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9 Year old Male MRI of Brain - Please help
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9 Year old Male MRI of Brain - Please help

Patient
9 year old male.  No signs of motor functions problems or development concerns at all.  Makes straight A’s every year, started school 1 year early.  Plays sports very well.  Has had “fibril seizures” – 4 in total spread out of the past 8 years.

Why?
An MRI was done because the patient said he had a headache later characterized by the doctor as a “Thunderclap headache” so the family doctor ordered EEG and MRI.  Now we are being referred to Pediatric Neurologist.

The report, which was picked up from the MRI imaging facility, is retyped below. (excuse any spelling mistakes).  I have numbered each “category” spoke of in the report section titled “FINDINGS”  The Impression section below was identified on the report as “Impression”

Given that items 2, 4, 5, 6, 7, 8, 10, 11, 12, 13 seem to indicate “normal” things, I have no questions regarding these unless someone feels I should have any information about them, and I am certainly welcoming all information.

Items 1, 3 and 9, which are later identified in the impression section (not numbered the same) pose concerns to me and my wife.  We will soon, however definitely not soon enough, see the only pediatric neurologist in the state.  

As parents, we are overwhelmed with this information and seeking help in understanding what all this means.  Certainly the Dr. will further explain, but we would like to know what we are up against in the mean time since it might be a while until we see the Doctor (we have no appointment yet, they said they will call on Monday, July 13th, 2009 to schedule one)

MRI FINDINGS:


1. There is an irregular globular shape of the marrow of the sphenoid portion of the spheno-occipital synchondrosis of the clivus.  Given the patient’s age, this is likely irregular ossification.  This marrow is minimally hyperintense on T2.  Given the lack of significant marrow abnormality, this is likely age-related.  A head CT with bone windows would be helpful to confirm and exclude the less likely possibility of a lesion such as fibrous dysplasia.

2. The midbrain and pons appear normal.

3. There is abnormal gliotic signal seen within the periventricular white matter adjacent to the posterior horns, right greater than left.  There is ex vacuo enlargemement of the right posterior horn.  This is consistent with non-acute leukomalacia possibly related to periventricular leukomalacia related to prematurity.  

4. The temporal horns appear normal.

5. The hippocampus appears normal bilaterally.

6. There is no evidence of the mesial temporal sclerosis.

7. Optic chiasm appears normal.

8. Pituitary appears normal.

9. There is a midline posterior fossa cyst, which is isointense to the CSF on all sequences.  The corpus callosum appears normal.

10. Colliculi plate and pineal gland appear normal.

11. Visualized intercerebral vasculature appears normal.

12. There is mild prominence of the nasopharyngeal adenoids (adenoids).

13. There is no sinus opacification.


REPORT IMPRESSIONS INDICATED BY DOCTOR:
1. Posterior parietal periventricular leukomalacia, right greater than left.
2. Posterior fossa cyst
3. Irregular sphenoid portion of the clivus as described above.
657231_tn?1390151580
I did some research - please take this with a "grain of salt" as these excerpts are taken from medical sites and the situation may or may not exactly match that of your son.

This was about cognitive visual defects -  "We suggest a widespread involvement of higher visual processing systems, involving both the ventral and dorsal streams, in preterm children with periventricular leukomalacia. The lack of major alterations on conventional MRI does not exclude the possibility of malfunctioning of higher visual processing systems, expressing itself through discrete CVDs. Possible mechanisms underlying these neuropsychological deficits are discussed."

"Posterior fossa cysts — Dorsal cyst associated with holoprosencephaly, Dandy-Walker cyst, and vein of Galen aneurysm"

I could not find a good site for the clivis.

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rumpled
Northern, NJ