Findings explained
What “encephalomalacia” means on a brain scan
Read Your Scan Editorial Team·Last updated ·6 min read
Written from published radiology references and reviewed for plain language. Not written or signed by a physician, and not a diagnosis. How we write these pages →
The short answer
Encephalomalacia is an area of the brain where tissue was lost — after a stroke, a bleed, an infection or an injury — and replaced by fluid. It is a scar, not an active process. The word describes the end state of something that already happened, often years earlier, and by the time it appears on a report it has usually finished changing.
- It is damage that has already completed. The report is describing a result, not something in progress.
- The commonest causes are an old stroke, an old bleed and an old head injury — sometimes one the person does not remember.
- "Gliosis" next to it is the brain’s scar tissue at the edge. The two words describe one thing from two angles.
- The size of the area says little about what a person can do. Where it sits says far more.
- It does not spread and it is not degenerative. If a report describes it as stable or unchanged, that is the whole story.
What the word is describing
Encephalomalacia means, literally, softening of the brain. In a radiology report it is used for something more specific: an area where brain tissue has been lost and the space it occupied has filled with fluid. On MRI that area then behaves like fluid rather than like tissue, which is what makes it recognisable.
The important grammatical fact about the word is that it names an outcome. Something happened — the blood supply was interrupted, there was bleeding, there was an injury or an infection — the tissue in that area did not survive, and this is what was left afterwards. The report is describing the scar, not the event.
The same construction appears elsewhere in the same reports: myelomalacia is the equivalent term for the spinal cord, and it means the same thing in a different place.
What produces it
- An old stroke. By far the commonest cause, and the reason a report often pairs the word with "remote infarct" or "chronic infarct" in the same sentence.
- An old bleed, whether from injury or from a vessel.
- A previous head injury, including one severe enough to bruise the brain without breaking the skull.
- Previous surgery, in which case the report usually says so — "status post" plus the operation.
- Previous infection or inflammation of the brain.
- In some people, an event around birth or in early childhood that nobody has a memory of.
That last one is why this finding so often arrives as a surprise. An area of encephalomalacia can be entirely silent: found on a scan ordered for headaches, for dizziness, after a fall, in someone who has never been told they had a stroke and has no symptoms attributable to it. The brain compensated a long time ago.
The word that usually comes with it
Reports pair encephalomalacia with gliosis so consistently that the two are worth reading as a unit.
| What the report says | What it describes |
|---|---|
| Encephalomalacia | The tissue is gone; fluid occupies the space. The hole, in effect. |
| Gliosis / gliotic change | The brain’s own scar tissue at the rim of that area. Supporting cells fill in around the edge, the way scar forms anywhere else. |
| Encephalomalacia with surrounding gliosis | Both together — the standard description of a completed, healed injury. This phrasing is, in itself, a statement that the process is finished. |
| Remote / chronic infarct | The cause named: an old stroke. "Remote" and "chronic" both mean long ago, and are the words that separate this from an acute event. |
| Ex vacuo dilatation | The nearby ventricle has widened to occupy the space left behind. A consequence of the tissue loss, not a separate problem. |
| Volume loss in the affected territory | The area is smaller than its counterpart on the other side. Again a description of the aftermath. |
What it does and does not predict
This is where the fear usually sits, and the honest answer has two halves.
- It is not progressive. Encephalomalacia is a completed change. It does not spread, it is not a degenerative disease, and a scan describing it as stable compared with a prior study is describing something that has not moved.
- Its size is a poor guide to its consequences. A small area in a critical location can matter a great deal; a larger one elsewhere can be silent. Location is what the neurologist reads, not volume.
- It can matter for what comes next. An old stroke found by accident is still evidence that a stroke happened, and that usually prompts a look at blood pressure, cholesterol, heart rhythm and diabetes — not because of the scar, but because of what caused it.
- It does not, by itself, explain a new symptom. Something old cannot cause something new. A report describing only chronic change has, in effect, not found the cause of a recent problem.
That last point is the one worth carrying into an appointment. If you were scanned for a new symptom and the only finding is old, the question "so what is causing this?" is still open.
What to ask
- What is likely to have caused it, and is there anything to do about that cause now?
- Is it unchanged from any earlier scan? Stability across studies is the strongest reassurance available.
- Does its location fit any symptom I actually have — weakness, speech, vision, memory?
- If I was scanned for something new, does this explain it, or is the question still open?
Frequently asked questions
- Is encephalomalacia serious?
- It describes damage that has already happened and finished. Whether it matters depends on where it is and what a person can do, not on the word itself — and plenty of people have an area of it with no symptoms at all, found on a scan ordered for something else.
- Does encephalomalacia get worse over time?
- No. It is not a progressive or degenerative process. The area can look slightly different as fluid settles, but the tissue loss is complete. A report describing it as stable or unchanged is describing exactly that.
- Can brain tissue grow back?
- The lost tissue does not regenerate. What can improve is function, because the brain reorganises around a completed injury — which is why someone can recover substantially while the scan looks the same.
- What does “encephalomalacia with gliosis” mean?
- Two halves of one description: the area where tissue was lost, and the scar tissue the brain formed around its edge. Together they are the standard way of saying a completed, healed injury.
- I never had a stroke. Why does my scan show this?
- Small strokes can pass unnoticed, and injuries or events from long ago — including around birth — can leave an area behind. Finding one without a history is common enough that it has its own name in the literature: a silent infarct.
When you want a second read of the images themselves
Understanding your radiologist’s report is free. A Second Opinion is the other thing: an independent AI reading of your images, done from the pictures rather than from the report, with the differences called out and a Q&A on the result. It is informational — not a diagnosis, and not a substitute for your doctor.
Words on this page
Each of these has its own page in the report glossary.
Report glossary, A–Z →Sources
- Patient-facing procedure descriptions (MRI, CT, X-ray, ultrasound)RadiologyInfo.org — Radiological Society of North America & American College of Radiology
- MRI scan — overview, how it is performed and resultsNHS (United Kingdom)
- ACR Appropriateness Criteria and practice parameters for reportingAmerican College of Radiology
Keep reading
Read Your Scan is informational only — not a medical diagnosis, and not a substitute for a licensed radiologist or your doctor. This page explains what a report says and what a radiologist looks at; it cannot tell you what your own images show. If you have urgent symptoms, seek care.