Multicystic encephalomalacia: An autopsy report of 4 cases

Madakshira, Manoj Gopal; Gupta, Kirti; Uthamalingam, Preithy; Kapatia, Gargi; Saini, Sushma Kumari

doi:10.4322/acr.2020.208

Cited by 3 publications

(10 citation statements)

References 16 publications

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“…Identification of glial septa is important as it distinguishes injury that occurred around term development from other cystic injury which occurred in utero before the fetus' ability to mount a gliotic response (resulting in hydranencephaly or schizencephaly). 2 The appearance of multicystic encephalomalacia with bulging smooth cortical mantle is also distinct from cystic encephalomalacia from other causes. 15,28 Further distinguishing multicystic encephalomalacia from other causes is the typical distribution of the deep nuclei injury in HII, involving the posterior putamina and ventrolateral thalami.…”

Section: Discussionmentioning

confidence: 99%

“…In 1954, while examining a number of deaths associated with cerebral atrophy and components of cerebral softening described as "encephalomalacia" during autopsy, Wolf and Cowen identified multicystic encephalomalacia as a gross manifestation of cerebral injury in early infants. 1,2 Multicystic encephalomalacia as an entity is a type of encephalomalacia that is more frequently observed in neonates, and is caused by a severe brain insult due to total hypoxia or anoxia that results in large cystic lesions divided by gliotic strands involving large portions of the supratentorial brain. In this condition, which is also known as catastrophic hypoxic ischemic injury (HII), the injury extends beyond the watershed zones and involves major vascular territories, causing extensive irreversible damage visible on MRI.…”

Section: Introductionmentioning

confidence: 99%

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Distinguishing multicystic from focal encephalomalacia on delayed MRI in children with term hypoxic ischemic injury

Alkhulaifat,

Venkatakrishna,

Alves

et al. 2024

Journal of Neuroimaging

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Background and PurposeTo define cystic patterns resulting from term hypoxic ischemic injury (HII) on delayed Magnetic Resonance Imaging (MRI) and determine associated HII patterns and lesions that reflect the severity of injury, from a database of African children with cerebral palsy.MethodsRetrospective review of 1175 children with cerebral palsy due to term HII diagnosed on late MRI, identifying those with cystic changes. These were classified as multicystic or (multi‐) focal‐cystic, and were evaluated for associated injuries—thalami, basal ganglia, hippocampi, cerebellum, and presence of ulegyria.ResultsThree hundred and eighty‐eight of 1175 (33%) children had cystic encephalomalacia. Two hundred and seven of 388 (53.3%) had focal‐cystic and 181/388 (46.6%) had multicystic injury. The focal‐cystic group comprised 87.9% (182/207) with thalamic injury, 25.6% (53/207) with basal ganglia injury, and 15% (31/207) with cerebellar involvement. Basal‐ganglia‐thalamus (BGT) pattern was present in 43.9% (91/207) and ulegyria in 69.6% (144/207). In the multicystic group, 88.9% (161/181) had thalamic injury, 30.9% (56/181) had basal ganglia injury, and 21% (38/181) had cerebellar involvement. BGT pattern was observed in 29.8% (54/181) and ulegyria in 28.7%. (52/181). Significant associations (p<.05) were found between multicystic injury and caudate/globus pallidus involvement, and between focal‐cystic pattern of injury and ulegyria.ConclusionsCystic encephalomalacia was seen in almost one‐third of patients with term HII imaged with delayed MRI, with a similar prevalence of focal‐cystic and multicystic injury. Multicystic injury was associated with caudate and globus pallidi involvement, typical of the BGT pattern of HII, whereas the focal‐cystic pattern was associated with ulegyria, typical of watershed injury.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Distinguishing multicystic from focal encephalomalacia on delayed MRI in children with term hypoxic ischemic injury

Alkhulaifat,

Venkatakrishna,

Alves

et al. 2024

Journal of Neuroimaging

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“…However, the deep gray matter nuclei, cortices, hippocampi, and cerebellum are mostly affected in older children and adults after severe hypoxic-ischemic injury [ 8 ]. Cystic encephalomalacia is commonly seen in perinatal hypoxic encephalopathy [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cystic encephalomalacia is a variant of encephalomalacia in which varying-sized cystic lesions within the white matter and cortex are present as a result of an extensive brain insult. It is mostly reported in neonates who have undergone prenatal or perinatal hypoxic events, leading to irreversible neuronal damage [ 1 ]. While hypoxic-ischemic brain injury is the most common cause of cystic encephalomalacia in neonates [ 2 ], it can be a consequence of several etiologies, including viral encephalitis, head trauma, and severe congenital metabolic disorders [ 1 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is mostly reported in neonates who have undergone prenatal or perinatal hypoxic events, leading to irreversible neuronal damage [ 1 ]. While hypoxic-ischemic brain injury is the most common cause of cystic encephalomalacia in neonates [ 2 ], it can be a consequence of several etiologies, including viral encephalitis, head trauma, and severe congenital metabolic disorders [ 1 , 3 ]. In adults, although rare, cystic encephalomalacia can follow an acquired parenchymal brain injury such as infection [ 4 ], trauma [ 5 ], or infarction [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Cystic Encephalomalacia in a Young Woman After Cardiac Arrest Due to Diabetic Ketoacidosis and Thyroid Storm

Chang¹,

Lian²,

Sung³

2022

Cureus

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Cystic encephalomalacia is commonly reported in neonates with prenatal or perinatal hypoxic events. It is rarely observed in adults. A 25-year-old woman with a history of type 1 diabetes mellitus and hyperthyroidism presented to the emergency department with diabetic ketoacidosis (DKA) and a thyroid storm. She sustained cardiac arrest due to ventricular fibrillation and subsequently developed hypoxic encephalopathy. Initial brain computed tomography showed no significant findings; however, follow-up magnetic resonance imaging three months later revealed cystic encephalomalacia in the bilateral parieto-occipital lobes. A Tc-99m ethyl cysteinate dimer (ECD) brain perfusion scan revealed extensive hypoperfusion in the bilateral frontal and parieto-occipital lobes. She showed severe cognitive impairment and marked spasticity in all her limbs. Although cystic encephalomalacia is mostly reported in neonates with hypoxic injury, it can be seen in adults with hypoxic encephalopathy, leading to a significant neurological deficit.

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Clinical Applications of Fetal MRI in the Brain

Nagaraj

Kline‐Fath

2022

Diagnostics

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Fetal magnetic resonance imaging (MRI) has become a widely used tool in clinical practice, providing increased accuracy in prenatal diagnoses of congenital abnormalities of the brain, allowing for more accurate prenatal counseling, optimization of perinatal management, and in some cases fetal intervention. In this article, a brief description of how fetal ultrasound (US) and fetal MRI are used in clinical practice will be followed by an overview of the most common reasons for referral for fetal MRI of the brain, including ventriculomegaly, absence of the cavum septi pellucidi (CSP) and posterior fossa anomalies.

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Multicystic encephalomalacia: An autopsy report of 4 cases

Cited by 3 publications

References 16 publications

Distinguishing multicystic from focal encephalomalacia on delayed MRI in children with term hypoxic ischemic injury

Distinguishing multicystic from focal encephalomalacia on delayed MRI in children with term hypoxic ischemic injury

Cystic Encephalomalacia in a Young Woman After Cardiac Arrest Due to Diabetic Ketoacidosis and Thyroid Storm

Clinical Applications of Fetal MRI in the Brain

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