Brain Reserve in a Case of Cognitive Resilience to Severe Leukoaraiosis.
Brain Reserve in a Case of Cognitive Resilience to Severe Leukoaraiosis.
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DOI：
10.1017/s1355617720000569
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Benitez A
中科院分区：
文献类型：
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作者：
Szeles DM;Milano NJ;Moss HJ;Spampinato MV;Jensen JH;Benitez A
脑白质疏松，或称白色物质稀疏，是老年人常见的影像学表现，被认为是血管疾病的反映。当表现严重时，调查潜在的先天性或后天性病因，提示除了神经影像学外，还应转诊进行神经心理学评估。T2加权成像是识别白色疾病的最常见MRI方法。然而，更先进的扩散MRI技术可能会提供额外的洞察机制，影响异常T2信号，特别是当临床表现与影像学结果不一致。我们提出了一个74岁的妇女严重脑白质疏松症的情况下。她接受了神经科医生、神经心理学家和风湿病学家的检查，并完成了常规（T1、T2-FLAIR）MRI、扩散张量成像（DTI）和高级单壳、高b值扩散MRI（即纤维球成像[FBI]）。发现患者几乎没有神经系统体征，无明显认知障碍，白质脑病检查阴性，干燥病抗体阳性，其白质疏松程度高度不典型。纤维束成像结果表明，完整的轴突结构，更好地解决使用FBI，而不是DTI。这个病例说明了在面对严重脑白质疏松症时的特殊认知弹性和先进的弥散MRI识别脑储备的潜力。
Leukoaraiosis, or white matter rarefaction, is a common imaging finding in aging and is presumed to reflect vascular disease. When severe in presentation, potential congenital or acquired etiologies are investigated, prompting referral for neuropsychological evaluation in addition to neuroimaging. T2-weighted imaging is the most common MRI approach to identifying white matter disease. However, more advanced diffusion MRI techniques may provide additional insight into mechanisms that influence the abnormal T2 signal, especially when clinical presentations are discrepant with imaging findings. We present a case of a 74-year-old woman with severe leukoaraoisis. She was examined by a neurologist, neuropsychologist, and rheumatologist, and completed conventional (T1, T2-FLAIR) MRI, diffusion tensor imaging (DTI), and advanced single-shell, high b-value diffusion MRI (i.e. Fiber Ball Imaging [FBI]). The patient was found to have few neurological signs, no significant cognitive impairment, a negative workup for leukoencephalopathy, and a positive antibody for Sjogren’s disease for which her degree of leukoaraiosis would be highly atypical. Tractography results indicate intact axonal architecture that was better resolved using FBI rather than DTI. This case illustrates exceptional cognitive resilience in the face of severe leukoaraiosis and the potential for advanced diffusion MRI to identify brain reserve.