Dr. Hitesh Kumar
Neurology
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Patient's Query
Hello doctor,
My son recently had an MRI done and would like to know the findings of the radiology report explained.
The report shows:
Prominent dilated perivascular space in the right parietal white matter.
Possible oval shaped 8 x 2 mm cyst deep in white matter right side.
Slight asymmetry of lateral ventricles with right being slightly larger than left.
Low lying tonsils of 1 mm.
Possible slight trunaction and hypoplasia of corpus collasum.
Could any of these findings explain his current issues?
He just turned 5. He has a severe language disorder, starring spells, suspected apraxia of speech, and fine motor delays. He has suffered from chronic ear infections and glue ear since he was an infant and had four tubes.
Other than ear infections, he is healthy. At seven months, he was hospitalized. And the day after his vaccinations, he had a WBC of 24,800 and CRP 76.3.
Due to COVID- 19, his EEG to rule out absence seizures was canceled as well as his appointment with a neurologist. We would like to understand what the MRI report means.
Hello,
Welcome to icliniq.com.
I would like to know some history from birth onward.
Was the child born at term gestation, or preterm, or post-term? Was the delivery normal, or by forceps, or vacuum, or by C section? Soon after delivery, in how much time the baby cried? Did he turn blue shortly after delivery? At what age (months), he started to have held on his neck? At what age, he began to babble two digits, like dad/ mama?
At what age he started to stand (with support), stand (without support), walk (with and without support), achieved toilet training? Do you feel he has been a little late in achieving milestones (compared to other kids)? Had there been a history of seizures, weakness of one side of limbs? Did he have jaundice in neonatal or infancy time? How many siblings the child has? What is their age? Are they fully normal?
Please revert with the above-mentioned information for better understanding. Also, I suggest you upload the MRI (magnetic resonance imaging) images.
Patient's Query
Thank you doctor,
He was born around 36.5 weeks gestation due to low amniotic fluid. He cried immediately and did not turn blue. He did have jaundice and was hospitalized for a few days. They did tests to make sure liver function was good, and was diagnosed with breast milk jaundice. Delivery was normal.
He hit all milestones pretty much on time from 0-12 months. If I remember correctly, he rolled over at three months. Held his head up at four months, crawled at six months, said mama at six months. I think he began to stand around eight or nine months and walked on his own around 12 months.
He never had a seizure that we know of but does have starring spells. We are waiting to be able to get EEG to confirm or rule out absence seizures. He has two older sisters who are completely neurotypical. His biggest delays have been with language and fine motor skills. He was also late to the toilet train.
He did begin limping with right-side weakness and a temporary decline in gross motor skills. We had x-rays done, saw an orthopedic doctor, no injury, and CRP levels were normal. PT described the limp as an ataxic gait. It improved completely, and gross motor skills seem to be back to normal.
Hello,
Welcome back to icliniq.com.
By MRI findings (prominent dilated perivascular space in the right parietal white matter. Possible oval shaped 8 x 2 mm cyst deep in white matter right side. The slight asymmetry of lateral ventricles with right being slightly larger than left. Low lying tonsils of 1 mm. Possible slight truncation and hypoplasia of corpus callosum), and with history of delayed language, fine motor skills, and toilet training, possible differential come in my thoughts:
1. Some developmental anomaly.
2. Some birth asphyxia.
3. Due to metabolic derangement in neonatal jaundice.
4. Wilson disease.
5. NBIA (neurodegeneration with brain iron accumulation).
The fourth and fifth possibilities seem unlikely.
Moreover, it is not possible to make an etiological diagnosis by MRI alone. It needs detailed clinical evaluation too. As you said that he had staring spells, EEG should be done to look for any epileptic syndromes.
I would also like to know if he has intermittent jerky movements of limbs, body, any abnormal movement, or tightening of limbs or jaw?
If intermittent jerky movements also are present, there can be a possibility of progressive myoclonic epilepsy, in which developmental milestones are initially normal, but decline with time. Also, I would like to keep a differential of urea cycle disorders and amino aciduria disorders though these are rare entities.
Investigations to be done
Patient's Query
Thank you doctor,
Do the MRI findings point to anything specific or indicate anything abnormal? He will sometimes clench his fists to his mouth (arms bend at the elbow), and his jaw clenches and eyes widen. It is like a sudden tightening of his jaw and jerking of his arms, if that makes sense. I will try to get it on the video to send. He is making progress, but it is very slow.
What is the long term EEG? Is that different from the standard EEG done at the hospital? Could severe infection have caused anything? He got after vaccinations at 7 months old when he was hospitalized.
Hello,
Welcome back to icliniq.com.
MRI does not point anything specific. Sudden jerking of body parts may be a myoclonic jerk. Please make a video and send it as an attachment.
Long term video EEG is - EEG with a patient's video recording for a little longer duration (i.e., a few hours or more).
One possibility of the previous infection can be subacute sclerosing panencephalitis (SSPE) caused by infancy measles infection.
For diagnosis of that, lumbar puncture needs to be done, and CSF antibodies need to be tested. Did he have any fever with rashes in infancy or early childhood time?
Patient's Query
Thank you doctor,
I found some videos that caught the clenching hands to mouth episode that he sometimes does. I am still trying to find one with the starring spell captured. The radiology report mentioned 2 x 8 mm cyst in white matter. It dilated prominent perivascular space, and the second report mentioned slight hypoplasia of corpus callosum and asymmetry of ventricles. Can you tell me what those things mean in relation to possibly causing his issues, and are all three typically present at birth, or do they have other causes?
Hello,
Welcome back to icliniq.com.
These MRI findings do not seem specific enough to point toward some etiology or a particular cause. Such changes can be developmental, can be since birth, or due to birth asphyxia.
Patient's Query
Thank you doctor,
I uploaded three videos that captured the odd clenching my son will sometimes do. Does it look concerning, in your opinion? I have not been able to get his starring spells on video yet.
Hello,
Welcome back to icliniq.com.
I do not found any uploaded video. If possible, can you please reupload videos?
Patient's Query
Thank you doctor,
I have uploaded again.
Hello,
Welcome back to icliniq.com.
I have seen the videos (attachment removed to protect patient identity).
The movements in the attached video are almost the same in all three videos. He put both hands on the side of the nose, and he can walk that time without any tightening of limbs.
On gross looks, these movements look stereotypic movements, unlikely to be a seizure.
Investigations to be done
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