1. < Stroke & Cerebrovascular Diseases

Prominent Perivascular Spaces in Child's Brain MRI

Posted by katiea13 @katiea13, Oct 22 12:53pm

My five-year-old son had a MRI + MRA that showed "patchy T2 Hyperintensity in the periatrial white matter as well as linear foci in the frontal and parietal subcortical regions particularly at the frontal vertex - could represent a combination of prominent perivascular spaces and/or subtle gliosis."

He's been diagnosed with ADHD and Apraxia of Speech - and when I asked the neurologist what this meant, she said it was non-specific findings and that she leans towards it being "prominent perivascular spaces" - which would indicate a host of things, but what comes up the most is - a biomarker for the start of small vessel disease, a dysfunctional glymphatic system that isn't removing toxins quickly enough out of his brain, and, generally how patients exhibiting cognitive impairment are diagnosed with Alzheimer's.

Has anyone had a diagnosis of prominent/enlarged perivascular spaces and if so, what diagnostic tools were used to identify the root cause/underlying pathology?

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Moderator
Lisa Lucier, Moderator | @lisalucier | Oct 23 9:48am

Hi, @katiea13, and welcome to Mayo Clinic Connect. As a mother, I realize this is a lot to go through with your young son.

@upnort @suzfuse46 @eclayto4 and @hnrharrison have mentioned the topic of T2 hyperintensity and may have some input on this or other findings you mentioned in your son.

What symptoms was your son exhibiting that started your journey investigating his health status?

REPLY
katiea13 | @katiea13 | Oct 23 10:22am

Hi @lisalucier, thank you for your kind words and support.

My son was diagnosed with a 'mega cisterna magna' during our 20 week ultra sound appointment, and we have since continued to keep an eye on it. It is considered a normal, isolated anatomical variant (which many folks have surprisingly, they just don't find out until they need a brain MRI!)

We had his routine Brain MRI this past week, and this time we had a new neurologist (our other one retired). While the trajectory of his mega cisterna magna is still charting normal, this time the neuroradiologist highlighted these T2 hyper intensities (noting unchanged from two years ago, so the other neuroradiologist didn't report it in the findings). When I asked our new neurologist what this could mean, it was shared more than likely they were prominent perivascular spaces and/or gliosis.

As part of this, he was diagnosed with ADHD and Apraxia of speech. Prior to the new Brain MRI test results, we trialed an ADHD stimulant (Quillivant) that over the course of three days, significantly regressed his behavior and it took him a while to return back to his 'normal' hyperactive state.

When I asked the neurologist the significance of these findings, there really wasn't much of a response or understanding as to why he has these prominent perivascular spaces and how they could be impacting his behavior or even apraxia, or if the medications we are trialing could harm him more vs. help. I know these can be biomarkers for small vessel disease, a dysfunctional glymphatic system, etc. So perhaps the slowing of his glymphatic system means he's not getting proper rest at night, causing more metabolic waste to build up in his brain, or, an indication of higher risk for stroke... or, perhaps the spaces themselves based on where they are located are the root cause of his dysregulation and apraxia. So many unknowns... but if I just knew what diagnostic tool(s) could be used to identify the underlying pathology, and the right MD to help (perhaps it's not neurology) to obtain a second opinion, I'd sleep a lot better at night on this incredibly already very hard journey.

Thanks for reading (i.e., listening), and tagging others who may have experience with this.

REPLY
1 reply
charleenboone | @charleenboone | Oct 29 4:08pm
In reply to @katiea13 "Hi @lisalucier, thank you for your kind words and support. My son was diagnosed with a..." + (show)
@katiea13

Hi @lisalucier, thank you for your kind words and support.

My son was diagnosed with a 'mega cisterna magna' during our 20 week ultra sound appointment, and we have since continued to keep an eye on it. It is considered a normal, isolated anatomical variant (which many folks have surprisingly, they just don't find out until they need a brain MRI!)

We had his routine Brain MRI this past week, and this time we had a new neurologist (our other one retired). While the trajectory of his mega cisterna magna is still charting normal, this time the neuroradiologist highlighted these T2 hyper intensities (noting unchanged from two years ago, so the other neuroradiologist didn't report it in the findings). When I asked our new neurologist what this could mean, it was shared more than likely they were prominent perivascular spaces and/or gliosis.

As part of this, he was diagnosed with ADHD and Apraxia of speech. Prior to the new Brain MRI test results, we trialed an ADHD stimulant (Quillivant) that over the course of three days, significantly regressed his behavior and it took him a while to return back to his 'normal' hyperactive state.

When I asked the neurologist the significance of these findings, there really wasn't much of a response or understanding as to why he has these prominent perivascular spaces and how they could be impacting his behavior or even apraxia, or if the medications we are trialing could harm him more vs. help. I know these can be biomarkers for small vessel disease, a dysfunctional glymphatic system, etc. So perhaps the slowing of his glymphatic system means he's not getting proper rest at night, causing more metabolic waste to build up in his brain, or, an indication of higher risk for stroke... or, perhaps the spaces themselves based on where they are located are the root cause of his dysregulation and apraxia. So many unknowns... but if I just knew what diagnostic tool(s) could be used to identify the underlying pathology, and the right MD to help (perhaps it's not neurology) to obtain a second opinion, I'd sleep a lot better at night on this incredibly already very hard journey.

Thanks for reading (i.e., listening), and tagging others who may have experience with this.

Jump to this post

Please take him to a leading children’s hospital neurologist. Don’t spin round and round. You

REPLY
1 reply
Moderator
Lisa Lucier, Moderator | @lisalucier | Oct 29 4:33pm
In reply to @charleenboone "Please take him to a leading children’s hospital neurologist. Don’t spin round and round. You" + (show)
@charleenboone

Please take him to a leading children’s hospital neurologist. Don’t spin round and round. You

Jump to this post

@charleenboone - it appears that part of your message to @katiea13 somehow got cut off midsentence. It would be good to hear/read the rest of what you planned to say.

@katiea13 - wow, all the way since your 20-week ultrasound is quite a journey with your son's brain condition. It sounds like you still have some lingering unanswered questions after your son's brain MRI and meeting with the doctor. I hope someone can answer these for you, as your questions and getting them answered are important.

You mentioned your son was diagnosed with ADHD and apraxia of speech. You also talked about trying a stimulant he didn't respond to as you'd hoped.

Have you and your doctor looked at trying another medication for ADHD? If so, what are you considering?

REPLY
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