Male, 13 days old, ex 34 week infant, with feeding intolerance, right eye ptosis, and head ultrasound with questionable findings in the thalamus. A 5 mm focus of T1 and T2 hyperintensity is seen within the region of the ventrolateral nucleus of the left thalamus. In addition, a 4 mm focus of T1 hypointensity and T2 hyperintensity suggesting cystic degeneration is seen along the superior margin of the right frontal horn. Several very small cystic spaces are suspected along the left frontal horn, best seen on coronal T2-weighted images.No restricted diffusion is seen. No parenchymal edema or mass effect is detected. There is no evidence of any significant acute intracranial hemorrhage or abnormal extra-axial fluid. The ventricles are normal in size and morphology.The pituitary region is within normal limits. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed. The corpus callosum is fully formed and intact. The pattern of white matter myelination is appropriate for the corrected gestational age.
A focus of parenchymal injury is evident centered on the ventrolateral nucleus of the left thalamus. Small cystic areas within the white matter along the frontal horns are also favored to represent foci of parenchymal injury, less likely congenital or developmental cysts. Such findings are most commonly seen in the context of perinatal ischemia. Lack of diffusion restriction would suggest that the insult occurred at least 7-10 days previously.