Pediatric head trauma is very common and accounts for most of the emergency hospital visits. It is also the most common cause for a pediatrician to refer a child for neuroimaging. Pediatric head injury causes lot of morbidity and mortality in children and can be due to accidental or abusive injury. Falls are most common in small children, whereas motor vehicle accident is more common in older children and adolescents. Pediatric brain injury differs from adult brain injury due to immature brain, mechanism of injury, and difficulty in neurological evaluation in children. The radiologist needs to be familiar with these to correctly interpret the scans and guide clinicians in appropriate patient care.
Subacute sclerosing panencephalitis (SSPE) is a late progressive fatal central nervous system sequelae of measles infection. The diagnosis is made based on clinical and electroencephalography (EEG) findings and confirmed by elevated titers of anti-measles antibodies in cerebrospinal fluid. The usual clinical presentation is in the form of progressive behavioral change, cognitive decline, and myoclonic jerks with some cases presenting in an atypical manner in the form of ataxia, epilepsy, and stroke. EEG is quiet characteristic in the form of periodic discharges of slow wave complex. Magnetic resonance imaging (MRI) early in the disease is usually normal with abnormal scans showing focal leukodystrophy, predominantly in the posterior cerebral white matter, and development of cortical atrophy with disease progression. Cord involvement is not common in SSPE. We report a child with SSPE who had initial presentation with cerebellar ataxia, acute progression of encephalitis, and atypical EEG findings. MRI brain on the initial presentation showed very subtle and focal abnormality which later progressed to have disseminated brain lesions and dorsal cord myelitis and further in the disease course showed cerebral venous sinus thrombosis. This case report emphasizes that SSPE can have very atypical presentation with rapid deterioration and can mimic as acute encephalitis or demyelinating disease.
Molybdenum cofactor deficiency (MoCD) is an inborn error of metabolism which presents with neonatal encephalopathy, seizures, and a turbulent postnatal course. It is an under-recognized cause of neonatal encephalopathy as it mimics hypoxic ischemic encephalopathy (HIE) on imaging. We present the case of an affected male neonate of a twin pregnancy whose magnetic resonance imaging in the early neonatal period showed restricted diffusion in lobar distribution with areas of cystic gliosis and mild tortuosity of the intracranial vessels. There are only a few case reports to the best of our knowledge which describe magnetic resonance (MR) findings of MoCD on diffusion-weighted images, none of which mentions unilateral changes or vessel tortuosity. MoCD should be considered in children with MR findings mimicking HIE in the absence of a history of perinatal hypoxia. This is important as the disorder has a poorer prognosis and the parents need appropriate prenatal counseling.
Cystic changes in the lungs in neonatal age group as well as children are commonly encountered in day-to-day practice of paediatric chest imaging. It is therefore important to know the patterns of cystic disease, many of which are classical with definitive treatment options, to enable appropriate clinical care. This article briefly reviews the common conditions presented in our patient population with cystic changes in the lungs. The lesions have be classified as Congenital or autoimmune and Acquired conditions. The acquired lesions are largely infective in nature and represent a wide variety of infectious conditions.
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