#1
Old 05-12-2017, 12:22 AM
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"Severe Cerebral Atrophy"

This came up in a hosp test.

I understand each of the words - the questions:

What is this?

How serious?

Is it progressive?

Is it curable?

Prognosis?


Yes, I do have an apt with Int Medicine. I simply wish to get a thumbnail-sized idea of what the MD will have to say.

If you must grow old, do not look up medical test results
#2
Old 05-12-2017, 01:39 AM
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What is this?

Our brains lose mass as they age. This is normal. Some diseases or injuries can increase the normal loss, either in part or overall. See here for more info:

https://en.wikipedia.org/wiki/Cerebral_atrophy

https://ninds.nih.gov/Disorders/...formation-Page


Causes include injury, stroke or nervous system diseases. There's too many possible causes to be more specific, here, but it's serious and you'll want to follow up on it thoroughly.


How serious?

Very. You'll want to make that next appointment pronto.


Is it progressive?

Maybe, depending on the cause.


Is it curable?

Again, it depends on the cause. The brain tissue can't be replaced, as I understand it, but in some local cases, like a stroke, more damage might be prevented.


Prognosis?

Sorry - it depends. I'm not a doctor, I should stipulates. FWIW, you're here and posting quite lucidly, so there's that.


Quote:
Yes, I do have an apt with Int Medicine. I simply wish to get a thumbnail-sized idea of what the MD will have to say.

If you must grow old, do not look up medical test results
Google will scare ten years off your life. Good luck with the Doctor!
#3
Old 05-12-2017, 03:06 AM
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the tissue loss is listed as "normal for age"

No sign of stroke or other acute problem with brain - about 50 test were done - X-Ray for lungs (good), CT and MRI for cranial.

My reading is "Normal for age/sex/lifestyle" - except for this troubling item.

SDMB - apologies for the mess over in GQ - I wanted the info itemized this time, hence the GQ placement.

Merneith - thanks for the link.

Bed beckons, will dig into it tomorrow
#4
Old 05-12-2017, 06:53 AM
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You're going to have to share the whole report for us to help you understand what it means.
#5
Old 05-12-2017, 07:35 AM
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Quote:
Originally Posted by USCDiver View Post
You're going to have to share the whole report for us to help you understand what it means.
USCDiver, in general how big of a mismatches can you see between the sort of function one might reasonably expect based on an MRI report, what is daily life observable, and what would be seen on more comprehensive neuropsychological testing?
#6
Old 05-12-2017, 07:42 AM
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Quote:
Originally Posted by DSeid View Post
USCDiver, in general how big of a mismatches can you see between the sort of function one might reasonably expect based on an MRI report, what is daily life observable, and what would be seen on more comprehensive neuropsychological testing?
Certainly there are many older people walking around and functioning independently with varying degrees age related atrophy on imaging studies.

As to the question of comprehensive neuropsychological testing, I'll leave that to others with more experience. We don't really do that stuff much in the ER, y'know.
#7
Old 05-12-2017, 07:49 AM
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It's the word 'severe' that would give me pause, yipes!

Wishing you Good Luck, moving forward!
#8
Old 05-12-2017, 08:55 AM
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Quote:
Originally Posted by USCDiver View Post
Certainly there are many older people walking around and functioning independently with varying degrees age related atrophy on imaging studies.

As to the question of comprehensive neuropsychological testing, I'll leave that to others with more experience. We don't really do that stuff much in the ER, y'know.
More knowledge and experience with the population than I have!

FWIW I've occasionally seen some kids' brain MRIs comes back shocking me given how fairly well they were appearing to function and even how they had performed overall on various cognitive tests. Obviously in kids the causes are different and the outcomes dependent on both the cause, the timing developmentally, and if not global atrophy then what portion(s) are impacted and how much other portions can partially take over those functions. I'd suspect that an adult brain has relatively less plasticity. Of course though the fact I've been shocked does say something about what is more typically seen with that sort of finding.

From our op's alluded to GQ post the "severe cerebral atrophy' is "volume loss greater than indicated by age" but "unchanged from previous test". Of course below he says the report reads "normal for age" so we don't really know.

usedtobe, the report means that the thinking portions of your brain look significantly shrunken compared to both normal adults and apparently to normal adults of your age group. The potential good news is if the report does indeed say that it is unchanged from previous exam(s). That would mean that the large scale shrinkage is not rapidly getting worse. We have no idea how long you have this level of cerebral atrophy, or at least this degree more than age-matched peers. It could even be that you had cerebral atrophy all your life and never knew it.

Researching out a little (and again NOT an adult MD) my personal best guess is that it is related to your very longstanding kidney failure. Apparently marked cerebral atrophy is correlated with kidney dysfunction even in younger adults without disability.
#9
Old 05-12-2017, 12:09 PM
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I remember when the first MRI's were done (showing my age), there were images Time Magazine. One of them had large ventricles without much brain tissue. The person was a college student, math or physics major. So it doesn't always correlate.

