San-Kan Lee

MRI of Joubert's syndrome

OBJECTIVE To report five cases of the rare Jouberts syndrome. SUBJECTS All five cases were studied by 1.0-Tesla MRI. All the patients showed typical clinical manifestations of Jouberts syndrome including neonatal respiratory abnormalities, developmental delay, ataxia, retinal atrophy and nystagmus. RESULTS The T1WI of MRI showed characteristic MRI features of Jouberts syndrome including dilatation of the fourth ventricle with some appearing bat-wing shaped, elongation and stretching of the superior cerebellar peduncles, dysphasia of the vermis, widening of the foramen of Magendie and the posterior cistern. One case was associated with encephalomeningocele. CONCLUSIONS MRI can provide characteristic findings of Jouberts syndrome and confirm the clinical diagnosis.

MRI of porencephalic cyst associated with cerebral hemiatrophy

Whereport seven cases of porencephalic cyst associated with cerebral hemiatrophy. One case was due to an unknown prenatal factor. One case had maternal injury and shock, which presumably caused temporary fetal asphyxia. One case had perinatal asphyxia. The other four cases had infantile head injury; of these, two cases had serial follow-up computed tomography (CT) and magnetic resonance imaging (MRI) that verified the evidence of post-traumatic infarction of the brain, and then caused porencephaly with cerebral hemiatrophy. In the other two cases, MRI clearly showed “ulegyria” on the side of the lesion, which is evidence of remote hypoxic ischemic damage. These cases lead us to believe that hypoxic ischemic damage of the brain is the etiology of porencephalic cyst when associated with cerebral hemiatrophy or when adjacent ulegyria is present.

MRI of kernicterus

We report six cases of kernicterus examined by MRI. All showed symmetrical high-signal lesions in the globus pallidus bilaterally on long TR images. Two showed high-signal lesions in the subthalamic nuclei and in the corticospinal tracts of the midbrain. Three revealed dilatation of both lateral ventricles, reflecting atrophy of the hippocampus. The lesions described correspond to the pathological reports of kernicterus, that is, icteric discoloration, atrophy with loss of nerve cells and glial scarring in the globus pallidus, subthalamic nuclei and Ammon’s horn of the hippocampus.

MRI of spinal hematoma as a result of lumbar puncture

A 59-year-old woman was suspected of having meningitis. A lumbar puncture was performed for CSF analysis; however, a traumatic tap induced hemorrhage in the subarachnoid space and formed a hematoma from the L3 to the S1 level. This resulted in a paraparesis. Myelography showed a band-like filling defect and a subsequent computed tomography (CT) myelogram showed a soft tissue mass in the intradural space. T1 weighted magnetic resonance imaging revealed a lesion with moderate hyperintensity within the dural sac, hinting that the lesion was a hematoma. Laminectomy was performed, and the hematoma was entirely removed.

Acute spinal epidural abscess in the whole spine: case report of a 2-year-old boy

We report on an acute epidural abscess in a 2-year-old boy, extending from the C1 level to the L5 level. The causative agent was Staphylococcus aureus as proved by pus and blood culture. The infectious source was in the scrotum. The diffuse epidural abscess was readily detected by MRI, which showed hypo-intensity in T1 WI and hyperintensity in gradient echo T2-weighted images. The abscess capsule was enhanced by Gadolinium-DTPA. The patient recovered completely after adequate treatment with antibiotics and follow up MRI showed complete disappearace of the epidural abscess. abscess.