Multicystic encephalomalacia

Othman Al-Asali

Maternity Department, Al-Hammadi Hospital, Riyadh, Saudi Arabia.

Case report:

A 41-year-old, G6P5, non-consanguineous marriage, negative TORCH was admitted to the labor room for nearly-34-week twin pregnancy of which one was healthy without associated anomalies, the other with multicystic brain lesion. After delivery, the 2155-gram baby of multicystic brain lesion had some convulsions and was treated with Phenobarbital during one-week follow-up. Apgar score was 7, 9 at 1 and 5 minutes, respectively.
Cranial ultrasound of one-day neonate was performed through the anterior fontanelle. 

Postnatal renal sonography: 
Liver, gall bladder and spleen were normal.
Minimal amount of perihepatic fluid and minimal amount of bilateral pleural effusion was noted, more at right side.
Mild bilateral calyceal dilatation.

Postnatal cranial sonography:
Little brain tissue was present but the bulk of the intracranial space was occupied by the multicystic lesions. There is no evidence of intracranial hemorrhage and no parenchymal calcifications. 
Marked hydrocephalic changes involved nearly all components of the ventricular system, especially at the lateral ventricles, including its all horns (anterior, posterior and temporal horns).
Significant internal septations and echoes was seen within the lateral ventricles.
No shift of the midline structures.
No definite evidence of intracerebral hemorrhage.

Multicystic encephalomalacia with hydrocephalic changes.
Here are series images of the second twin:

Image 1, 2: At 32 weeks 4 days and later; BPD of normal range and multicystic brain lesion.  


Image 3-5: Mild calyceal dilatation predominantly on the left side, polyhydramnios in diamniotic monochondrionic twin.


Image 6-10: First-day scanning after delivery the anterior fontanelle.

Image 11-14: Normal liver and spleen, mild calyceal dilatation predominant to the left side. Both kidneys were mildly enlarged and hyper- echogenicity according to infant age.

Right kidney measured about 4.18 X 2.19 cm in size while left kidney measured about 4.46 X 2.37 cm in size.



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