From the Guidelines
A head CT showing cerebrocerebellar atrophy and chronic small vessel ischemic changes indicates age-related brain shrinkage and evidence of small blood vessel damage in the brain, and management should focus on controlling vascular risk factors through lifestyle modifications and medications, as recommended by the most recent guidelines 1. These findings are common in older adults and suggest gradual deterioration of brain tissue and blood supply. The presence of cerebrocerebellar atrophy and chronic small vessel ischemic changes may explain symptoms like mild memory problems, balance issues, or gait disturbances. Some key points to consider in management include:
- Regular blood pressure monitoring with a target below 130/80 mmHg
- Cholesterol management with statins if appropriate
- Blood sugar control if diabetic
- Smoking cessation
- Regular physical activity, aiming for 150 minutes weekly
- A Mediterranean-style diet
- Cognitive stimulation through mental activities and social engagement is beneficial While these changes aren't reversible, controlling risk factors can slow progression. Regular follow-up with a neurologist is important, especially if new or worsening symptoms develop. The changes represent cumulative damage to small vessels from conditions like hypertension, diabetes, and aging, which gradually affect brain tissue and function over time, as discussed in recent studies 1. It's essential to note that imaging, such as MRI, can be used to track changes or progression of the condition over time, and radiology reports should describe covert cerebrovascular disease according to Standards for Reporting Vascular Changes on Neuroimaging (STRIVE) 1.
From the Research
Cerebrocerebellar Atrophy and Chronic Small Vessel Ischemic Changes
- Cerebrocerebellar atrophy and chronic small vessel ischemic changes are indicative of cerebral small vessel disease (CSVD), a common and progressive vascular disease affecting the brain 2, 3.
- CSVD is characterized by changes in arterioles, capillaries, and small veins supplying the white matter and deep structures of the brain, leading to stroke incidents, gait disturbances, depression, cognitive impairment, and dementia in the elderly 2.
- The disease is highly heterogeneous in neuroimaging and clinical presentation, with small subcortical infarcts, lacunes, cerebral microbleeds, cortical microinfarcts, and white matter hyperintensity of presumed vascular origin being major neuroimaging markers of small vessel disease 3.
Association with Brain Atrophy
- Brain atrophy is reduced in patients with CSVD, and a decline is detectable prospectively, with a significant association between brain volume and executive function 4.
- Frontal lobe atrophy is associated with small vessel disease in ischemic stroke patients, with subcortical ischemic changes being more associated with frontal lobe atrophy than with parietal lobe atrophy and temporal lobe atrophy 5.
Management and Treatment
- There is no causal treatment for CSVD, and management is mainly based on combating known risk factors for cardiovascular disease (CVD) 2.
- Antiplatelet therapy appears to provide persistent secondary stroke prevention in patients with lacunar stroke, with no clear benefit with dual over single antiplatelet therapy 6.