The report doesn't make a lot of sense - unless you are very old indeed, how can "severe" atrophy be "normal for age"?
#10
Old 05-12-2017, 12:29 PM
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Yeah, "Severe" is rarely welcome in medical circles

The time-frame for "unchanged" is on the order of 2 months (must graffiti the MR/CT tunnels)

The GQ thread has a list of the tests run first day - over a dozen

Here is the cranial CT:

************************************************************
EXAM: CT HEAD WITHOUT CONTRAST

EXAM DATE: 4/21/2017 3:40 PM

COMPARISON: 02/16/2017.

INDICATION:

Altered mental status.

TECHNIQUE:

Noncontrast transaxial and reformatted sagittal and coronal images.

RADIATION DOSE:
This study involved (1) CT acquisition(s). The CTDIvol and DLP values are
included below as required by state law:

1; Series: 3; Head; 16 cm; CTDIvol=48.3 mGy; DLP 908.2 mGy-cm

Total estimated effective dose for this examination: 2.1 mSv
For further information on CT radiation dose, see
http://ucdmc.ucdavis.edu/radiolo...ationDose.html


FINDINGS:

The cranial vault, facial and skull base regions are unremarkable.

Intracranially, again seen is severe cerebral atrophy. There is no evidence
of infarct, hemorrhage, mass effect, or definitive evidence of
hydrocephalus.

CONCLUSION:

NO INTERVAL CHANGE. NO ACUTE PROCESS.

************************************************************

The interval delta is 1/16/ 2017

Mental status due to pulse of 37 (both chronic and acute anemia - lack of cerebral oxygen is an old acquaintance) Oh well...

Yeah, a long-term sickie here - medical terminology is now second-hand. Member of
WebMD

I will need to get a detailed "Medical History" on a chip such as used to track small pets - a chip reader in the ER

CKD* (kidney failure) Right kidney is atrophied and I write it off

OA (Osteoarthritis - the cartilage between bones is going - L5 is now rubbing directly on L4

Severe tolerance of CNS depressants - pain, sedation, anesthesia, sleep (hypnosis)

Lifelong insomnia - as in Sch 2 ("Good Stuff"). High school was covered by parent's beer - it was provided for the purpose.

Everybody loves irony - notice the "Tolerance" AND "Insomnia" AND "Pain" - I am on 3 pharmacy databases (and, late to the party - DEA!) I have a long list of nasty drugs which do NOT work, and a tiny list of those which do work.

Every damned (and a few blessed) MD thinks he/she has knowledge superior to mine - more drugs which do not work.

I have been prescribed Gabapentin 300 by at least 4 MD's - for bone pain. It does do a wonderful job with CKD pruritus (look this one up for yourselves, kids (snicker)).

Kidney failure says no more benzodiazepines - now the dance resumes for sleep.

Again, much gratitude to all

Last edited by usedtobe; 05-12-2017 at 12:32 PM.
#11
Old 05-12-2017, 12:36 PM
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So yeah, getting old and having a bunch of chronic medically problems has caused your brain to get smaller.
To answer your OP questions, it's only as serious as the underlying medical conditions, it is progressive (again chronic medical problems) not curable, prognosis depends on how well you control your other medical problems.

ETA: one good thing about having a shrunken brain is that you can tolerate swelling from a stroke or head injury without suffering the ill effects as severely as someone with a larger brain (There's more room for swelling before vital stuff gets pushed around)

Last edited by USCDiver; 05-12-2017 at 12:38 PM.
#12
Old 05-12-2017, 12:36 PM
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Oh - 67/68 years (b. 1949), male, midwest. Diet as fed by OH farm kids - beef and potatoes, milk (REAL milk).

I have the MR plates of rt shoulder - in and out of obscenely expensive hardware. Any "shrunken brain/hollow skull" would have been nailed years ago.
#13
Old 05-12-2017, 01:05 PM
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Quote:
Originally Posted by USCDiver View Post
...

ETA: one good thing about having a shrunken brain is that you can tolerate swelling from a stroke or head injury without suffering the ill effects as severely as someone with a larger brain (There's more room for swelling before vital stuff gets pushed around)
Way to look for the bright side.

I thought I remembered something about opioid dependence and cerebral atrophy, so I looked around. It doesn't seem to correlate greatly with generalized atrophy which I think the OP is describing, but it does strongly relate to a decrease in functional connectivity.

Article. Not light reading.
#14
Old 05-12-2017, 01:51 PM
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The doc took issue with my self-description of "old", let alone "dying".

Perhaps "aging", as in "Songs to aging children come" (thank you Joni)
#15
Old 05-12-2017, 04:40 PM
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If it's any comfort, I've also often been told that my facial region is unremarkable.


Last edited by Tom Tildrum; 05-12-2017 at 04:40 PM. Reason: Best wishes for continued health.
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