From stress to stroke: what can cause ‘holes’ and low-activity regions in the brain
If Kim Kardashian’s latest health update gave you a jolt at the phrase “holes on the brain,” you’re not alone. That wording sounds alarming, but on the scan she underwent, a so-called hole doesn’t mean tissue is missing. It indicates a brain region that is functioning at a lower level because it’s receiving less blood and oxygen, often tied to aging, chronic stress, or other long-term influences. That distinction matters: true holes look very different and usually point to serious disease.
In footage from her reality show The Kardashians, a physician refers to “holes” on a brain scan as areas of “low activity.” These observations come from a single-photon emission computed tomography (Spect) scan, which uses a small radioactive tracer and a specialized camera to map how well different parts of the brain are working. Around the same period, Kardashian was also diagnosed with a brain aneurysm, discovered during an MRI scan. An aneurysm is a structural weakness in a blood vessel and is not connected to the low-activity patches seen on Spect.
These so-called holes or dents are a normal part of brain aging and can appear in people in their forties. They don’t occur in everyone, but they’re a common feature of midlife brain scans and reflect reduced blood flow in small, localized areas. On average, the aging brain loses about five percent of its volume each decade, even in the absence of disease.
Lower activity on Spect can arise from many causes. Chronic stress, for example, has been shown to cause macroscopic changes in the brain, including altered connections between neurons. While there’s no evidence that Kardashian’s results are linked to drug use, recreational substances can affect brain function. Cocaine dependence speeds tissue loss at roughly twice the rate of normal aging, and opioids, marijuana, methamphetamine, heroin, and ketamine have each been associated with measurable structural changes.
True brain holes
True holes involve actual tissue loss and tend to result from more serious conditions. Fortunately, such cases are quite rare. Infections can destroy local brain tissue, such as Creutzfeldt–Jakob disease, in which a misfolded protein triggers widespread cell death, giving a sponge-like appearance to affected tissue. Bacterial infections like staphylococcus or streptococcus can form abscesses that leave visible cavities; these infections often spread from the ears, teeth, or sinuses and require urgent medical attention.
Another rare cause is taenia solium, a pork tapeworm whose larvae can inhabit the brain and deprive tissue of nutrients. The parasite drew attention after public reports about Robert F. Kennedy Jr., who said he experienced brain fog and memory problems linked to an infection.
More common causes include stroke, which affects millions worldwide each year. In both ischemic and hemorrhagic strokes, the brain’s blood supply is disrupted and tissue can die, leaving holes or areas of atrophy on imaging. Atrophy refers to a reduction in tissue size due to cell death or loss of function.
Other conditions that disrupt the brain’s fluid balance can also cause tissue damage. Hydrocephalus involves the buildup of cerebrospinal fluid inside the brain’s cavities, which can compress and kill nearby tissue if left untreated. Fluid flow is essential for delivering nutrients and clearing waste, so blocked drainage can have serious consequences.
Aggressive brain tumors, such as glioblastoma, can create cavities by crowding out healthy tissue and redirecting blood supply toward tumor cells. Treatments like radiation therapy can also damage healthy neurons because radiation is inherently toxic to brain cells.
These situations often produce swelling known as edema, including vasogenic edema, where leaking fluid increases pressure on surrounding tissue. Traumatic brain injury is another cause of progressive tissue loss. Repeated head impacts can lead to chronic traumatic encephalopathy (CTE), a condition observed in some contact-sport athletes. Recent research suggests a substantial portion of former American football players report symptoms related to CTE.
How these findings differ from Kardashian’s Spect results
All of the above conditions differ markedly from the Spect observations in Kardashian’s case. True holes denote actual tissue loss with clear neurological symptoms, and treatment cannot always reverse the damage, though early medical assessment can help manage symptoms and slow decline. Anyone experiencing memory problems, difficulty concentrating, or movement issues should seek medical advice promptly.
The low-activity patches seen on Kardashian’s Spect scan do not signify missing tissue and are not expected to cause symptoms. They are more consistent with normal aging, stress, or long-standing lifestyle factors rather than active disease.
