Female, 59 days old, with sepsis due to group B streptococcus, assess for abscess or structural abnormality. Presumed meningitis. Corrected gestational age of approximately 36 weeks. Relatively symmetric extensive gyriform T1 and T2 hyperintensity is seen involving the bilateral occipital and temporal lobes with associated diffusion restriction in the occipital lobes. The region demonstrates patchy susceptibility compatible with blood product. Evidence of developing encephalomalacia is also seen, particularly in both occipital lobes and the anterior left temporal lobe.Extra-axial presumably subdural hemorrhage is evident along the anterior lateral right temporal lobe measuring up to 6 mm in thickness. Bilateral subdural hemorrhages are also evident along the cerebellar hemispheres. The sigmoid sinus flow voids are evident but the transverse sinus flow voids are not well seen. Along the right cerebral hemisphere, a subdural hematoma is noted measuring up to 5 mm in thickness with T1 and T2 hyperattenuating material layering dependently.A 10 mm parenchymal hemorrhage is evident at the left caudothalamic groove. Hemorrhage extends from here into the left frontal horn. A small amount of hemorrhage is also evident at the level of the foramen of Magendie. There may be some hemorrhage layering within the occipital horns versus purulent material.Cystic encephalomalacia is seen within the left frontal lobe. The brain parenchyma is generally T2 hyperintense which may represent a combination of edema and immature myelination. Hemosiderin staining is seen along the choroid plexi.On postcontrast imaging, sulcal vascularity is noted, but there are no discretely rim-enhancing fluid collections.
1.Abnormal gyriform signal is seen within the occipital and temporal lobes with evidence of restricted diffusion in the occipital lobes. Some but not all of this parenchyma demonstrates susceptibility indicating the presence of blood product . Findings possibly represent a combination of ischemic injury with some laminar necrosis and superimposed hemorrhagic staining. The presence of purulent material could also potentially contribute to these findings.2.Evidence of developing encephalomalacia is seen in both occipital lobes and the anterior left temporal lobe. Cystic encephalomalacia is present in the left frontal lobe.3.Subdural fluid collections are present along the right lateral temporal lobe and along the right cerebral hemisphere. Blood product is seen layering along the cerebellar hemispheres adjacent to the transverse sinuses. The transverse sinus flow voids are not well visualized which could represent obscuration or compression from adjacent blood product. However, the possibility of sinus thrombosis or occlusion cannot be excluded.4.A germinal matrix hemorrhage is demonstrated on the left with intraventricular extension. Blood product is seen within the left frontal horn, and at the foramen of Magendie. Blood product and/or purulent material may also be present layering within the occipital horns. 5.Most or all of the above findings can be accounted for by a combination of prematurity and intracranial infection. No definite rim-enhancing collections are seen to suggest abscess.