16-year-old female, concern for hydrocephalus in a patient with history of seizure disorder. Developmental delays, reported seizures. The Sylvian fissures are normally formed and easily recognized however the other major sulci are not well formed or difficult to identify. The gyral pattern appearance of the cortex is disordered with evidence of diffuse polymicrogyria involving both cerebral hemispheres, more so superiorly than inferiorly. The pattern of the fissures and gyri in the cerebellum also appear to be somewhat disordered. There is patchy periventricular T2 hyperintensity along the atria and also more anteriorly in the corona radiata. The lateral ventricles appear widened specifically at the atria and temporal horns, favored to reflect a paucity of white matter. The frontal horns show normal contour. No findings to suggest elevated intraventricular pressure are seen. Prominence of the retrocerebellar CSF space is noted. The cerebellar vermis does appear to be normally formed, however, and the fourth ventricle and foramen of Magendie are unremarkable.The pituitary region is within normal limits. The corpus callosum is fully formed and intact. The brainstem is within normal limits.
1.Diffuse polymicrogyria with evidence of white matter loss and white matter injury. Findings could entirely reflect the sequelae of TORCH infection, or alternately, may reflect a prior parenchymal insult on a background of a syndromic migrational anomaly.2.Mild ventriculomegaly affecting the atria and temporal horns is favored to reflect loss of white matter rather than elevated intraventricular pressures.3.Prominence of the retrocerebellar CSF space may represent a mega cisterna magna or possibly an arachnoid cyst.