convulsions
Dizziness
Vertigo

-Treatment of offending cause (eg HIV)

-Mainly supportive
-Nutritional supplements involving Vitamin B1, B12 and proteins

Focal brain atrophy Head trauma

Localized space occupying lesion
Stroke or ischemia

Headache

Convulsions
One side body weakness

-Treatment of offending cause

-Mainly supportive involving anticonvulsant drugs.
-Neurofeedback stimulation

Central brain atrophy Previous hydrocephalus

Multiple sclerosis
Malnutrition

Headache

Tremors

-Treatment of offending cause (eg hydrocephalus)

-Mainly supportive
-Nutritional supplements involving Vitamin B1, B12 and proteins

Cortical brain atrophy Degenerative age related atrophy

HIV encephalitis
Hypoxic ischemic encephalopathy
Malnutrition

Headache

Tremors
Loss of memory

-Treatment of offending cause

-Mainly supportive care.
-Nutritional supplements involving Vitamin B1, B12 and proteins

Brain hemiatrophy Sturge Weber syndrome

Dyke-Davidoff Mason’s syndrome
Tuberous sclerosis
Stroke or ischemia

Headache

One side body weakness
Convulsions

-Mainly supportive involving anticonvulsant drugs
  1. 1.0 1.1 1.2 1.3 1.4 Sungura R, Onyambu C, Mpolya E, Sauli E, Vianney JM. The extended scope of neuroimaging and prospects in brain atrophy mitigation: a systematic review. Interdisciplinary Neurosurgery. 2021 Mar 1;23:100875.
  2. Ansari J, Triay R, Kandregula S, Adeeb N, Cuellar H, Sharma P. Endovascular intervention in acute ischemic stroke: history and evolution. Biomedicines. 2022 Feb 10;10(2):418.

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  3. Luijten SP, Compagne KC, van Es AC, Roos YB, Majoie CB, van Oostenbrugge RJ, van Zwam WH, Dippel DW, Wolters FJ, van der Lugt A, Bos D. Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial. International journal of stroke. 2022 Oct;17(8):881-8.

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