Two common types of brain atrophy

1 Geriatric cerebral atrophy

1.
Clinical overview

The enlargement of the ventricles and subarachnoid space secondary to the shrinkage of brain tissue is called brain atrophy, and the gray matter of the brain can begin to atrophy from the age of 20~50, and the degree of brain atrophy in the elderly greater than 65 years old is related to dementia and wirelessness; Cerebral atrophy includes diffuse cerebral atrophy (including cortical atrophy, cerebellar atrophy and cortical, cerebellum, brainstem atrophy) and localized brain atrophy (more common after localized brain organic lesions, such as trauma, vascular disease, intracranial localized infection, etc.
); Clinical manifestations can be divided into two categories: brain function decline and dementia and other mental decline, mainly manifested as memory loss, emotional instability, thinking ability decline, attention loss, severe development into dementia, and finally intellectual loss as its clinical characteristics
.
It is mainly related to
the location and degree of brain atrophy.

2.
CT performance

Normal elderly people have mild diffuse brain atrophy, a small number of people brain atrophy degree up to moderate, CT examination can see the ventricle, cistern slight enlargement and slight widening of the sulci, the width of the sulci is generally greater than 5mm, symmetrical on both sides, to the frontal lobe and parasickle parietal lobe of the brain is more obvious, can be accompanied by the anterior part of the cerebral hemisphere longitudinal fissure and the subarachnoid space around the cerebellar tonsils enlargement, ventricular enlargement to the anterior and lower horn of the lateral ventricle and the third ventricle more obvious
.

3.
Hazards

(1) Language barrier
.
Everyone may find the right word at a time, but often replace it with another appropriate word
.
Patients with senile brain atrophy often forget some words, or combine incoherent words irrationally, which is puzzling
.

(2) Loss
of time and orientation ability.
It is normal
to temporarily forget what day it is or to get disoriented.
But senile patients with cerebral atrophy can get lost in their doorstep or get lost in familiar department stores, and at the same time, they don't remember where they are now, how they got here, and how they got back to their original places
.

(3) The ability to think and summarize is extremely reduced
.
People who can usually deal with digital problems normally sometimes have no clue because things are more complicated, but they usually find a solution
that works.
Patients with senile brain atrophy not only forget the numbers, but also forget the use
of these numbers.

(4) Judgment is significantly reduced
.
When people get too involved in an activity, they may temporarily forget some other things, such as taking care of the children in time, but remember it
later.
Patients with senile brain atrophy will completely forget the child they are taking care of, go out alone for a long time, and cannot remember that the child needs to be taken care of
.

4.
Differential diagnosis

(1) Post-infarction cerebral atrophy: In addition to showing the general manifestations of localized cerebral atrophy, CT images often locate in areas prone to infarction, and the distribution is consistent with the large vascular innervation area in the brain, and old infarcts are
often seen in the atrophic area or adnexal brain tissue.

(2) Cerebral hemisphere atrophy: due to large-scale infarction caused by cerebral vascular occlusion in the fetal or neonatal period, CT shows that almost the entire cerebral hemisphere has atrophy, and may be accompanied by abnormal changes
such as thickening of the skull on the sick side, narrow cranial cavity, and displacement of the healthy ventricle to the sick side.

2 cerebellar atrophy

1.
Clinical overview

Cerebellar atrophy is a neuroimaging manifestation (non-disease) that can be divided into primary and secondary categories; Primary cerebellar atrophy can be seen in Friedreich ataxia, hereditary ataxia with muscular atrophy, hereditary cerebellar ataxia, olive pontine cerebellar atrophy, cerebellar olive degeneration, olive-like pontine atrophy, Joesph disease and other diseases; Secondary cerebellar atrophy is seen in normal older people, phenytoin, and alcoholism
.
Since the cerebellum is mainly involved in the regulation of somatic balance and muscle tone, patients with cerebellar atrophy often have symptoms
such as gait instability, ataxia, and slurred speech.

2.
Clinical manifestations

(1) Ataxia

Ataxia is the main clinical manifestation
of cerebellar atrophy.
Patients are unstable, shaky, and have difficulty standing on one leg, and generally cannot stand on one leg; The gait is staggering, the legs are far apart when walking, swaying from side to side, and the upper limbs are flexed and stretched forward as if they are about to fall; Poor distance recognition, easy to exceed the target, the closer to the target the more obvious the tremor, trembling when writing, irregular handwriting, writing is getting bigger and bigger
.

(2) Cerebellar dysarthria

Poetic language, manifested as slow speech, rambling, monotonous, nasal sounds
.
It is caused by
muscle ataxia of the speech organs such as the lips, tongue, throat, etc.

(3) Eye movement disorders

Patients with early cerebellar atrophy may present with convergence disorders and extraocular muscle movement disorders
.
There may be gross tremor in both eyes, and a small number of patients can see jumping nystagmus and rebound nystagmus.

(4) Decreased muscle tone

Occurs mainly in acute cerebellar hemispheric lesions and is less common
in chronic lesions.
However, in some cases of cerebellar atrophy, progressive generalized muscle strength may be seen, which may mimic tremor paralysis
.

(5) Non-sports performance

These include cognitive and language dysfunction, with some evidence linking cerebellum to psychiatric disorders, including schizophrenia, bipolar disorder, and addictive
behaviors.

2.
CT performance

The basal cistern of the brain expands, the transverse diameter, anteroposterior diameter of the fourth ventricle and its ratio to the transverse diameter increase, the cerebellar hemisphere and vermic sulci widen and deepen, and the subarachnoid space of the occipital large cistern and cerebellar hemisphere expands
.

3.
Cerebellar atrophy caused by different causes can have their own characteristics:

In hereditary ataxia, Marie's ataxia cerebellar atrophies, mainly involving the cerebellar cortex, while white matter is mildly affected, olive atrophy can be seen, but the pons is normal; Olive pontine cerebellar atrophy shows significant atrophy of the cerebellum, basal base of the pons and medullary olive, but the deep nucleus of the cerebellum, pons cover, and lower cerebellum are not affected
.