Reversible cerebral atrophy: a case report and literature review

Abstract

Reversible cerebral atrophy is not a typically considered phenomenon in the clinical setting although it may be responsible for a variety of symptoms, from mild cognitive difficulty to dementia. We describe a patient with schizophrenia who was found to have reversible brain atrophy during an episode of delirium of multiple etiologies, which resolved after the delirium was treated. According to our PubMed search, these brain changes may be more common (as against popular belief) in clinical scenarios such as alcohol use [1], endogenous or exogenous steroid alterations, malnutrition—particularly in anorexia nervosa [2] and kwashiorkor [3], valproic acid use [4–6] and normal pressure hydrocephalus when treated with cerebrospinal fluid (CSF) shunting [7]. Reversible cerebral atrophy is likely underrecognized due to the fact that serial brain imaging is rarely obtained in any given patient. If a patient develops cognitive decline in the above scenarios, it may be worthwhile considering that it is due to reversible brain atrophy, especially since the treatment can be as simple as correcting the implicated etiology. Reversible cerebral atrophy has been hypothesized to be caused by fluid loss followed by fluid intake [8], dehydration [9], reversible white matter loss [10] and gray matter structural changes.