# "Severe Cerebral Atrophy" **URL:** \ **Category:** In My Humble Opinion\ **Created:** [May 12, 2017, 5:22am UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429 "2017-05-12T05:22:41Z")\ **Posts on this page:** 15\ **Page:** 1
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [May 12, 2017, 5:22am UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/1 "2017-05-12T05:22:41Z")
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 😉 ---
**Author:** ![Merneith](https://avatars.discourse-cdn.com/v4/letter/m/57b2e6/32.png) [@Merneith](https://boards.straightdope.com/u/Merneith)\ **Post date:** [May 12, 2017, 6:39am UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/2 "2017-05-12T06:39:11Z")
**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: > **[Cerebral atrophy](https://en.wikipedia.org/wiki/Cerebral_atrophy)** > > Cerebral atrophy is a common feature of many of the diseases that affect the brain. Atrophy of any tissue means a decrement in the size of the cell, which can be due to progressive loss of cytoplasmic proteins. In brain tissue, atrophy describes a loss of neurons and the connections between them. Brain atrophy can be classified into two main categories: generalized and focal atrophy. Generalized atrophy occurs across the entire brain whereas focal atrophy affects cells in a specific locatio Some ... [https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebral-Atrophy-Information-Page](https://www.ninds.nih.gov/Disorders/All-Disorders/Cerebral-Atrophy-Information-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. > [@](#): > > 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! ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [May 12, 2017, 8:06am UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/3 "2017-05-12T08:06:57Z")
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 ---
**Author:** ![USCDiver](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/uscdiver/32/354_2.png) [@USCDiver](https://boards.straightdope.com/u/USCDiver)\ **Post date:** [May 12, 2017, 11:53am UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/4 "2017-05-12T11:53:12Z")
You’re going to have to share the whole report for us to help you understand what it means. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [May 12, 2017, 12:35pm UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/5 "2017-05-12T12:35:35Z")
> [@USCDiver](#): > > 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? ---
**Author:** ![USCDiver](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/uscdiver/32/354_2.png) [@USCDiver](https://boards.straightdope.com/u/USCDiver)\ **Post date:** [May 12, 2017, 12:42pm UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/6 "2017-05-12T12:42:33Z")
> [@DSeid](#): > > **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. ---
**Author:** ![elbows](https://avatars.discourse-cdn.com/v4/letter/e/b3f665/32.png) [@elbows](https://boards.straightdope.com/u/elbows)\ **Post date:** [May 12, 2017, 12:49pm UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/7 "2017-05-12T12:49:55Z")
It’s the word ‘severe’ that would give me pause, yipes! Wishing you Good Luck, moving forward! ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [May 12, 2017, 1:55pm UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/8 "2017-05-12T13:55:11Z")
> [@USCDiver](#): > > 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](http://boards.straightdope.com/sdmb/showthread.php?t=825990) 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](https://www.ncbi.nlm.nih.gov/pubmed/20944639). Apparently marked cerebral atrophy is correlated with kidney dysfunction even in younger adults without disability. ---
**Author:** ![MmeRose](https://avatars.discourse-cdn.com/v4/letter/m/ee7513/32.png) [@MmeRose](https://boards.straightdope.com/u/MmeRose)\ **Post date:** [May 12, 2017, 5:09pm UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/9 "2017-05-12T17:09:12Z")
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”? ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [May 12, 2017, 5:29pm UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/10 "2017-05-12T17:29:59Z")
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 > **[Radiation Dose Reporting | Department of Radiology | UC Davis Health](https://health.ucdavis.edu/radiology/RadiationDose.html)** > > California legislation requires that specific CT scanner dose metrics be included in the radiology report, for all patients undergoing diagnostic CT scans. 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 ---
**Author:** ![USCDiver](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/uscdiver/32/354_2.png) [@USCDiver](https://boards.straightdope.com/u/USCDiver)\ **Post date:** [May 12, 2017, 5:36pm UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/11 "2017-05-12T17:36:40Z")
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) ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [May 12, 2017, 5:36pm UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/12 "2017-05-12T17:36:50Z")
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. ---
**Author:** ![steatopygia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/steatopygia/32/3132_2.png) [@steatopygia](https://boards.straightdope.com/u/steatopygia)\ **Post date:** [May 12, 2017, 6:05pm UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/13 "2017-05-12T18:05:28Z")
> [@USCDiver](#): > > … > > 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](https://academic.oup.com/brain/article/133/7/2098/328543/Alterations-in-brain-structure-and-functional). Not light reading. ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [May 12, 2017, 6:51pm UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/14 "2017-05-12T18:51:57Z")
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) ---
**Author:** ![Tom\_Tildrum](https://avatars.discourse-cdn.com/v4/letter/t/e95f7d/32.png) [@Tom\_Tildrum](https://boards.straightdope.com/u/Tom_Tildrum)\ **Post date:** [May 12, 2017, 9:40pm UTC](https://boards.straightdope.com/t/severe-cerebral-atrophy/786429/15 "2017-05-12T21:40:22Z")
If it’s any comfort, I’ve also often been told that my facial region is unremarkable. 😉