Presentation
Neonatal sepsis. Full fontanelle, Maternal herpes simplex virus. Meningitis? Encephalitis?
Patient Data
Cavum septum pellucidum et vergae.
Extensive bilateral low attenuation in the frontal, temporal, parietal and occipital lobes in keeping with ischemic change.
Small amount of high attenuation in the left frontal horn and in the left cerebellar hemisphere suggestive of blood.
Cavum septum pellucidum et vergae.
Extensive supratentorial diffusion restriction and high T2 signal involving all lobes, with a superficial, parasagittal and occipital predominance.
Punctate diffusion restriction involving the basal ganglia bilaterally (right more than left) in keeping with perforator territory arteriopathy.
Small volume posterior fossa and left caudothalamic notch hemorrhage.
Diffusion restriction layering within the ventricles may represent hemorrhage or possibly ventriculitis.
No extra-axial collections or abscess formation. No hydrocephalus.
3 years later. Acquired brain injury secondary to Group B streptococcus at 3 days of age with extensive MRI changes. 4 limb cerebral palsy. Horizontal nystagmus. Scoliosis emerging.
Cavum septum pellucidum et vergae.
Bifrontal cortical atrophy with prefrontal cystic encephalomalacia. Mild ventriculomegaly with asymmetry of both the lateral ventricles with ex-vacuo dilatation of the frontal horns, worse on the right.
5 mm cyst in the right medial temporal lobe.
No focus of restricted diffusion, hemosiderin deposition or mass lesion.
Mild thinning of the corpus callosum.
The midline structures, including sella, brain stem, cerebellum are normal.
Normal craniocervical junction.
Case Discussion
The initial MR shows extensive hypoperfusion and perforator diffusion restriction, in keeping with an ischemic injury as a sequela of neonatal meningitis. This was due to a Group B streptococcus, one of the three commonest organisms in neonatal meningitis.
The follow-up MRI several years later is in keeping the permanent changes from a perfusion injury.