Extensive Areas of Patchy Gliosis

This post is a response by a doctor to a question one of our community members asked.

DWID Asks:

I recently had an MRI of the brain, because I have been experiencing some dizziness and balance issues in the past 2 months. I am 77 years old. The concluding sentence of the MRI report reads: “Extensive patchy areas of gliosis with underlying punctate hemosiderin susceptibility most compatible with amyloid angiopathy.” I’ve looked up the medical terms, but am still confused what this means. Could you please give me a “user friendly” interpretation of these results? I am most concerned if this means I have developed Alzheimer’s disease.

Dr Alejandro’s reply:

Hello DWID,

Gliosis is a medical term that refers to a common, non-specific reactive change of glial cells (a focal proliferation or hypertrophy, meaning a multiplication of glial cells, which a type of cells in the brain, that are non-neuronal, and provide support and protection for neurons), in the central nervous system, in response to an injury (any type of damage, including ischemic [lack of blood supply], traumatic injury, infectious disorders [mostly viral infections], and neurodegenerative disorders [Alzheimer’s disease and Multiple Sclerosis]).

Hemosiderin is an iron complex found normally within cells. However, several disease processes result in deposition of larger amounts of hemosiderin in tissues. These deposits cause no symptoms, although they can lead to organ damage. Hemosiderin deposits often form after bleeding. Amyloid angiopathy is a vascular disorder caused by the accumulation of amyloid-beta (an aging related protein) in some layers of the blood vessels of the brain, which makes these vessels fragile and thereby prone to bleeding. That is why hemosiderin deposits are sometimes related to amyloid angiopathy.

The MRI findings may correlate to your symptoms. I don’t have any information about your medical history, but in the setting of Diabetes or Hypertension, or even in relation to a normal aging process, the presence of amyloid angiopathy can be related to minor brain bleeding, which can cause the symptoms you have been having (both dizziness and balance issues), if affecting specific structures in your brain (the cerebellum). This sounds more serious than it really is. It can be controlled, and no further damage is done if the risks factors (Diabetes, Hypertension, High Cholesterol) are controlled.

I strongly believe you do not have Alzheimer’s Disease, you do not have the symptoms nor the MRI finding of amyloid angiopathy are consistent with it. I suggest you have a consult with your primary care physician to have an assessment for general cardiovascular risk factors, in order to lower your risk of future brain bleeding.

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