Atretic Parietal Cephalocele With First Trimester Chiari Malformation and Sinus Pericranii Companion Case.

Encephaloceles are the type of dysraphism in which a skull defect allows for herniation of meninges, with or without the inclusion of neural tissue, and are commonly associated with agenesis of the corpus callosum. Encephaloceles are classified as frontal, occipital, or parietal, with parietal cephaloceles, or vertex cephaloceles (VC), being the least common. Despite this, VCs present as the most common cause of a midline scalp mass, displaying complex venous and neural malformations commonly referred to as the "tip of the iceberg." Atretic parietal encephaloceles (APC), a type of VC, are benign lesions arising from meningeal and vestigial tissue which have undergone fibrotic degeneration. As a result, prognosis will generally be better than other encephaloceles due to vestigial tissue involvement. Here, we report a neonate presenting with APC, corpus callosum agenesis, and a cingulate gyrus lesion, along with a sinus pericranii companion case for comparison.

Pure Insular Cortex Infarct in Sepsis-Induced Hypoxic Ischemic Encephalopathy.

Each year there are an estimated 1.7 million adults in the United States that develop sepsis and nearly 16% of these adult patients die because of this disease process. Sepsis, however, can impact patients of all ages. Neonatal sepsis is currently one of the leading causes of morbidity and mortality among neonates. There are many complications of neonatal sepsis including meningitis, seizures, and hypoxic ischemic encephalopathy (HIE). HIE is estimated to impact one to five in 1000 live births worldwide, primarily impacting neonates. It is more commonly seen in premature infants and infants with low birth weights due to immature organ systems and a lack of adequate auto-regulatory mechanisms that would otherwise manage brain perfusion. In premature neonates, the most commonly recognized pathological pattern found on MRI is focal non-cystic white matter injury. HIE can also impact term infants as well. In these neonates, there exist two common MRI patterns that include either basal ganglia-thalamus ischemia, most often involving deep gray nuclei and perirolandic cortex, or watershed predominant ischemic changes that involve cortical gray matter.  We report a 38-week-old male neonate born at gestation diagnosed with HIE secondary to neonatal sepsis with an MRI finding of isolated insular cortex hypersensitivity on fluid-attenuated inversion recovery (FLAIR) and T1-weighted imaging. Isolated insular cortex hypersensitivity can be seen in non-lacunar ischemic middle cerebral artery (MCA) territory strokes but it is not common for it to present as a sole finding. In our case, these findings persisted for several weeks without evidence of any common patterns of hypoxia-induced cerebrovascular insult on MRI imaging.

Amplitude and phase of cerebrospinal fluid pulsations: experimental studies and review of the literature.

OBJECT: A recently developed model of communicating hydrocephalus suggests that ventricular dilation may be related to the redistribution of pulsations in the cranium from the subarachnoid spaces (SASs) into the ventricles. Based on this model, the authors have developed a method for analyzing flow pulsatility in the brain by using the ratio of aqueductal to cervical subarachnoid stroke volume and the phase of cerebrospinal fluid (CSF) flow, which is obtained at multiple locations throughout the cranium, relative to the phase of arterial flow. METHODS: Flow data were collected in a group of 15 healthy volunteers by using a series of images acquired with cardiac-gated, phase-contrast magnetic resonance imaging. The stroke volume ratio was 5.1 +/- 1.8% (mean +/- standard deviation). The phase lag in the aqueduct was -52.5 +/-16.5 degrees and the phase lag in the prepontine cistern was -22.1 +/- 8.2 degrees. The flow phase at the level of C-2 was -5.1 +/- 10.5 degrees, which was consistent with flow synchronous with the arterial pulse. The subarachnoid phase lag ventral to the pons was shown to decrease progressively to zero at the craniocervical junction. Flow in the posterior cervical SAS preceded the anterior space flow. CONCLUSIONS: Under normal conditions, pulsatile ventricular CSF flow is a small fraction of the net pulsatile CSF flow in the cranium. A thorough review of the literature supports the view that modified intracranial compliance can lead to redistribution of pulsations and increased intraventricular pulsations. The phase of CSF flow may also reflect the local and global compliance of the brain.