061031 GERMINAL MATRIX HEMORRHAGE AND MYELOMENINGOCELE

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061031 GERMINAL MATRIX HEMORRHAGE AND MYELOMENINGOCELE

Contributed by: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.

Patient: 1 day old

History:

Prematurity with gestational age: 30 wks; Birth body weight: 1330 gm
Poor activity and weakness of lower limbs at birth.
A reddish protruding mass over lower back with small clear discharge.
Pregnancy history: high alphfetoprotein (AFP):109(>20) at 17 wks.

Images:

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Fig. 1


Fig. 2: T2 sag


Fig. 3: T1 Gd sag


Fig. 4: T1 axi


Fig. 5: T2 axi


Fig. 6: T2 sag


Fig. 7: T2 sag


Fig. 8: T2 sag


Fig. 9: T1 Gd cor


Fig. 10: T1 Gd cor


Fig. 11: 3 month old, pre OP

Findings:

MRI of brain and lower spine with T1, T2, and with IV contrast:

1. Relative smooth cerebral gyri and shallow sulci with the
   appearance about 28-29 weeks, mild delayed brain development
   can be suspected. Transcerebellar diameter (TCD): 32mm.
2. Some short T1 and T2 materials in left subependymal region and
   bilateral occipital horns of lateral ventricles with
   fluid-fluid levels, suggesting intracellular methemoglobin
   from germinal matrix hemorrhage.
3. Mild dilatation of bilateral lateral ventricles (depth of lateral
   ventricle= 1.0cm > 0.8cm) and presence of MR dangling
   choroid plexus in left lateral ventricle, suggesting mild hydrocephalus.
4. A 2.4x0.8 cm long T1 and T2 protruding mass with CSF and
   neural tissue containment without IV contrast enhancement
   over sacral region, in favor of myelomeningocele with tethered
   cord, but without MR evidence of infection.

Diagnosis:

1. Germinal matrix periventricular and intraventricular
hemorrhage with mild hydrocephalus.
2. Myelomeningocele with tethered cord, sacral region.

Comments:

Q: Why this newborn received MR scan of brain?

A: Whenever a neural tube abnormality is detected, the fetal head

should be carefully evaluated for evidence of any brain

malformation, such as Arnold-Chiari type II malformation.

By Dr. Tsao

--pedrad CSH, 2006-11-07

Additional Details:

Case Number: 7099268Last Updated: 01-19-2007
Anatomy: Spine and Peripheral Nervous System Pathology: Congenital
Modality: Photograph, MRAccess Level: Readable by all users
Keywords: germinal matrix hemorrhage myelomeningocele danglingACR: 368.1452

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