Encephalomalacia is frequently used by radiologists to describe any area of cerebral parenchymal loss with or without surrounding gliosis.
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Terminology
Encephalomalacia is an old term coined by pathologists to describe the macroscopic appearance of the brain following a variety of insults (e.g. cerebral infarction) and literally means "softening of the brain", as a result of liquefactive necrosis.
However, English-speaking radiologists have appropriated the term and use it perhaps more loosely to denote an area that has undergone liquefactive necrosis, leaving behind an area that follows CSF on all sequences.
It should be distinguished from gliosis, where tissue remains present, and porencephaly where a circumscribed near-cystic space is present communicating with the ventricles and/or subarachnoid space (although the terminology of porencephaly is also not universally agreed upon).
Clinical presentation
asymptomatic
serve as a focus of seizure
Pathology
Encephalomalacia is the end result of liquefactive necrosis of brain parenchyma following insult, usually occurring after cerebral ischemia, cerebral infection, hemorrhage, traumatic brain injury, surgery or other insults. It is often surrounded by an area of gliosis, which is the proliferation of glial cells in response to injury.
Subtypes
Radiographic features
CT
hypoattenuation, somewhat, higher than CSF
volume loss
often associated with gliosis and Wallerian degeneration
MRI
Follows CSF signal on all sequences including FLAIR.
T1: low signal
T2: high signal, attenuating fully on FLAIR
ADC: facilitated diffusion
History and etymology
Encephalomalacia stems from the Ancient Greek ἐν (en, meaning "in") + κεφαλή (kephalḗ, meaning "head") giving the commonly used ἐγκέφαλος (enképhalos, meaning "brain") and μαλακία (malakía, meaning "softness, sickness").
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