R. Haase, Wolfgang Hirsch (Halle)  

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3 Weeks  

N/A  

Head-Brain and brain nerves  

inflammatory or infectious  

3 week-old infant, which was admitted because the mother was admitted for one week for acute mastitis in the gynecology department (Streptococcus agalacticae).

After the mother and child were discharged: Sudden shock and generalized seizures set in.  

The cause of the multicystic encephalopathy following meningitis is contributed to the edema and consecutive decrease in perfusion. It is still unclear if this is a local encephalitic concurring reaction of the brain (and therefore a local inflammatory edema), or if the origin of the edema is caused by a) a decreased local venous flow (stasis edema) or b) a vasogenic (arterial) spasm (insufficient perfusion edema).  

<- view Ultrasound 1

Ultrasound 1: upper series: Beginning findings on the first day of treatment: a: parasagittal slice: punctuated hyperechogenicities in the marrow (5 MHz). b & c: Part (12 MHz) coronal (b) and sagittal (c): confluent hyperechogenicities (Marrow edema)

Lower series: Follow-up examination on the 14th day of treatment: d: parasagittal slice: in the close-up with a sector transducer there are no echogenicity increases seen (5 MHz); e & f: (12 MHz) coronal (e) and sagittal (f): obvious multicystic cerebral parenchymal degeneration.




<- view MRI 1

MRI 1: Upper series: Beginning findings on the first day of treatment: a: T2-TSE transversal: frontal and parietal marrow edema.
b: T1-SE coronal: the high-lying parietal edema is seen as a slight decrease in signal.

Lower series: c: T2-TSE transversal: increased signal in a colliquation necrosis in the area of the previous frontal edema. The small cystic structure of the the necroses cannot be seen in MRI. b: T1-SE coronal: Areas of necrosis located parietally are shown with decreased signal in the follow-up.

 

Laboratory diagnostics  

Periventricular Leucomalasia of a mature child.

Regardless of the cause, every cerebral edema or every severe hypotonia can lead to a similar presentation.  

rare  

N/A  

N/A  

N/A  

Multicystic medullary degeneration, Leucencephalomalasia, meningitis, generalized seizures, shock, Streptococcus agalacticae, mother mastitis, child, childhood, pediatric radiology  

R Haase, Wolfgang Hirsch. Multicystic medullary degeneration after meningitis. PedRad [serial online] vol 2, no. 10.
URL: www.PedRad.info/?search=20021023155928