Male, 22 days old, full-term infant with history of meningitis and seizures. Since the prior examination, extensive diffuse and symmetric cystic encephalomalacia has developed affecting both cerebral hemispheres. The basal ganglia and inferior anterior temporal lobes are relatively spared though not completely free of signal abnormality. The brainstem and cerebellum are spared. The affected tissue demonstrates T1 hyperintensity without susceptibility effect likely indicating laminar necrosis. No evidence of diffusion restriction is seen. The ventricles have increased in caliber from the prior examination though they are not significantly dilated. The flow voids corresponding to the transverse sinuses and the right sigmoid sinus are absent with evidence of T1 hyperintensity and susceptibility within the sinuses.
Interval development of extensive supratentorial cystic encephalomalacia is noted. The brainstem and cerebellum are spared. The basal ganglia and anterior inferior temporal lobes are partially spared. The pattern and symmetry of the findings would favor hypoxic ischemic injury, though intracranial infection could also potentially produce or contribute to these abnormalities. Findings are also seen concerning for venous sinus thrombosis affecting the transverse and right sigmoid sinuses.