Female, 22 days old, ex 36 5/7 wga, with seizures. Assess for structural brain malformation. Also with metabolic acidosis. A 3 mm focus of very mildly restricted diffusion is seen adjacent to the right frontal horn associated with minimally elevated signal on T1 and FLAIR images. No associated susceptibility is detected.The remainder of the brain demonstrates normal morphology and signal characteristics. The pattern of white matter myelination is appropriate for age. The corpus callosum is fully formed and intact. The pituitary region is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is patent, symmetric and normal in size.Single voxel spectroscopy was performed on regions of predominantly parietal gray matter, predominantly parietal white matter, and the basal ganglia. The spectra obtained from each of these regions is within normal limits. Specifically, the pattern of relatively elevated myoinositol and choline and relatively depressed NAA is typical and expected during the neonatal period. No unusual resonances are detected. No evidence of any clinically significant lactate is seen.
1. A single small focus of mildly restricted diffusion is seen adjacent to the right frontal horn. This could represent a very tiny ischemic lesion, though the relevance of this finding to the patient's clinical presentation is uncertain. Follow-up imaging in one to two months may be considered if symptomatology does not improve.2. Spectroscopic assessment of gray matter, white matter and basal ganglia regions is within normal limits for the neonatal period. No evidence of clinically significant lactate is seen.