Presentation
Infant macrocephaly with an unprovoked seizure. MRI done 7 hours after the CT had demonstrated no acute findings.
Patient Data
Normal brain. Mild to moderately sized extra-axial fluid collection.
Extra-axial fluid collection, probably representing benign enlargement of subarachnoid space. Small bilateral posterior parietal subdural hematomas. Small bilateral CSF-blood levels of intraventricular hemorrhage in the occipital horns of the lateral ventricles. Multiple foci of subarachnoid hemorrhage.
Case Discussion
Prevously healthy 2-month-old infant with macrocephaly had a seizure. Physical exam and routine blood work were unremarkable. A head CT demonstrated no acute findings. A skeletal survey and ophthalmologic exam were normal. A head MR done 7 hours after the CT confirmed subdural, subarachnoid and intraventricular hemorrhage thought to be due to cortical venous thrombosis.
MRI scanning may not always be available for acutely ill infants. This case demonstrates the importance of obtaining urgent MRI studies if possible.