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Brain Reserve in a Case of Cognitive Resilience to Severe Leukoaraiosis

Published online by Cambridge University Press:  16 June 2020

Dana M. Szeles ,
Nicholas J. Milano ,
Hunter J. Moss ,
Maria Vittoria Spampinato ,
Jens H. Jensen  and
Andreana Benitez Open the ORCID record for Andreana Benitez [Opens in a new window]
Dana M. Szeles
Affiliation:
Department of Neurology, Medical University of South Carolina, Charleston, SC29425, USA
Nicholas J. Milano
Affiliation:
Department of Neurology, Medical University of South Carolina, Charleston, SC29425, USA
Hunter J. Moss
Affiliation:
Department of Neurosciences, Medical University of South Carolina, Charleston, SC29425, USA
Maria Vittoria Spampinato
Affiliation:
Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC29425, USA
Jens H. Jensen
Affiliation:
Department of Neurosciences, Medical University of South Carolina, Charleston, SC29425, USA Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC29425, USA
Andreana Benitez*
Affiliation:
Department of Neurology, Medical University of South Carolina, Charleston, SC29425, USA Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC29425, USA
*
*Correspondence and reprint requests to: Andreana Benitez, PhD, 96 Jonathan Lucas St, MSC 606, Charleston, SC29425, USA; Tel. +1 (843) 876-2479; E-mail: benitez@musc.edu
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Abstract

Objective:

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 magnetic resonance imaging (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.

Method:

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]).

Results:

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.

Conclusions:

This case illustrates exceptional cognitive resilience in the face of severe leukoaraiosis and the potential for advanced diffusion MRI to identify brain reserve.

Keywords

LeukoaraiosisWhite matter hyperintensitiesDiffusion MRICognitionCase studyReserve
Type
Case Report
Information
Journal of the International Neuropsychological Society , Volume 27 , Issue 1 , January 2021 , pp. 99 - 108
Copyright
Copyright © INS. Published by Cambridge University Press, 2020

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