PaedsNeuro: vasc/infect/trauma/spine

Playlist contributed by: Dr Annabelle Skelley

Vascular Malformations:

Malformations with AV shunts:

  1. AVM -> feeding artery, nidus, draining vein (calcification) -> serpiginous
  2. Dural AVF -> not in paeds (acquired) -.arterialization of dural venous sinuses

Malformations without AV shunts:

  1. Cavernoma -> pons common, heterogenous with haemosiderin rim, calcification
  2. DVA -> "leash" of vessels draining towards anomalous vein

Sturge Weber

  1. Gyriform calcification = pial angiomas (gyral atrophy and ischaemia of grey matter)
  2. Ipsilateral choroid plexus hypertrophy
  3. Port wine nevus (same side and gyral calcification) 

Moya Moya

  • Idiopathic, non-inflammatory vaso-occlusive disease of COW (usually supraclinoid ICAs, also PCAs)
  • Small/occluded distal ICAs with multiple small collateral vessels -> puff of smoke appearance on angio
  • Cause watershed infarcts

Meningitis

  • Cause of hydrocephalus -> may be communicating or obstructive
  • CT often normal 
  • Look for subdural effusion/empyema
  • Cerebritis: parenchymal low attenuation (may develop into abscess) 
  • Abscess: thin walled, rim enhancing, central diffusion restriction 

Encephalitis

  • Increased T2 signal in medial temporal lobes, insula, cingulate gyrus
  • Usually bilateral but asymmetric
  • Atrophy/gliosis/encephalomalacia long-term 

NAI

  • Skull fractures -> look for wormian bones to differentiate from OI

Scoliosis

  • Idiopathic (80%)
  • Neuromuscular

Scheuermann's Condition

  • Juvenile kyphosis
  • Thoracic kyphosis >40deg with wedging of 3 consecutive vertebrae
  • Can involve lumbar spine

Congenital Malformations of the Spine

  • T1WI = anatomy & fat

Open:

  • Associated dermal defect (usually detected prenatally)
  • Meningocele
  • Myelomeningocele 
  • Lipomyelocele (most common) - posterior defect with fatty subcutaneous mass

Closed:

  • Spina bifida occulta = non-fusion of posterior elements
  • Cord tethering = low-lying conus (below L2 in newborns -> ascends as they grow); thickened filum terminale > 2mm 
  • Spinal lipomas = seen in normal or bifid canals, can be incidental
  • Fatty filum terminale - can be associated with tethered cord, fat signal in filum terminale
  • Caudal regression
  • Diastematomyelia = two hemicords split by sagittal bony or cartilagenous spur, associated vertebral segmentation abnormality, associated syrinx in 50% 

Note: developmental lesion are most common cause of paediatric intraspinal masses

Sacrococygeal Teratoma

  • Coccyx always involved

 

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