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Radiology/Frontal Lobe Atrophy?

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Axial cuts
Axial cuts  
Sagital cuts
Sagital cuts  
QUESTION: Dear Dr. Mickael K.,

I am 38 years old, and am struggling with severe and debilitating treatment resistant depression for about 3 years.
My main physical symptom since this started has been a constant and unrelenting acid burning/numbing on my left frontal lobe.
This sensation is so debilitating that has me bed-bound 90%+ of the time as gives me some degree of movement and balance difficulties, partial numbness on the left side of my face and memory and cognitive confusion.

I have done a MRI scan on 2014, about 8 months after the onset of the symptoms, and the report came normal at the time.

Considering the severity of the physical symptoms in my brain, I am wondering if I have any form of frontal lobe atrophy or degenerative condition: http://www.alzheimers.net/frontal-lobe-dementia/

My layman interpretation of the exam shows the existence of a noticeable "gap" between the frontal lobes and the skull bone,
specially visible in the sagital and axial MRI cuts, suggesting that an atrophy has been taking place:

http://tinyurl.com/mri-sagital
http://tinyurl.com/mri-axial
http://tinyurl.com/mri-coronal

Do you think, that attending to my executive functioning impairment this is likely to be a case of frontal lobe atrophy?

Thank you for your help,
Best Regards,
Joao Gaspar

ANSWER: Dear Joao

This space is absolutely normal.  It does not indicate any atrophy.  

Hope this is satisfactory of an answer.

MK

---------- FOLLOW-UP ----------

Image 1
Image 1  

Image 2
Image 2  
QUESTION: Hello Dr. Michael.

Thank you for your prompt answer,
It certainly brings me some relief, but..

Still, as I couldn't find any examples online of MRIs with this spacing, and not wanting to take much of your time, I have to ask :

1) In Image 1, sagital cut, shouldn't the brain countour be like the yellow curve instead of the abrupt angle made by the 2 red straight lines?
2) In image 1, coronal cut, doesn't the "hill" in the midline suggest that some atrophy occurred on the sides?
3) In image 2, axial cut, aren't the "venous lakes" the result of incomplete gaps created during atrophy of the underlying brain mass?

Or putting it another way: Wasn't the healthy brain supposed to fill the skull without "empty volumes" inside?
How frequent would you say these spaces are, in non-elderly, mental healthy subjects?

Apologies for insisting with these questions,
Best Regards
Joao

Answer
These spaces are normal  and can vary is size between different people greatly.  The brain is surrounded by fluid so it doesn't hit the skull and get bruised.  The space is not really a space but rather fluid around the brain.  These are all normal.

Hope this helps.

MK

Radiology

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Michael K.

Expertise

Almost any kind of questions regarding any types of radiology exams, procedures, meaning of radiology reports etc...

Experience

12 year experience in the field of radiology

Organizations
American Society of Neuroradiology, Senior Member Society of Pediatric Radiology, Active Member

Publications
Radiology Seminars in pediatric neurology American Journal of Roentgenology American Journal of Neuroradiology

Education/Credentials
Board Certified in Diagnostic Radiology Additional Certificate of Qualification in Neuroradiology

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