Cerebral atrophy
Cerebral atrophy also called brain atrophy, is a common feature of many of the diseases that affect the brain. Atrophy of any tissue means loss of cells. In brain tissue, atrophy describes a loss of neurons and the connections between them. Cerebral atrophy can be generalized, which means that all of the brain has shrunk; or it can be focal, affecting only a limited area of the brain and resulting in a decrease of the functions that area of the brain controls. If the cerebral hemispheres (the two lobes of the brain that form the cerebrum) are affected, conscious thought and voluntary processes may be impaired. The pattern and rate of progression of cerebral atrophy depends on the disease involved.
Cerebral atrophy is the morphological presentation of brain parenchymal volume loss that is frequently seen on cross sectional imaging. Rather than being a primary diagnosis, it is the common endpoint for range disease processes that affect the central nervous system. Though often no identifiable cause is found, certain patterns of cerebral atrophy can be helpful in certain clinical scenarios, most notably in neurodegenerative diseases.
Brain atrophy is a common finding in the elderly population, and so there is some controversy as to when imaging changes are labeled as cerebral atrophy, rather than simply “involutional” or “age related” when the patient has normal cognition.
Cerebral atrophy causes
Diseases that cause cerebral atrophy include:
- Stroke and traumatic brain injury
- Alzheimer’s disease, Pick’s disease, and fronto-temporal dementia
- Cerebral palsy, in which lesions (damaged areas) may impair motor coordination
- Huntington’s disease, and other hereditary diseases that are associated with genetic mutations
- Leukodystrophies, such as Krabbe disease, which destroy the myelin sheath that protects axons
- Mitochondrial encephalomyopathies, such as Kearns-Sayre syndrome, which interfere with the basic functions of neurons
- Multiple sclerosis, which causes inflammation, myelin damage, and lesions in cerebral tissue
- Infectious diseases, such as encephalitis, neurosyphilis, and AIDS, in which an infectious agent or the inflammatory reaction to it destroys neurons and their axons.
The underlying pathological causes can be broadly distinguished based on whether the cerebral atrophy is focal or generalized:
Focal cerebral atrophy
- age-related
- cerebrovascular disease
- end-stage multiple sclerosis
- alcohol abuse (cerebellar vermian atrophy)
- drug abuse
- post-traumatic (diffuse axonal injury)
- post-infective (eg. meningitis)
- certain neurodegenerative diseases
- progressive supranuclear palsy
Generalized cerebral atrophy
- post-ischemic injury
- post-traumatic (hemorrhage, contusion)
- certain neurodegenerative disease
- Alzheimer dementia
- Parkinson disease
- frontotemporal dementia
- Pick disease
- Huntington disease
- corticobasal degeneration
Brain atrophy symptoms
Many diseases that cause brain atrophy are associated with dementia, seizures, and a group of language disorders called the aphasias.
Symptoms of cerebral atrophy:
- Dementia is characterized by a progressive impairment of memory and intellectual function that is severe enough to interfere with social and work skills. Memory, orientation, abstraction, ability to learn, visual-spatial perception, and higher executive functions such as planning, organizing, and sequencing may also be impaired.
- Seizures can take different forms, appearing as disorientation, repetitive movements, loss of consciousness, or convulsions.
- Aphasias are a group of disorders characterized by disturbances in speaking and understanding language. Receptive aphasia causes impaired comprehension. Expressive aphasia is reflected in odd choices of words, the use of partial phrases, disjointed clauses, and incomplete sentences.
Cerebral atrophy diagnosis
CT and MRI are equally able to demonstrate cortical atrophy, but MRI is more sensitive in detecting focal atrophic changes in the nuclei. Characteristic features include prominent cerebral sulci (i.e. cortical atrophy) and ventriculomegaly (i.e. central atrophy) without bulging of the third ventricular recesses. It can be difficult to distinguish this from the changes seen in normal pressure hydrocephalus.
Certain important patterns of cerebral atrophy that are more specific include 1:
- Severe frontal and anterior temporal lobes: Pick disease
- Head of caudate nuclei: Huntington disease
- Posterior parietal and frontal lobes: Corticobasal degeneration
- Atrophy of tectum, globus pallidus, and frontal lobes: Progressive supranuclear palsy (PSP)
- Generalized with atrophy of substantia nigra: Parkinson disease
- Severe hippocampal atrophy: Alzheimer dementia
Cerebral atrophy treatment
There is no specific treatment or cure for cerebral atrophy. Some symptoms of underlying causes can be managed and treated. Controlling blood pressure and eating a healthy, balanced diet is advised. Some research suggests that physical exercise may slow the speed of atrophy. People should also stay active mentally and socially.
Cerebral atrophy prognosis
Cerebral atrophy can affect a person’s lifespan. Some illnesses and diseases that cause cerebral atrophy are progressive, meaning the damage continues to worsen. Some individuals may eventually need supervised care either at home or in a nursing home. Disorders such as stroke can affect a person’s quality of life and lifespan.
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