From the Research
Management for a patient with ex vacuo ventriculomegaly and sulcal enlargement indicating diffuse brain volume loss without mass or abnormal enhancement should focus on identifying and treating the underlying cause while managing symptoms. The primary approach involves a comprehensive neurological evaluation to determine the etiology, which may include neurodegenerative disorders, normal pressure hydrocephalus, or age-related atrophy. Key considerations in the management include:
- Cognitive assessment using standardized tools like the Mini-Mental State Examination or Montreal Cognitive Assessment to establish a baseline 1.
- If cognitive impairment is present, medications such as cholinesterase inhibitors (donepezil 5-10mg daily, rivastigmine 1.5-6mg twice daily, or galantamine 4-12mg twice daily) or memantine (starting at 5mg daily, titrating to 10mg twice daily) may be considered depending on the specific diagnosis.
- Regular follow-up with serial imaging (MRI or CT) every 6-12 months is recommended to monitor progression, as suggested by studies on ventriculomegaly and cognitive decline 2, 3.
- Supportive care addressing specific symptoms, patient education, and caregiver support are essential components of management. This approach is based on the understanding that ex vacuo ventriculomegaly represents secondary enlargement of ventricles due to loss of brain parenchyma rather than a primary ventricular process requiring direct intervention, as indicated by research on brain morphology and hydrocephalus 4, 5.