High T2 signal of the central tegmental tract, which connects the red nucleus and inferior olivary nucleus, is an uncommon finding typically encountered in early childhood.
The central tegmental tract refers mainly to the extrapyramidal tracts connecting between the red nucleus and the inferior olivary nucleus. This tract is one of the earliest regions in which myelination begins (9 months after conception) 3. Symmetrical central tegmental tract hyperintensities on T2-weighted images are an uncommon finding 2.
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Epidemiology
The symmetrical central tegmental tract hyperintensity occurs more frequently during the early childhood between 1 and 5 years of age 2,3. It is encountered in a variety of settings including 2,5:
epilepsy
metabolic disorders
Occasionally it is found in children with no clinical neurological finding 2,3.
Pathology
The etiology is unclear and numerous theories for the pathogenesis have been suggested, including intramyelination edema, gliosis or secondary degeneration of the cerebral white matter 1.
Some authors suggest that the majority of imaging findings simply represent a physiological maturation-related process 3.
Radiographic features
MRI
T2: symmetrical hyperintensities in the central tegmental tracts
DWI/ADC: may show restricted diffusion
Treatment and prognosis
The meaning of this finding, its clinical correlation with various neurologic deficits and prognosis remains unclear, and in some instances it is reversible 3,4.
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