February 21, 2026

@michaelokun

Do you know what the honeycomb brain pattern may be telling you if you see it on a MRI? Spoiler alert: could it be hidden small vessel disease? Honeycomb appearance refers to enlarged fluid filled spaces in deep brain regions that resemble the pattern of a honeycomb on MRI scans, and this pattern can signal an underlying genetic small vessel disease. Tabea Zang and colleagues describe in a new teaching neuroimage that appeared in Neurology how a striking honeycomb pattern in the basal ganglia on MRI pointed to a rare genetic disorder involving the NIT1 gene. Key points: – MRI showed progressively enlarged perivascular spaces in the basal ganglia, creating a honeycomb like pattern that worsened over time. – The imaging changes were linked to biallelic NIT1 gene variants, which seem to cause a small vessel disease associated w/ movement problems and cognitive decline. – The clinical picture included progressive cognitive impairment, cerebellar ataxia, bradykinesia and increased risk of stroke, as well as brain hemorrhage. My take: This is a beautiful example of how imaging patterns over time can unlock a diagnosis. The honeycomb brain is not just a radiology curiosity, it is a clue to a specific genetic and possible small vessel disease. Recognizing these patterns can help health care providers pursue genetic testing, guide prognosis and counsel families more precisely. It also reminds us that small vessel disease is not always due to aging or vascular risk factors, and sometimes genetics plays a central role. Here are 5 points that resonated w/ me: 1- Brain MRI patterns can provide critical clues to hidden genetic diseases. 2- Honeycomb appearance reflects abnormal enlargement of fluid spaces surrounding our brain based blood vessels. 3- NIT1 related disease can cause movement symptoms, thinking problems and increase stroke/vascular risk. 4- Genetic testing may be necessary when imaging findings do not fit common diagnoses. 5- Recognizing rare imaging signatures can help health care providers deliver more precise care and counseling. https://neurology.org/doi/pdf/10.1212/WNL.0000000000214692 #MRI #neuroradiology #michaelokun #fixelinstitute