What are the main imaging findings?
T2/FLAIR hyperintensities in the white matter, predominantly in the parietal lobes. There is sparing of the immediate subcortical matter. Microcephaly is also evident.
This is a chronic condition for this patient, who had a normal birth. Can you suggest a diagnosis from this?
This is most likely congenital CMV infection (one of the TORCH conditions). More overt periventricular changes, or with a history of perinatal hypoxia, may sway towards periventricular leukomalacia (PVL). In an adult, such overt white matter change could suggest a vascular pathology. Note no U-fibre involvement, nor other areas of the CNS, reducing the likelihood of demyelination on imaging.
Deep white matter hyperintensities, predominantly in the parietal and right temporal lobes. These spare the immediate subcortical matter/U-fibres. Dedicated seizure sequences not performed but no gross migrational abnormality. Normal posterior fossa. Normal midline structures and brainstem. No abnormal restricted diffusion.
Normal CSF configuration. Normal expected vascular flow voids.
Microcephaly. Normal skull base and craniocervical junction.