Encephalomalacia

Last revised by Dr Rania Adel Anan on 27 Apr 2022

Encephalomalacia is frequently used by radiologists to describe any area of cerebral parenchymal loss with or without surrounding gliosis

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. 

English-speaking radiologists have, however, 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). 

  • asymptomatic 
  • serve as a focus of seizure

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.

Follows CSF signal on all sequences including FLAIR. 

  • T1: low signal 
  • T2: high signal, attenuating fully on FLAIR
  • ADC: facilitated diffusion 

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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