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Background and Purpose: Cerebral sinovenous thrombosis (CSVT) is increasingly encountered in children, including neonates. The purpose of this study was to assess the frequency and topographic distribution of parenchymal brain lesions associated with CSVT in children and to compare these with the known anatomic venous drainage pathways., Materials and Methods: Brain CT/CT venograms and/or MR imaging/MR venograms of 71 consecutive patients with CSVT were reviewed retrospectively. The patients were grouped into neonates, infants, and older children. The site of CSVT, the location and size of the brain lesions, and the presence of hemorrhage were documented. The frequency of the brain lesions was calculated., Results: There were 34 neonates, 10 infants, and 27 older children with CSVT who were included. The most common sites of CSVT were the transverse sinuses, the superior sagittal sinus, and the straight sinus. Overall, 37 of 71 children with CSVT had parenchymal brain lesions. There were 21 of 34 neonates, 4 of 10 infants, and 12 of 27 older children who had brain lesions. The most common locations were in the frontal and parietal lobes. The topographic distribution of lesions correlated with the corresponding venous drainage territory in 16 of 21 neonates, all infants, and all older children. The neonates had smaller-sized lesions. Brain lesions were hemorrhagic in 76% of neonates, 75% of infants, and 33% of older children., Conclusion: The topographic distribution of brain lesions associated with CSVT correlates with the known drainage territories of the dural venous sinus in children.

Objective: Posterior reversible encephalopathy syndrome (PRES) is classically characterized as symmetric parietooccipital edema but may occur in other distributions with varying imaging appearances. This study determines the incidence of atypical and typical regions of involvement and unusual imaging manifestations., Materials and Methods: Seventy-six patients were eventually included as having confirmed PRES from 111 initially suspected cases, per imaging and clinical follow-up. Two neuroradiologists retrospectively reviewed each MR image. Standard sequences were unenhanced FLAIR and T1- and T2-weighted images in all patients, with diffusion-weighted imaging (n = 75) and contrast-enhanced T1-weighted imaging (n = 69) in most. The regions involved were recorded on the basis of FLAIR findings, and the presence of atypical imaging findings (contrast enhancement, restricted diffusion, hemorrhage) was correlated with the severity (extent) of hyperintensity or mass effect on FLAIR., Results: The incidence of regions of involvement was parietooccipital, 98.7%; posterior frontal, 78.9%; temporal, 68.4%; thalamus, 30.3%; cerebellum, 34.2%; brainstem, 18.4%; and basal ganglia, 11.8%. The incidence of less common manifestations was enhancement, 37.7%; restricted diffusion, 17.3%; hemorrhage, 17.1%; and a newly described unilateral variant, 2.6%. Poor correlation was found between edema severity and enhancement (r = 0.072), restricted diffusion (r = 0.271), hemorrhage (r = 0.267), blood pressure (systolic, r = 0.13; diastolic, r = 0.02). Potentially new PRES causes included contrast-related anaphylaxis and alcohol withdrawal., Conclusion: This large series of PRES cases shows that atypical distributions and imaging manifestations of PRES have a higher incidence than commonly perceived, and atypical manifestations do not correlate well with the edema severity.

A 35-year-old woman presented with neurotoxicity correlated to an i.v. regimen of 5-fluorouracil as episodes of acute confusional state and abnormalities of symmetrically restricted diffusion in the periventricular white matter and corpus callosum. On discontinuing the medication, the areas of severely restricted diffusion had entirely resolved, with minimal residual T2 signal abnormality. In this case, immediate discontinuation of the chemotherapeutic agent apparently reversed the patient's symptoms and findings on MRI. The scant information available in the published literature regarding this phenomenon is reviewed with regard to 5-fluorouracil.

We present a case of severe Dandy-Walker malformation with enlarged posterior fossa cyst extruding through the incisura of the tentorium and causing severe hydrocephalus. A posterior fossa malformation was suspected by ultrasonography and was further evaluated by fetal magnetic resonance imaging (MRI). Fetal MRI demonstrated that there were no associated anomalies and the decision was made to continue with labor instead of terminating the pregnancy. The precise diagnosis and absence of associated anomalies revealed by MRI aided in parent counseling and obstetrical management., (Copyright (c) 2005 S. Karger AG, Basel.)

We report a 35-year-old male with an unusual contrast-enhancing sterile spinal subdural collection on magnetic resonance imaging (MRI), apparently occurring as a complication of lumbar puncture. Follow-up MRI after 4 weeks demonstrated spontaneous resolution of the collection without intervening treatment.

Diffusion-weighted MR imaging (DWI) of two patients with carbon monoxide (CO) poisoning demonstrated white matter and cortical hyperintensities. In one patient, the changes on the FLAIR sequence were more subtle than those on DWI. The DWI abnormality in this patient represented true restriction. In the second patient, repeated exposure to CO caused restricted diffusion. DWI may be helpful for earlier identification of the changes of acute CO poisoning.

We report a 7-year-old boy who presented with two-month history of worsening low back and right leg pain. Conventional MR images demonstrated a poorly outlined intradural mass recognized by the displacement of the conus medullaris and the nerve roots of the cauda equina at the L2-3 level. The signal intensity of the lesion was similar to CSF There was no contrast enhancement of the lesion. Diffusion-weighted images and ADC values revealed restricted diffusion within the mass. Myelography confirmed the mass as an intradural filling defect with myelographic block at the L2-3 level. The patient underwent total surgical excision of the mass. Pathologic examination revealed the diagnosis of epidermoid cyst.

A 13-year-old girl with a renal transplant presented with hypertension and seizures. CT and MRI demonstrated typical bilateral parietal, occipital and posterior frontal cortical and subcortical edema, thought to represent posterior reversible encephalopathy syndrome. The cause was presumed to be hypertension. Antihypertensive therapy was started, lowering of the blood pressure in the range of 110–120 mmHg systolic. However, stable xenon (Xe) CT perfusion imaging revealed ischemia within the left parietal occipital region. The antihypertensive was adjusted which increased both the systolic and diastolic blood pressure by 31 mm Hg. The patient was re-imaged with Xe CT and was found to have resolution of the ischemic changes within the left parietal occipital region. In this report, we present a case in which stable Xe CT was used to monitor the degree of cerebral perfusion and guide titration of antihypertensive therapy. Such brain perfusion monitoring may have helped to prevent infarction of our patient. [ABSTRACT FROM AUTHOR]

We present the computed tomography (CT) and magnetic resonance imaging (MRI) findings of brain metastases in an unusual case of a premature, 33-week gestational age neonate who was emergently delivered from a mother suspected of having lung cancer according to imaging performed during the third trimester of pregnancy. Owing to the presence of placental metastases noted after delivery, the fetus had initial screening with brain MRI and chest/abdomen CT as well as serial screening imaging studies during the first 5 months of life, all of which were apparently normal. However, serial examinations eventually revealed a cerebellar lesion that significantly improved after chemotherapy but recurred and enlarged within a few months. This lesion was later confirmed to be metastasis by subsequent biopsy and resection. More metastatic lesions were identified in the frontal and temporal lobes on follow-up MRI. In the setting of aggressive maternal malignancy (without known fetal primary malignancy) an intracranial mass can, on the exceedingly rare occasion, result from maternal high-grade malignancy and the neuroradiologist should be alerted to this phenomenon. [ABSTRACT FROM AUTHOR]