CT in Pediatrics-Tool for DNB Practical examination in Pediatrics

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Slide 1 :

Tool for DNB Practical examination in pediatrics CT in pediatrics

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Identify: A B C D E F G H I J k

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D E A B C F G H I

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WHAT IS THE ROLE OF NEUROIMAGING IN MENINGITIS? WHAT IS THE ROLE OF NEUROIMAGING IN DIAGNOSING EARLY TBM? WHAT ARE THE FEATURES OF BASAL EXUDATES ON CT/MRI?

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Meningitis (tuberculous)

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Meningitis

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Meningitis with Hydrocephalus

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Subdural Effusion Secondary To Meningitis

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IN CASE OF HEALTHY CHILDREN WITH SEIZURES ONE SHOULD SUSPECT AN INTRACRANIAL GRANULOMA. INTRACRANIAL GRANULOMA- A CLINICAL DILEMMA. IS IT A TUBERCULOMA OR NEUROCYSTICERCOSIS? HOW WOULD NEUROIMAGING HELP?

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TUBERCULOMA

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TUBERCULOMAS

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NEUROCYSTICERCOSIS

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NEUROCYSTICERCOSIS

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NEUROCYSTICERCOSIS

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NEUROCYSTICERCOSIS

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Calcified Granuloma

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A CHILD PRESENTED WITH FEVER AND ALTERED SENSORIUM. A PROVISIONAL DIAGNOSIS OF ENCEPHALITIS WAS MADE. WHAT ARE CT FINDINGS

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Herpes encephalitis

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Japanese B Encephalitis

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Meningo-Encephalitis

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HOW DO YOU PROCEED WITH A SUSPECTED CASE OF INFARCT? WHAT WOULD BE THE INVESTIGATION OF CHOICE?

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DENSE MCA

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MCA ( 3 diff patients)

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Acute Infarct

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PROTEIN C DEF.

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PROTEIN C DEF.

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MOYA MOYA

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Venous sinus thrombosis PLAIN CECT

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Venous infarct

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I.C.Bleed

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INTRAPARENCHYMAL BLEED

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Encephalomalacia

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Porencephalic Cyst

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ONE AND A HALF YEAR OLD CHILD – A CASE OF CEREBRAL PALSY WITH SPASTIC QUADRIPARESIS, MICROCEPHALY AND NORMAL VISION, WHAT WOULD YOU EXPECT TO SEE IN NEUROIMAGING ?

Slide 38 :

HIE

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Hypoxic ischaemic encephalopathy Perinatal insult

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PVL Perinatal insult

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GERMINAL MATRIX HAEMMORAGE IN A PRETERM INFANT

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BASAL GANGLIA CALCIFICATION- AN INCIDENTAL FINDING. IS IT NORMAL OR ABNORMAL? WHAT CLUES ON NEUROIMAGING WOULD HELP?

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Basal Ganglia Calcification

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CAUSES OF BASAL GANGLIA CALCIFICATION COMMON Idiopathic Fahr’s Disease Hypoparathyroidism Postinflammatory ( TB, CID, toxoplasmosis, cysticercosis, congenital HIV ) UNCOMMON Congenital ( Tuberous sclerosis, Downs syndrome, MELAS/MERRF, Cockayne syndrome ) Post anoxic/toxic ( carbon monoxide poisoning, chemotherapy and radiation therapy)

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TORCH(CMV)

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TORCH(CMV)

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WHICH ARE THE NEURODEGENERATIVE DISORDERS THAT SHOW POSITIVE NEUROIMAGING FINDINGS? HOW MANY CASES HAVE YOU SEEN SO FAR? WHAT ARE SPECIFIC OBSERVATIONS ON IMAGING?

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Leukodystrophy

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KEY POINTS HEAD CIRCUMFERENCE AGE OF ONSET PATTERN OF INVOLVEMENT

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Normal head circumference Central to peripheral pattern Metachromatic leukodystrophy (onset: 4 to 8 years) Krabbe's disease (onset: before 4 years) Pelizaeus-Merzbacher disease (onset: 4 to 8 years, boys) Dorsal to ventral pattern Adrenoleukodystrophy* (onset: 4 to 8 years) Increased head circumference Peripheral to central pattern Canavan's disease (onset: infancy) Ventral to dorsal pattern Alexander's disease* (onset: infancy) *Enhances with gadolinium.

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DISTINCTIVE FEATURES OF LEUKODYSTROPHIES COMPLETE OR NEAR LACK OF MYELINATION Canavan Disease Pelizaeus-Merzbacher Disease FRONTAL WHITE MATTER MOST INVOLVED Alexander Disease OCCIPITAL WHITE MATTER MOST INVOLVED Adrenoleukodystrophy THICK MENINGES Hurler Syndrome

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Adrenal Leukodystrophy

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Alexander’s Disease

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Canavan’s disease

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LEUKODYSTROPHY

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LEUKODYSTROPHY

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Occurs in highly predictable orderly fashion. Caudad to cephalad, dorsal to ventral and central to peripheral. NORMAL MYELINATION

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Normal Myelination Pattern

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BIRTH Medulla, Dorsal midbrain, Cerebellar peduncles, Posterior limb of internal capsule. ONE MONTH Deep cerebellar white matter, Corticospinal tracts, Pre/postcentral gyrus, optic nerves and tracts. THREE MONTHS Brachium pontis, ventral brainstem, optic radiations, anterior limb of internal capsule, corpus callosal splenium. SIX MONTHS Corpus callosum genu, paracentral subcortical U fibres, centrum semiovale. EIGHT MONTHS Centrum semiovale, Subcortical U fibres. EIGHTEEN MONTHS Essentially like adult.

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Normal Myelination - Age 1 Day On T2-weighted images the white matter has a higher signal intensity than the gray matter except. Low–signal intensity myelin is seen in the ventrolateral thalamus, dorsal pons, and rolandic and perirolandic gyri.

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Normal Myelination - Age 1 Month T2-weighted images show further deposition of myelin in the ventrolateral thalamus, posterior limb of the internal capsule, and rolandic and perirolandic gyri. Note the small amount of myelin in the optic radiations.

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Normal Myelination - Age 3 Months On T2-weighted images, myelin deposition is seen throughout the posterior limb of the internal capsule and in the optic radiations and the white matter of the central semiovale adjacent to the precentral and postcentral gyri. The entire medulla and the central cerebellar white matter are now myelinated.

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Normal Myelination - Age 13 Months On T2-weighted images the white matter now has a lower signal intensity than the gray matter (early adult pattern).

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WHAT ARE THE VARIOUS NEURONAL MIGRATION ANOMALIES? WHAT MODALITY OF NEUROIMAGING WOULD YOU PREFER?

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Neuronal migration anomalies Agyria/pachygyria

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Agyria/pachygyria

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Cortical Dysplasia

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Polymicrogyria

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Heterotopia

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Schizencephaly

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CT in Pediatrics-Tool for DNB Practical examination in Pediatrics
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