Detection of intracranial bleeding by 99mTc sulfur colloid scintigraphy.

In her article in the May/June 1984 issue of AJNR, Dr. LeMay [1] provides a comprehensive review of the computed tomographic (CT), pneumoencephalographic , and radiographic changes of the brain and skull as seen in the aging population. She concludes that further understanding of the involutionary changes in the brain may require other, more sensitive methods of investigation than are now available . One cannot disagree with that. One can disagree, however, with the statement that "regression of the brain with aging is a normal process" [1]. While she may be using normal in the sense defined by Webster's New Collegiate Dictionary (ninth edition), "as occurring naturally, " I prefer to use the word common, "occurring or appearing frequently. " To state that regression of the brain is a normal process may mislead students and scientists alike to think that large ventricles are a normal finding ; thus , they may cease trying to understand the aging process. Such a statement is tantamount to saying that atherosclerosis is a normal process simply because it is seen so often on chest radiographs. On the other hand, if one takes the position that involutionary changes in the brain are common but abnormal , the continued exploration of the causes of this phenomenon is given due importance. There are quite a few "aged" persons, some as old as 80, whose ventricles and sulci on CT resemble those of a 25or 30-year-old . A subjective evaluation of some of these patients suggests that they may be mentally sharper than age-matched patients with enlarged ventricles . I may be nit-picking, but I maintain that this has some conceptual importance.