Swiss Cheese Striatum: Clinical Implications | Cerebrovascular Disease | JAMA Neurology | JAMA Network
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Original Investigation
June 2014

Swiss Cheese Striatum: Clinical Implications

Author Affiliations
  • 1Division of Movement Disorders, Department of Neurology, Mayo Clinic, Rochester, Minnesota
  • 2Department of Radiology, Mayo Clinic, Rochester, Minnesota
JAMA Neurol. 2014;71(6):735-741. doi:10.1001/jamaneurol.2014.286

Importance  Markedly enlarged Virchow-Robin spaces throughout the striatum appear occasionally on magnetic resonance imaging (MRI) scans of the elderly, and this type of striatum is known as the Swiss cheese striatum (SCS); however, its clinical impact is unknown.

Objective  To determine the clinical features associated with SCS detected on MRI scans.

Design, Setting, and Participants  A blinded, retrospective case-control study using medical records from 2000 to 2007 obtained from an MRI database at the Mayo Clinic in Rochester, Minnesota, of residents 40 years of age or older of Olmsted County, Minnesota, who had extensive Mayo Clinic medical records and MRI reports suggestive of SCS. Cases with a severe form of SCS (n = 27) were randomly selected for comparison with age-, sex-, and examination year–matched controls (n = 52) with a minimal form of SCS or no SCS.

Exposure  Magnetic resonance imaging.

Main Outcomes and Measures  Associations of clinical and imaging features with the presence of a severe form of SCS. Medical records were reviewed for clinical features such as parkinsonism, dementia, and vascular risk factors. The MRI scans were visually scored for degree of leukoaraiosis, central atrophy, and cortical atrophy.

Results  No significant differences were found between those with a severe form of SCS and controls in rates of parkinsonism (19% vs 17%; odds ratio, 1.09 [95% CI, 0.28-4.16]) or dementia of any type (30% vs 21%; odds ratio, 1.57 [95% CI, 0.48-5.13]). Vascular risk factors were not significantly different between groups. Swiss cheese striatum correlated with degree of leukoaraiosis (P < .001). Potential associations with visualized cortical atrophy (P = .01), nonobstructive urinary incontinence (18.5% vs 3.9%; P = .04), and syncope (37% vs 9.6%; P = .01) did not hold up after correction for the false discovery rate.

Conclusions and Relevance  Our study suggests that marked cribriform change in the striatum was not associated with the development of extrapyramidal clinical disorders, including parkinsonism. The association of SCS with leukoaraiosis suggests that it is part of a more generalized cerebrovascular process. Skepticism is called for when attributing clinical symptoms to this MRI finding.