Multiple congenital anomalies (including encephalocele and macrocephaly). Status post encephalocele repair. BRAIN:There are changes of the recent occipital encephalocele resection. Blood products are present along the resection margin from the left occipital lobe and in the posterior body of the left lateral ventricle. There is also minimal similar signal intensity deep in the left occipital lobe, within or just inferior to the occipital horn of the left lateral ventricle, image #11 of series #401 and series #501. The right lateral ventricle continues to be almost entirely collapsed while the left lateral ventricle is mildly dilated. While the corpus callosum is absent posteriorly, the genu and anterior body of the corpus callosum appear to be present but thin. There is suggestion of malformation of cortical development, probably polymicrogyria, involving the remaining left occipital lobe. The sylvian fissures are not well formed, worse on the right. Nodularity that is isointense to gray matter along the margins of the left lateral ventricle probably represent subependymal heterotopia. Similar signal intensity in the deep right frontal white-matter which likely is also periventricular around the the collapsed right lateral ventricle is fel to be of the same etiology. The posterior pituitary bright spot is preserved.There is no evidence of peri-Rolandic/central deep white matter myelination. Myelination of the posterior limb of internal capsules is difficult to assess given the distortion caused by the large left occipital encephalocele and posterior fossa malformation, although there may be minimal linear T2 hypointensity in the posterior limb if the right internal capsule.The posterior fossa is crowded with the cerebellum wrapped around the brainstem, although this configuration may be related to the presence of previous occipital encephalocele. The tectum is beaked-shaped. The cerebellar tonsils are peg-shaped and extend below the level of foramen magnum though it is difficult to measure the degree of ectopia. The fourth ventricle is small. These findings are similar to the Chiari II malformation. Of note, the occipital encephaloceles typically associated with the rare Chiari III malformation contain cerebellum or other posterior fossa structure unlikely this patient.Secretions are present in the nasopharynx and oropharynx by the patient is intubated. There is no gross orbital abnormality.WHOLE SPINE:Alignment of the spine is anatomic. The spinal canal is preserved. There is mild expansion of the central canal within the cord which is most prominent in the cervical region at C5-C6 level down to C7-T1 level, where it less then 2 mm in diameter.The spinal cord shows normal signal otherwise. The tip of the conus medullaris is at L1-L2 level, which is normal. There is no open spinal dysraphism. Linear thickening of the posterior subcutaneous fat to the left of midline might be part of the Y shaped gluteal cleft described in the clinical note. Unfortunately, it is only included on the last axial image.6 mm T1-hypointense, T2-hyperintense subcarinal focus may reflect a small bronchogenic/foregut duplication cyst or fluid-filled pericardial recess. There is suggestion of asymmetric enlargement of the left first sacral segment ala.
1.Expected findings related to the recent occipital encephalocele resection.2.Other congenital brain abnormalities include Chiari type appearance of the posterior fossa, partial callosal agenesis with dilated left lateral ventricle containing blood products, and suspected left occipital polymicrogyria which can be further evaluated in the future with 3D T1 weighted images. There is bilateral subependymal heterotopia. For the posterior fossa malformation, although the morphology is similar to Chiari II or III malformations, there is no open spinal dysraphism and the occipital encephalocele did not contain posterior fossa structures to fit any of these 2 diagnoses, respectively. The configuration may more be due to distortion of the intracranial structures with respect to abnormal calvarial contour from the encephalocele.3.There is no open spinal dysraphism. Incompletely imaged linear hypointensity reversing the inferior lumbar posterior subcutaneous fat to the left of midline may represent a portion of the Y-shaped gluteal cleft described in the clinical note. 4.Mild but focal expansion of the lower cervical spinal canal is compatible with a syrinx. Otherwise, diffuse subtle prominence of the remainder of the central canal within the cord may reflect either transient dilatation or soft syrinx. Contrast-enhanced follow-up MR of the spine may be obtained.5.Other developmental abnormalities including delayed myelination and poor sylvian sulcal development.6.Subcentimeter subcarinal fluid signal may reflect a small bronchogenic/foregut duplication cyst or fluid-filled pericardial recess.