IMAGING DEPARTMENT

June 14th, 2012 Reported by Dr. Giang

I. Name: Nguyen Quang Huy Sex: Male Age: 5 years old Dept: Outpatient

Clinical

Cerebral sequela Hemiparesis Spasticity

MRI Findings(T2WI, Axial, Pre C+)

Right temporal hemisphere : Lacunar cerebral parenchyma

Canal: extend from subarachnoid space to the right lateral ventricular

Lined by displastic Gray matter

MRI Findings(T2WI, Axial, Pre C+)

Dimple of left ventricular wall. Left parieto- temporal hemisphere : narrowed cleft

cerebral parenchyma extend from subarachnoid space to left lateral ventricular

Lined by displastic Gray matter

MRI Findings(Flair, Coronal, Pre C+)

Bilateral Cleft of cerebral parenchyma

Right cleft: Large & open Left cleft: Narrow & closed. Absent of septum pellucidum

MRI Findings(T1WI, Sagital, Pre C+)

Posterior part of Corpus Callosum: thin

MRI Diagnosis

Bilateral Schizencephaly . Corpus Callosum hypoplasia.

Background of Schizencephaly

Definition: Clefts in the brain parenchyma that extend from

the cortical surface to the ventricle (pia to ependyma),

Lined by dysplastic Gray matter

Pathology: Early prenatal insult affecting germinal zone prior

to neuronal migration Insult can be genetically determined (EMX2 gene),

or 2° to infection (CMV), trauma, vascular insult.

Background of Schizencephaly

Morphology: Up to half of schizencephalies are bilateral Size: ’’Open lip’’: Large cleft. ’’Closed lip’’: Small, narrow cleft When bilateral, 60% open on both sides , 20%

open on only one side When unilateral, 2/3 are open Absence of the septum pellucidum in 70% of

schizencephaly, especially bilateral

Background of Schizencephaly

Treatment: Treat seizures and hydrocephalus Physiotherapy for motor deficits

II. Name: Nguyen Viet Anh Sex: Male Age: 15 months old Dept: Outpatient

Clinical

Left squint eye. Hemifacial palsy Seizure History: Subarachnoid hematoma at 7

months old

CT Findings(Pre C+)

Left fronto-temporal lobe: decreased volume Fronto- temporal subarachnoid effusion: 24x11 mm Well-delineated round extra-axial mass in left basal cerebrum

(33x23mm) with peripheral calcification

CT Findings(Post C+)

Mass: strongly enhance like cerebral artery. Cacification in wall.

MRI Findings(T2WI, Axial, Pre C+)

Hypo-intense signal mass ( Flow void signal) in left basal cerebrum (33x23mm)

Compress & diplace adjacent structure. Left fronto- temporal lobe: hypoplasia Subarachnoid effusion: 22mm

MRI Findings(Flair, Coronal, Pre C+)

Mass: mixed signal Left fronto- temporal lobe: hypoplasia Subarachnoid effusion: hypo-signal = liquid.

MRI Findings(T1W1, Sagital, Pre C+)

Mass: iso signal Subarachnoid effusion: hypo-signal = liquid.

MRI Findings(T1W1, Sagital, Pre C+)

Mass: iso signal Subarachnoid effusion: hypo-signal = liquid.

MRI Findings(T2*, axial, Pre C+)

Mass: hemosiderin rim = hemorrhage

MRI Findings(TOF, axial, Pre C+)

Mass: at level of left side of Circle of Willis (M1 of left MCA & PCoA )

Absent of Left MCA

MRI Findings(TOF, reformated vessel structure, Pre C+)

Mass: saccular aneurysme of M1 of left MCA &PCoA

Absent of Left MCA.

MRI Diagnosis

Giant saccular aneurysm of left Midle Cerebral Artery & Posterior Communicating Artery ( hemorrhage & thrombose) MCA hypoplasia Fronto-temporal lobe hypoplasia.

Old left fronto-temporal subarachnoid hematoma .

Thank you for attention!