Resident on call CMH cases
Collected by:
Lisa H. Lowe, MD
History: Not waking up for night time
feeding & hypotonia
a
Findings:
•Lens shaped
hyperdense area
indicates epidural
hematoma
•Midline shift
•Some dark nonclotted blood is
seen also
a
Dx: Epidural hematoma
•Nonaccidental
trauma
•Surgically
evacuated
a
Hx: 8y male s/p MVA not waking
Findings:
•Hyperdense
perimesencephalic
cisterns indicate
subarachnoid blood
•Narrowed midbrain
worrisome for diffuse
cerebral edema
Dx: Subarachnoid hemorrhage
•Hyperdense
perimesencephalic
cisterns indicate
subarachnoid blood
•Narrowed midbrain
worrisome for diffuse
cerebral edema
Hx: 6y female severe headache & past hx
of arachnoid cyst
Findings:
•Subdural fluid,
hypodense bilateral
(flattened gyri and no
crossing vessels seen)
•Not subarachnoid fluid
•Arachnoid cyst seen at
lower level in temporal
fossa
Dx: Subdural
effusion due
to arachnoid
cyst rupture
Hx: 1 yr female seizures
Findings
•Square shape frontal horns is seen with absent septum pellucidum
•Clefts in the brain bilateral, left > right indicates schizencephaly
Dx: Septooptic dysplasia
Hx: 3 yr near drowning
Findings
•Diffuse loss of gray
white differentiation
•Bilateral foci of low
density in the thalami
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
Hx: Premature infant with drop in
hematocrit
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
Dx: Posterior fossa hemorrhage
Hx: Macrocephaly
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
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
Hx: Apnea in a 2 week old
Findings
•Prominent
venous
structures,
including the
internal cerebral
veins & straight
sinus
Dx: Normal prominent venous sinuses
•Can mimic venous
sinus thrombosus
•Should do
contrasted exam if
unsure and if not
thrombus will see
enhancement
Hx: Persistent vomiting in 4-yr-old male
Findings:
•Posterior fossa
low density mass
with peripheral
calcification
Dx: Ependymoma
DDx:
•Medulloblastoma
•Juvenile pilocytic
astrocytoma
•PNET
Hx: Baby fell of couch
Hx: Baby fell of couch
•Hyperdense
subdural blood on
left side indicates
recent trauma
•Loss of left side
sulci due to
subdural fluid
Dx: Nonaccidental injury
•Hyperdense
subdural blood on
left side indicates
recent trauma
Hx: Child stopped
breathing
a
Findings:
Mixed density
left subdural
blood with left to
right shift
a
Left loss of gray white
differentiation and shift
left to right of midline
Dx: Hyperacute subdural
hematoma
Mixed density
indicates blood
has not had time
to clot yet
Requires
urgent surgical
intervention
Must distinguish from
acute on chronic SDH, in
which there is there is not
acute mass effect
a
Hx: Seizure in 8 day old
Findings:
•Bilateral high
density in the thalami
•Prominent internal
cerebral veins
(arrowhead)
•Focus of right
frontal horn
intraventricular blood
(arrow)
Dx: Venous hemorrhage due to venous
sinus thrombosis
•Internal cerebral vein thrombus, most common in babies,
classically causes bilateral thalamic ischemia/hemorrhage
Hx: Newborn with CHF and head bruit
Findings:
•Hydrocephalus
from obstruction of
4th
•Enlarged Vein of
Galen and
transverse sinuses
Dx: Vein of Galen varix
•Treated with
intravenous coils
Hx: Newborn with in utero hydrocephalus
Findings
•CSF space that
connects with 4th
ventricle (arrow)
•Hypoplastic
cerebellum and large
retrocerebellar fluid
collection
•Hyrocephalus
•Macrocephaly
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
Hx: Seizure and headache 15yf
Findings
•Hypodense area left
frontal lobe
•Vague
•No contrast given
•MRI planned
Hx: Multiple sclerosis
•Multiple
foci in
white
matter on
FLAIR MRI