Patient with background of cerebral palsy. Presents with acutely reduced GCS and confusion.
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There is cystic expansion of the body and frontal horn of the right lateral ventricle into the right frontal lobe. The cyst is lined by white matter. Contents of the cyst follow CSF signal on all sequences. These findings are in keeping with an internal porencephalic cyst.
Note multiple small foci of high T2 and FLAIR signal scattered in the left frontal lobe which are nonspecific but likely due to mild chronic small vessel ischemia.
In this case, there was no evidence of acute intracranial pathology to account for the sudden decrease in GCS. The patient's acute presentation was later attributed to urosepsis.
The patient's cerebral palsy is likely a result of this porencephalic cyst.
Key findings consistent with an internal porencephalic cyst in this case were:
- communication of the cyst with the lateral ventricle
- contents of the cyst follows CSF signal
- cyst lined by white matter