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Resident on call CMH cases

Resident on call CMH cases. Collected by: Lisa H. Lowe, MD. History: Not waking up for night time feeding & hypotonia. a. Findings:. Lens shaped hyperdense area indicates epidural hematoma Midline shift Some dark non-clotted blood is seen also. a. Dx: Epidural hematoma.

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Resident on call CMH cases

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  1. Resident on call CMH cases Collected by: Lisa H. Lowe, MD

  2. History: Not waking up for night time feeding & hypotonia a

  3. Findings: • Lens shaped hyperdense area indicates epidural hematoma • Midline shift • Some dark non-clotted blood is seen also a

  4. Dx: Epidural hematoma • Nonaccidental trauma • Surgically evacuated a

  5. Hx: 8y male s/p MVA not waking

  6. Findings: • Hyperdense perimesencephalic cisterns indicate subarachnoid blood • Narrowed midbrain worrisome for diffuse cerebral edema

  7. Dx: Subarachnoid hemorrhage • Hyperdense perimesencephalic cisterns indicate subarachnoid blood • Narrowed midbrain worrisome for diffuse cerebral edema

  8. Hx: 6y female severe headache & past hx of arachnoid cyst

  9. Findings: • Subdural fluid, hypodense bilateral (flattened gyri and no crossing vessels seen) • Not subarachnoid fluid • Arachnoid cyst seen at lower level in temporal fossa

  10. Dx: Subdural effusion due to arachnoid cyst rupture

  11. Hx: 1 yr female seizures

  12. Findings • Square shape frontal horns is seen with absent septum pellucidum • Clefts in the brain bilateral, left > right indicates schizencephaly

  13. Dx: Septooptic dysplasia

  14. Hx: 3 yr near drowning

  15. Findings • Diffuse loss of gray white differentiation • Bilateral foci of low density in the thalami

  16. Dx: Profound hypoxic ischemic injury in a child • With not so severe HIE, there is often watershed injury with preservation of thalami (due to preferential shunting of oxygenated blood to thalami) • With total anoxia or prolonged hypoxia, the shunting does not work and the thalami may take the biggest hit • This worst situation is with both involved as in this child

  17. Hx: Premature infant with drop in hematocrit

  18. Findings: • Heterogeneous lesion in the posterior fossa with high and low density indicating partially clotted blood • Linear periventricular high density and at the caudothalamic grooves indicates germinal matrix still present (arrowhead) • Cortex also high density due to extreme prematurity

  19. Dx: Posterior fossa hemorrhage

  20. Hx: Macrocephaly

  21. Findings • Prominence of the CSF spaces around the brain • There is no flattening of the gyri and there are tiny vessels in the CSF indicating it is the subarachnoid, not subdural space

  22. Dx: Benign enlarged subarachnoid spaces • Seen most 3m - 3yrs • Presents with macrocephaly in an otherwise healthy child • Resolves spontaneously • Associated with slight increased risk of subdural bleed

  23. Hx: Apnea in a 2 week old

  24. Findings • Prominent venous structures, including the internal cerebral veins & straight sinus

  25. Dx: Normal prominent venous sinuses • Can mimic venous sinus thrombosus • Should do contrasted exam if unsure and if not thrombus will see enhancement

  26. Hx: Persistent vomiting in 4-yr-old male

  27. Findings: • Posterior fossa low density mass with peripheral calcification

  28. Dx: Ependymoma • DDx: • Medulloblastoma • Juvenile pilocytic astrocytoma • PNET

  29. Hx: Baby fell of couch

  30. Hx: Baby fell of couch • Hyperdense subdural blood on left side indicates recent trauma • Loss of left side sulci due to subdural fluid

  31. Dx: Nonaccidental injury • Hyperdense subdural blood on left side indicates recent trauma

  32. Hx: Child stopped breathing a

  33. Findings: Mixed density left subdural blood with left to right shift a Left loss of gray white differentiation and shift left to right of midline

  34. Dx: Hyperacute subdural hematoma Mixed density indicates blood has not had time to clot yet Requires urgent surgical intervention Must distinguish from acute on chronic SDH, in which there is there is not acute mass effect a

  35. Hx: Seizure in 8 day old

  36. Findings: • Bilateral high density in the thalami • Prominent internal cerebral veins (arrowhead) • Focus of right frontal horn intraventricular blood (arrow)

  37. Dx: Venous hemorrhage due to venous sinus thrombosis • Internal cerebral vein thrombus, most common in babies, classically causes bilateral thalamic ischemia/hemorrhage

  38. Hx: Newborn with CHF and head bruit

  39. Findings: • Hydrocephalus from obstruction of 4th • Enlarged Vein of Galen and transverse sinuses

  40. Dx: Vein of Galen varix • Treated with intravenous coils

  41. Hx: Newborn with in utero hydrocephalus

  42. Findings • CSF space that connects with 4th ventricle (arrow) • Hypoplastic cerebellum and large retrocerebellar fluid collection • Hyrocephalus • Macrocephaly

  43. Dx: Dandy Walker malformation • DW cyst has NO cerebellar vermis • DW variant has some vermis • DW malformation includes DW cyst and variant • On CT hard to know if there may be a little vermis, so just say DWM and leave specifics to MRI reports

  44. Hx: Seizure and headache 15yf

  45. Findings • Hypodense area left frontal lobe • Vague • No contrast given • MRI planned

  46. Hx: Multiple sclerosis • Multiple foci in white matter on FLAIR MRI

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