We review the cases diagnosed in our health area from 2012 to 2016:
- Case 1: Infant of 8 months with left hemiparesis predominantly in the left arm.
- Case 2: A 3-year-old girl (international adoption without prenatal or postnatal data) presenting partial motor epileptic crisis in the context of febrile symptoms.
- Case 3: An 8-year-old boy with a clinic of paresthesias in hand and right jaw of two months of evolution.
Imaging studies were performed in the 3 cases,
both transfontanelar ultrasound in lactation of 8 months,
and computed tomography (CT) in 3 and 8 year olds and in all of them a magnetic resonance imaging (MRI) was performed,
identifying cerebral hemiatrophy that associates the widening of the ipsilateral diploe,
in the 8-year-old child the very developed left frontal sinus is also evident.
Likewise,
subtle alterations of the cerebral vascular territory ipsilateral to cerebral hemiatrophy were observed in all,
in two of them the reduction in length and caliber of the M1 segment of the ipsilateral middle cerebral artery was detected and in another,
a slight decrease in the caliber of the right carotid artery is identified.
Radiological findings:
- Case 1:
Fig. 1: Sagittal images of transfontanellar ultrasound: The size of the lateral ventricles is asymmetric, the right one is larger.
Fig. 2: Coronal image of transfontanellar ultrasound: The frontal horn of the right lateral ventricle is larger than the left one and is retracted by two anechoic lesions suggestive of encephalomalacia areas.
Fig. 3: Cerebral MRI. A: T1 axial; B: T2 coronal.
In the right cerebral hemisphere, an extensive chronic lesion is observed, whose distribution adapts to the territory of the right middle cerebral artery (MCA) and presents a signal intensity alteration similar to the liquid, with loss of cortical-subcortical differentiation.
In addition, we can see a generalized decrease in the volume of the entire right cerebral hemisphere with respect to the contralateral hemisphere, loss of ipsilateral basal ganglia and thinning of the homolateral cerebral peduncle.
Fig. 4: TOF 3D axial: MIP reconstruction.
Asymmetry between both middle cerebral arteries with a decrease
of the caliber of the right one and of all its distal branches, as well as diminution of signal intensity that suggests a decrease of the flow with respect to the left artery.
- Case 2:
Fig. 5: Cranial CT.
Bone window: Elevation of the petrous portion of the temporal bone, the lesser wing of sphenoid bone and orbital roof.
Brain window: Right hemicerebral hypoplasia. Cortical-subcortical hypodensity without perilesional edema that afects to the right parietal lobe. In addition, there are lineal and elongated hypodensities in relation to the described lesion that correspond to prominent parietal sulci.
Fig. 6: Brain MRI: (A) IR-T1-3D coronal and (B) TSE-T2 axial and coronal.
Difference in size between both cerebral hemispheres. In the right cerebral hemisphere, a chronic-looking lesion is identified, which adopts triangular morphology with peripheral base and affects part of the parietal and occipital lobes. The lesion manifests as marked cortical atrophy and signal alteration that affects the cortex and extends towards subcortical white matter, suggestive of gliosis, reaching the limit with the lateral ventricle with retraction of his occipital horn. We also appreciate slight widening of the diploe on the right side, more evident where the parenchymal lesion described is located.
Fig. 7: Angio-supraaortic trunks (TSA): GE TOF 2D with MIP reconstruction; Angio-Willis: GE TOF 3D with MIP reconstruction.
No significant alterations are observed in the morphology or in the caliber of the vessels. There is only a minimal difference in the caliber between both carotid arteries, the right one shows a slightly lower caliber.
- Case 3:
Fig. 8: Cranial CT. Bone window: Changes in the left side of the skull like thickening of the diploe, enlargement of the frontal sinus, elevation of the petrous portion of the temporal bone, sphenoid wing and orbital roof and decrease in the size of the middle cranial fossae.
Brain window: Left hemicerebral hypoplasia with a cortical-subcortical parietal hypodensity without associated edema, suggestive of ischemic injury that causes retraction of the occipital horn of the ipsilateral lateral ventricle.
Fig. 9: Brain MRI: (A) T1 axial and coronal; (B) FLAIR coronal and sagittal.
Left parieto-temporal encephalomalacia area that is accompanied by retraction of the atrium and occipital horn of the left lateral ventricle, prominence of the Sylvian fissure and discrete area of gliosis in the surrounding brain parenchyma.
Asymmetry of the size of the cerebral hemispheres at the expense of the left one, discrete asymmetric thickening of the left parietal diploe and widening of the homolateral frontal sinus
Fig. 10: Angio-Willis TOF 3D with MIP reconstruction: a decrease in the number and caliber of the arteries is observed in the distal vascular bed of the left middle cerebral artery.