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This past weekend I went to the ER for a

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Posted on Sun, 24 Mar 2019
Question: This past weekend I went to the ER for a CT scan due to a possible ruptured aneurysm. I had a headache severe, and they've been watching a cerebral aneurysm for eight years with no changes. I had no brain bleed but the report said there is mild cerebral atrophy. Changes of periventricular
leukomalacia are noted. I had had a CT three months ago in December and this was not noted and it was actually read by the same radiologist. My doctor pulled all of my CT's including three from this last year and two from 2018 and had two other radiologist look at all the CT's. They did not feel they were any changes. Felt this was an overread, He said some people can have a small amount to atrophy at 55 but he didn't really see any, and saw no change since in the last two years. My question is would it be normal to see some mild atrophy in be a 55-year-old brain? I had a grandmother with early onset AD, my father does not have. I am worried.
doctor
Answered by Dr. Kaushal Bhavsar (1 hour later)
Brief Answer:
Thanks for your question on Ask a doctor forum.

Detailed Answer:
Thanks for your question on Ask a doctor forum.
I can understand your concern.
I have gone through the images you have attached.
No need to worry for atrophy or leucomalacia.
And at the age of 55 it is common to have mild atrophy on CT.
Don't worry for this mild atrophy on CT.
And over reporting (false positive) is very common i. It CT scans.
So don't think too much about this mild atrophy.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Kaushal Bhavsar (11 hours later)
First my doctors and all radiologist who read the new CT said they saw not changes from CT for prior two years and they would not note any atrophy, they called it an over read.
How many people would have mild atrophy on a ct at 55, like what percentage, all people? we all start to atrophy at age 40? What about the drug clonazapam? my doctor has had me on it for 25 years and now says to wean because it has been shown to cause Alzheimers, what are your thoughts on the risk with this drug?

Is it good that 4 doctors when reviewing the CT did not agree that there was atrophy they should note, they said "normal for age"? Does everyone my age have minimal atrophy and some doctors might call it and others not?
doctor
Answered by Dr. Kaushal Bhavsar (10 hours later)
Brief Answer:
Around 40-50% people will have mild atrophy at your age.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.

Answer to your 1st question.

At the age of 55 years, around 40-50% people have mild atrophy on CT scan.

Answer to your 2nd question.

Atrophy usually starts at the age of 50 not 40.

Answer to your 3rd question.

This depends on the indication of Clonazepam use in your case. So please let me know why it was started in your case.

Answer to your 4rth question.

Interobserver (interradiologist) variations are highest in CT and MRI reading. So it is quite possible to have normal CT brain from one radiologist and mild atrophy from other radiologist.

Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Kaushal Bhavsar (1 hour later)
I was put on clonozapam 25 years ago for restless legs and tremors at night, due to lupus.

SO you think if my doctor and 3 other radiologist think that this is an over read, it likely is?

Even if they saw some at 55 it would not be abnormal?
doctor
Answered by Dr. Kaushal Bhavsar (12 minutes later)
Brief Answer:
Yes, this is over read.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
Yes, it is over read.
No need to worry. It is not abnormal.
How is your rest leg syndrome now?
Is it controlled on Clonazepam?
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Kaushal Bhavsar (57 minutes later)
Yes, very well and tremors too, I am one 1 mg a night, so not a very big dose, but he is gonna have me wean due to new study about it causing AD, but I read if you are over it 90 days it increases your risk, so seems a tad late to go off now?
doctor
Answered by Dr. Kaushal Bhavsar (31 minutes later)
Brief Answer:
In my opinion, you should continue.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
In my opinion, you should continue with Clonazepam.
Don't stop or wean.
I forgot to ask why CT brain was done in your case?
Any brain symptoms?
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Kaushal Bhavsar

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This past weekend I went to the ER for a

Brief Answer: Thanks for your question on Ask a doctor forum. Detailed Answer: Thanks for your question on Ask a doctor forum. I can understand your concern. I have gone through the images you have attached. No need to worry for atrophy or leucomalacia. And at the age of 55 it is common to have mild atrophy on CT. Don't worry for this mild atrophy on CT. And over reporting (false positive) is very common i. It CT scans. So don't think too much about this mild atrophy. Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.