Female, 2 years old, with microcephaly, hypoxic brain injury in infancy, hemiparesis, history of seizures. Encephalomalacia is redemonstrated within the right cerebral hemisphere in a largely watershed distribution similar to that seen on the prior examination. The degree of encephalomalacia has, however, progressed. Much less extensive encephalomalacia is seen within the left cerebral hemisphere, mainly along the precentral gyrus and within the subjacent deeper white matter, also somewhat more prominent when compared to the prior examination.Additional more focal areas of tissue loss and/or signal abnormality are seen in the bilateral basal ganglia, similar to prior, as well as within the cerebellar hemispheres, also similar to prior. Vague signal abnormality within the bilateral thalami is new when compared to the prior examination.No evidence of restricted diffusion is seen to suggest acute ischemia. No parenchymal edema or mass effect is observed. A punctate focus of susceptibility is seen along the left caudothalamic groove compatible with microhemorrhage. No significant intracranial hemorrhage or any abnormal extra axial fluid collection is seen.On postcontrast imaging, no pathologic parenchymal or extra-axial enhancement is detected.
1.Sequelae of extensive prior ischemic injury are demonstrated, most conspicuously within the right cerebral hemisphere where the pattern is largely in a watershed distribution.2.Conspicuity of chronic appearing ischemic injury has increased within the cerebral hemispheres and at the level of the thalami, which could represent evolution of old lesions or interval accumulation of additional lesions. Lesions within the cerebellum appear grossly unchanged from prior.3.No evidence of acute ischemia is detected on this examination, nor of any other definite acute intracranial abnormality.