Please read this after reading pediatric neuroimaging presentation

How to differentiate between mass effect and gliosis..?

Subdural hematoma

Area of gliosis due to old infarct

Review of anatomy on CT

What is myelination on MRI…?

• As you know brain white matter is not fully myelinated at birth.

• This myelination progresses throughout 1 year , reaching completion by 12-18 months.

• MRI can show myelination of brain and delay or dysmyelination.

Myelination on T2Myelination at 3-4 months

Normal myelination at 3-4 months

Case 1

• 5 month old infant with growth retardation and recurrent seizures.

• Sibling had similar history and died due to unknown illness.

T2 hyperintensity seen in basal ganglia.

No abnormality in FLAIR or T1 sequence

Diffusion imaging shows areas of diffusion restriction.

Diffusion imaging shows areas of recent ischemia / infarct well.It also has other applications.

Diagnosis– Mitochondrial cytopathy / Leigh`s disease

• Bilateral symmetrical areas of abnormal signal in an infant with diffusion restriction in an infant is suggestive of mitochondrial disease.

• Findings need to be confirmed with serum lactate estimation.

Case 2

• 4 months old baby with Progressively enlarging head

Severe hydrocephalus due to aqueductal stenosis.

Case 3

• 2 year old boy Presenting with regression of milestones.

Extensive abnormal signal in white matter--- leukodystrophy.

MRI in leukodystrophy

• Sensitive in detection.• Not always specific.• It can show sometimes exact leukodystrophy ,

often points to few differential diagnosis.

Case 4

• One and half year old boy , anxious parents complain that child`s head size is increasing. History of minor fall.

Normal. Prominence of CSF spaces is normal for the age.

Case 5

• 4 year old child with Spastic diplegia , seizures

Thin or gracile corpus callosum

Periventricular leukomalacia

Case 6

• 7 year old boy with uncontrolled seizures. Also has poor school performance.

Normal for comparison

Corpus callosum agenesis