From the Guidelines
Moderate cerebral atrophy and small vessel ischemic changes on a non-contrast head computed tomography (CT) scan indicate age-related brain shrinkage and damage to small blood vessels in the brain, which can be associated with conditions like mild cognitive impairment, vascular dementia, and increased stroke risk. These findings are common in older adults and can be associated with a range of symptoms, including:
- Memory problems
- Difficulty with complex tasks
- Slowed thinking
- Balance issues
- Mild mood changes These changes develop gradually over time and vary in severity from person to person. The small vessel disease suggests chronic reduced blood flow to certain brain regions, which can affect the white matter pathways that connect different parts of the brain. According to the most recent guidelines, noncontrast CT of the head is essential in the initial evaluation of stroke to exclude underlying intracranial hemorrhage (ICH) and other potential etiologies for the patient’s symptoms and to evaluate for early ischemic changes 1.
While no specific medication directly reverses these changes, managing risk factors like high blood pressure, diabetes, high cholesterol, and smoking can help slow progression 1. Regular physical exercise, cognitive stimulation, and a heart-healthy diet may also be beneficial. The use of semi-quantitative scales for routine interpretation of both MRI and CT scans, including the medial temporal lobe atrophy (MTA) scale, Fazekas scale, and global cortical atrophy (GCA), is recommended to qualify global atrophy 1.
It is essential to discuss these findings with a neurologist who can provide personalized recommendations based on your specific symptoms and medical history. A neurologist can help determine the best course of action and recommend further testing or treatment as needed. Magnetic resonance imaging (MRI) is recommended over computed tomography (CT) for its higher sensitivity to vascular lesions and some subtypes of dementia, but non-contrast CT can be used if MRI is not available 1.
From the Research
Implications of Moderate Cerebral Atrophy and Small Vessel Ischemic Changes
The implications of moderate cerebral atrophy and small vessel ischemic changes on a non-contrast head computed tomography (CT) scan are significant and can be understood through various studies.
- Cerebral small vessel diseases (SVDs) are a leading cause of age and hypertension-related stroke and dementia, and their salient features include white matter hyperintensities, small infarcts, macrohemorrhages, dilated perivascular spaces, microbleeds, and brain atrophy 2.
- Brain atrophy is increasingly evaluated in cerebral small vessel diseases, and its extent, correlates, and cognitive consequences are being studied 3.
- CT scans can be used to differentiate between Alzheimer's disease and vascular dementia, with brain atrophy on CT having a positive correlation with the degree of dementia 4.
- Small vessel disease is a disorder of cerebral microvessels and is a common cause of stroke and dementia, with the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) criteria standardizing the nomenclature for small vessel disease imaging markers 5.
- Longitudinal patterns of leukoaraiosis and brain atrophy in symptomatic small vessel disease have been studied, showing a strong correlation between the rates of white matter hyperintensity expansion and grey matter atrophy 6.
Key Findings
- Moderate cerebral atrophy and small vessel ischemic changes on a non-contrast head CT scan can indicate cerebral small vessel disease, which is a leading cause of age and hypertension-related stroke and dementia.
- Brain atrophy is a significant consequence of cerebral small vessel disease and can be correlated with cognitive alterations.
- The STRIVE criteria provide a standardized nomenclature for small vessel disease imaging markers, including white matter hyperintensities, recent small subcortical infarcts, lacunes, prominent perivascular spaces, cerebral microbleeds, superficial siderosis, cortical microinfarcts, and brain atrophy.
- Longitudinal studies have shown that the progression of white matter hyperintensities is linked to increasing rates of regional grey matter atrophy, and that grey matter atrophy is the major contributor to whole brain atrophy in symptomatic cerebral small vessel disease 2, 3, 5, 6.