If a brain pathology is suspected, patients are prescribed magnetic resonance imaging. Often, the results of the study indicate that the patient has enlarged perivascular spaces. How dangerous is this? And what diseases can this sign indicate? We will consider these issues in the article.
What it is
Perivascular spaces are located between the walls of blood vessels and the white matter of the brain. These formations are also called cribbles or Virchow-Robin spaces. They are filled with cerebrospinal fluid and regulate the outflow of cerebrospinal fluid.
Normally, the scribbles are so small that they are not visible in the MRI image. However, there are cases when, during the examination, expanded perivascular spaces are determined. What does this diagnostic result mean? This suggests that the scribbles are visualized during an MRI scan. They look like white spots in the picture.
Causes
The expanded perivascular spaces of Robin - Virchow are not always a sign of pathology. Such a diagnostic result is also observed in completely healthy people. Most often, cribular enlargement is observed in elderly patients and is associated with age-related changes in the brain.
However, in some cases, expanded perivascular spaces may be a sign of the following diseases and conditions:
- atrophy of the brain;
- leukoaraiosis;
- cerebral ischemia (including cerebral infarction);
- disseminated encephalomyelitis.
In elderly people, the expansion of the cribules is often noted with hypertension, atherosclerosis, dementia. These pathologies are usually accompanied by memory impairment and other cognitive impairment.
Additional diagnostic methods
What to do if the MRI results indicate that you have expanded perivascular spaces of Virchow - Robin? It is necessary to show the transcript of the study to a neurologist. Only a specialist can determine whether this is a variant of the norm, an age feature or a sign of pathology.
There are cases when MRI does not reveal any changes in the brain, but the expanded perivascular spaces of Virkhov-Robin are visible in the image. What does this mean? As a rule, such a sign does not indicate pathology. Doctors consider an increase in cribbles only in combination with other changes identified during an MRI scan.
If necessary, the doctor may prescribe additional studies:
- multispiral computed tomography;
- angiography of blood vessels;
- dopplerography;
- study of cerebrospinal fluid.
Let us consider in more detail the most common diseases and conditions that can lead to the expansion of kriblyur.
Cerebral atrophy
If the patient has enlarged perivascular spaces and at the same time reduces the volume of the brain, then doctors talk about organ atrophy. Most often, this is a sign of the following diseases:
- senile dementia;
- atherosclerosis;
- Alzheimer's disease.
With these diseases, neurons die. This is accompanied by memory impairment, impaired mental activity, and mental disorders. Typically, such diseases are noted in elderly patients.
In some cases, the expanded perivascular spaces of Virchow-Robin are determined in newborn children. This may be a sign of serious genetic diseases, accompanied by the death of neurons.
How to treat such pathologies? After all, it is no longer possible to restore lost neurons. You can only slow down the process of death of nerve cells. Patients are prescribed the following drugs for symptomatic therapy:
- Nootropics: Piracetam, Cavinton, Nootropil;
- sedatives: "Phenazepam", "Phenibut";
- antidepressants: Valdoxan, Amitriptyline.
The prognosis of such pathologies is usually unfavorable, since brain atrophy and neuronal death progress.
Leukoaraiosis
Doctors call leukoaraiosis a rarefaction of the white matter of the brain. Due to structural changes in the nervous tissue in patients, perivascular spaces are enlarged. This is also a sign of diseases inherent in the elderly:
- hypertension
- atherosclerosis;
- senile dementia.
Changes in the white matter of the brain cause cognitive impairment. Patients undergo symptomatic treatment with nootropic drugs. These drugs improve the nutrition of neurons and stop their death. With atherosclerosis, statins are indicated. With high blood pressure, antihypertensive drugs are prescribed.
Ischemic conditions
With ischemia, the blood supply to the brain worsens. This is usually a consequence of atherosclerotic changes in the vessels. The patient periodically experiences dizziness, double vision, impaired coordination of movements, impaired speech and memory. Due to changes in the vessels, the spaces around their walls expand.
Patients are prescribed nootropic drugs (Piracetam, Cerebrolysin, Actovegin), as well as drugs that normalize metabolism in the brain cells (Cortexin, Ceraxon). It is very important to carry out etiotropic treatment of atherosclerosis with statins. Prescribe drugs "Lovastatin", "Atorvastatin", "Simvastatin". Such therapy eliminates the cause of ischemia.
Cerebral infarction
Often, perivascular spaces are enlarged in patients after a cerebral infarction. This disease is the result of prolonged ischemia. In some cases, cerebral infarction is asymptomatic and goes unnoticed by the patient. Its effects can only be seen in the image with an MRI scan.
It is important to remember that if a patient has risk factors (high blood pressure, atherosclerosis, diabetes mellitus), then a heart attack can recur in a severe form. To prevent a recurrence of acute ischemia, patients are prescribed antihypertensive drugs, hypoglycemic agents and blood thinners.
Disseminated encephalomyelitis
Multiple encephalomyelitis (SEM) is an acute pathology of the central nervous system. With this disease, the myelin sheath of nerve fibers is destroyed. The perivascular spaces of Virchow - Robin are enlarged due to the defeat of white and gray matter. Foci of demyelination are visible on an MRI image.
This pathology is of autoimmune origin. The clinical picture of the disease resembles the signs of multiple sclerosis. Patients have impaired gait and movement, speech disorders, dizziness, inflammation of the optic nerve.
Unlike many other demyelinating diseases, SEM is treatable. Patients are prescribed corticosteroids to suppress the autoimmune reaction:
- Prednisolone
- "Dexamethasone";
- Metipred.
After a course of therapy, 70% of patients have a full recovery. In advanced cases, the consequences of the disease may persist in patients: impaired limb sensitivity, gait disturbance, and visual impairment.
Prevention
How to prevent the above pathologies? It can be concluded that elderly patients are more susceptible to such diseases. Therefore, all people over 60 must regularly visit a neurologist and undergo an MRI scan of the brain.
It is also important to constantly monitor blood cholesterol and blood pressure. After all, diseases accompanied by pathological changes in the white matter most often develop against the background of atherosclerosis and hypertension.