Unexpected findings on brain and spine imaging in children

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Prominence of the subarachnoid spaces

MRI of the brain obtained for macrocephaly in infancy usually demonstrates prominence of the subarachnoid spaces (Fig. 1), in which case it supports the diagnosis of external hydrocephalus. It is an occasional finding among infants with nonspecific developmental delay and a large number of more exotic conditions, including achondroplasia [1], Marfan syndrome, Sotos syndrome [2], Kneist disease [3], congenital myotonic dystrophy [4], hypomagnesemia [5], chronic glucocorticoid exposure [6], [7],

Arachnoid cyst

An arachnoid cyst is a closed cavity adjacent to the brain occupied by cerebrospinal fluid (CSF) and lined with a thin, transparent membrane of arachnoid. It is a congenital lesion thought to arise in the space between the leaves of an abnormal duplication of the arachnoid membrane [12]. The CSF within the cyst may collect by diffusion through the arachnoid lining from surrounding CSF cisterns, by ball-valve flow through a macroscopic communication with those cisterns, or from the secretory

Other brain cysts

CSF-filled cysts can occur within the brain itself. On MRI the cyst contents appear identical to CSF on each imaging sequence, and there is no surrounding signal change or contrast enhancement. One common location for such cysts is within the choroidal fissure of the temporal lobe, adjacent to the temporal horn of the lateral ventricle (Fig. 3) [29]. Similar lesions within the parenchyma of the brain are thought to be attributable to focal dilatations of the Virchow-Robin spaces, which are the

Developmental venous anomalies of the brain

The intracranial venous system conforms fairly consistently to a well-recognized pattern on the scale of the larger cerebral veins and dural venous sinuses, and, like the arterial system, there is greater variation at the level of the secondary and tertiary vessels. Occasionally, developmental aberrations of the larger veins create startling MRI abnormalities. The most distinctive is the caput medusae pattern in which a number of smaller subcortical veins (the snakes) converge at the origin of

Spelunking in the brain

There are three midline cava in the brain: the cavum septi pellucidi, the cavum vergae and the cavum veli interpositi. These cava represent dilatations of normal developmental potential spaces. The cavum septi pellucidi is a dilatation of the space between the leaves of the septum pellucidum, the thin glioependymal membrane separating the frontal horns of the lateral ventricles in the midline (Fig. 8A). It is a perfectly normal structure through fetal development and well into the first

Lipomas of the central nervous system

Although they have been described at almost any site that can be named within the central nervous system, lipomas are developmental aberrations that tend to appear in midline locations. By far the most common is the filum terminale, where a small quantity of adipose tissue is present normally [74], [75], [76]. Lipomas are sometimes discovered in the corpus callosum, the chiasm/hypothalamus, and the pineal region, and they have been described less commonly at sites off the midline, such as in

Syringomyelia

The word syrinx is derived from the Greek word for tube, and it signifies a cavitation within the substance of the spinal cord. The terms syrinx, syringomyelia, and hydromyelia are often used interchangeably, although some authors use the last term more narrowly to signify dilatation of the central canal of the spinal cord. The demonstration of syringomyelia and its associated conditions by MRI is now so facile, particularly by comparison with the arduous neurodiagnostic methods required in the

Imaging studies and the cascade effect

The motivation for this article has been to empower pediatricians, in cooperation with their colleagues in pediatric neurosurgery, to interrupt what has been called the cascade effect [90] in the assessment of unexpected findings on imaging studies. The cascade effect is familiar to every clinician. In order not to overlook anything, a physician decides to err on the side of caution and orders a marginal test. Perhaps because of statistical variation or perhaps, as in the case of neuroimaging,

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      With increased availability of MRI, there is an increasing referral of patients with incidental findings, so-called Victims Of Modern Imaging Technology (VOMIT).26 This increase in access to high-quality imaging is likely the reason for incidental pineal cysts being increasingly reported.2,4,6,12,17,27-32 It is therefore necessary to identify patients who are at risk of developing symptom; this reduces the burden of unnecessary follow-up appointments on neurosurgical and neuroradiologic institutions.

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      Enlargement of the subarachnoid spaces is characterized radiologically by increased cerebrospinal fluid in the subarachnoid spaces, usually bifrontal, with a widened interhemispheric fissure and normal to slightly increased ventricular size (Fig 1) [1]. It is an occasional finding in the neuroimaging of children with macrocephaly [2]. The overall incidence of enlargement of the subarachnoid spaces is difficult to estimate.

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