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Resident on call CMH cases Collected by: Lisa H. Lowe, MD
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Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dec 15, 2015

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Page 1: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Resident on call CMH cases

Collected by: Lisa H. Lowe, MD

Page 2: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

History: Not waking up for night time feeding & hypotonia

a

Page 3: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings:

•Lens shaped hyperdense area indicates epidural hematoma

•Midline shift

•Some dark non-clotted blood is seen also

a

Page 4: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Epidural hematoma

•Nonaccidental trauma

•Surgically evacuated

a

Page 5: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: 8y male s/p MVA not waking

Page 6: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings:

•Hyperdense perimesencephalic cisterns indicate subarachnoid blood

•Narrowed midbrain worrisome for diffuse cerebral edema

Page 7: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Subarachnoid hemorrhage

•Hyperdense perimesencephalic cisterns indicate subarachnoid blood

•Narrowed midbrain worrisome for diffuse cerebral edema

Page 8: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: 6y female severe headache & past hx of arachnoid cyst

Page 9: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings:

•Subdural fluid, hypodense bilateral (flattened gyri and no crossing vessels seen)

•Not subarachnoid fluid

•Arachnoid cyst seen at lower level in temporal fossa

Page 10: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Subdural effusion due to arachnoid cyst rupture

Page 11: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: 1 yr female seizures

Page 12: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings

•Square shape frontal horns is seen with absent septum pellucidum

•Clefts in the brain bilateral, left > right indicates schizencephaly

Page 13: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Septooptic dysplasia

Page 14: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: 3 yr near drowning

Page 15: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings

•Diffuse loss of gray white differentiation

•Bilateral foci of low density in the thalami

Page 16: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Profound hypoxic ischemic injury in a child

•With not so severe HIE, there is often watershed injury with preservation of thalami (due to preferential shunting of oxygenated blood to thalami)

•With total anoxia or prolonged hypoxia, the shunting does not work and the thalami may take the biggest hit

•This worst situation is with both involved as in this child

Page 17: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: Premature infant with drop in hematocrit

Page 18: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings:

•Heterogeneous lesion in the posterior fossa with high and low density indicating partially clotted blood

•Linear periventricular high density and at the caudothalamic grooves indicates germinal matrix still present (arrowhead)

•Cortex also high density due

to extreme prematurity

Page 19: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Posterior fossa hemorrhage

Page 20: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: Macrocephaly

Page 21: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings

•Prominence of the CSF spaces around the brain

•There is no flattening of the gyri and there are tiny vessels in the CSF indicating it is the subarachnoid, not subdural space

Page 22: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Benign enlarged subarachnoid spaces

•Seen most 3m - 3yrs

•Presents with macrocephaly in an otherwise healthy child

•Resolves spontaneously

•Associated with slight increased risk of subdural bleed

Page 23: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: Apnea in a 2 week old

Page 24: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings

•Prominent venous structures, including the internal cerebral veins & straight sinus

Page 25: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Normal prominent venous sinuses

•Can mimic venous sinus thrombosus

•Should do contrasted exam if unsure and if not thrombus will see enhancement

Page 26: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: Persistent vomiting in 4-yr-old male

Page 27: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings:

•Posterior fossa low density mass with peripheral calcification

Page 28: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Ependymoma

DDx:

•Medulloblastoma

•Juvenile pilocytic astrocytoma

•PNET

Page 29: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: Baby fell of couch

Page 30: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: Baby fell of couch

•Hyperdense subdural blood on left side indicates recent trauma

•Loss of left side sulci due to subdural fluid

Page 31: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Nonaccidental injury

•Hyperdense subdural blood on left side indicates recent trauma

Page 32: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: Child stopped breathing

a

Page 33: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings:

a

Mixed density left subdural blood with left to right shift

Left loss of gray white differentiation and shift left to right of midline

Page 34: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Hyperacute subdural hematoma

a

Mixed density indicates blood has not had time to clot yet

Must distinguish from acute on chronic SDH, in which there is there is not acute mass effect

Requires urgent surgical intervention

Page 35: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: Seizure in 8 day old

Page 36: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings:•Bilateral high density in the thalami

•Prominent internal cerebral veins (arrowhead)

•Focus of right frontal horn intraventricular blood (arrow)

Page 37: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Venous hemorrhage due to venous sinus thrombosis

•Internal cerebral vein thrombus, most common in babies, classically causes bilateral thalamic ischemia/hemorrhage

Page 38: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: Newborn with CHF and head bruit

Page 39: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings:

•Hydrocephalus from obstruction of 4th

•Enlarged Vein of Galen and transverse sinuses

Page 40: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Vein of Galen varix

•Treated with intravenous coils

Page 41: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: Newborn with in utero hydrocephalus

Page 42: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings

•CSF space that connects with 4th ventricle (arrow)

•Hypoplastic cerebellum and large retrocerebellar fluid collection

•Hyrocephalus

•Macrocephaly

Page 43: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Dx: Dandy Walker malformation

•DW cyst has NO cerebellar vermis

•DW variant has some vermis

•DW malformation includes DW cyst and variant

•On CT hard to know if there may be a little vermis, so just say DWM and leave specifics to MRI reports

Page 44: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: Seizure and headache 15yf

Page 45: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Findings

•Hypodense area left frontal lobe

•Vague

•No contrast given

•MRI planned

Page 46: Resident on call CMH cases Collected by: Lisa H. Lowe, MD.

Hx: Multiple sclerosis

•Multiple foci in white matter on FLAIR MRI