 There are numerous areas of cystic encephalomalacia, corresponding to areas of previously seen hemorrhagic insult on the previous perinatal MRI. The most conspicuous areas involve the right anterior frontal lobe as well as involving the right superior frontal gyrus near the vertex. Smaller areas of abnormality are seen along the occipital poles bilaterally. There is associated ex vacuo dilatation of the frontal horns. There is also focal ex vacuo dilatation of the lateral margin of the body the left ventricle areas of additional encephalomalacia in the region of the basal ganglia bilaterally. In additiona, the caudate nuclei are barely identifiable. Areas of T2 hyperintensity were seen to involve these deep gray nuclei previously. There is a relative severe paucity of white matter limiting assessment for normal myelination, although this appears delayed.The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is prominence of Waldeyer's ring structures as well as cervical and retropharyngeal lymph nodes, which are nonspecific but most likely reactive in a patient of this age. There is mild fluid signal within the mastoid air cells bilaterally.SPINE
1. Interval expected evolution of previously seen scattered areas of parenchymal hemorrhagic insult, with subsequent development of encephalomalacia. Also suggestion of previous insult to basal ganglia and bilateral caudate nuclei now with associated encephalomalacia.2. Overall paucity of white matter volume limiting evaluation for degree of myelination, although it appears to be delayed.3. Skin marker along its sacral dimple at most minimal linear low signal within the subcutaneous fat extending to the left aspect of the coccyx, without evidence of a clear sinus tract extending into the central spinal canal.4. No MR evidence of tethered cord. Abnormal focal somewhat linear T2 hyperintense signal along the midline dorsal aspect of the distal cord at the T12 level. Differential diagnosis includes a developmental conus cyst, a small area of focal myelomalacia, atypical cervical hydromyelia, with cystic neoplasm not entirely excluded, and follow-up postcontrast imaging is recommended. Ventricularis terminalis cyst is felt to be less likely given its eccentric location within the cord, and partial split notochord is felt to be unlikely given lack of any associated segmentation anomalies.5. Trace scattered prominence of the central spinal canal within the cord, likely within normal limits.