Neuro_MR_Brain: 6 F, limping.

MRI BRAIN WITH AND WITHOUT CONTRAST PLUS BRAINLAB PROTOCOL:

 

CLINICAL HISTORY: 8 years of age, female, right hand incoordination, limping left intraventricular mass.

 

FINDINGS: 

 

Approximately 5.5 x 5.0 cm hypercellular (DWI/ADC reduced diffusion, T2 hypointensity, marked gadolinium enhancement) and hypervascular (increased blood flow on ASL, spin-echo/gradient echo flow voids, gadolinium blood-pool enhancement) left lateral intraventricular/periventricular mass with cysts and septations. Some intrinsic tumor T2* hypointensities are present consistent with some hemorrhage or mineralization. No definite intracranial seeding is seen although there is prominent left linear intracerebral enhancement likely representing a venous congestion.

 

Marked left greater than right hydrocephalus including left atrial entrapment including the temporal and occipital horns plus periventricular/subcortical edema, left greater than right.  

 

There is 12 mm left-to-right shift of midline markers with left uncal and transtentorial herniation including brainstem deformity and effacement of the aqueduct. 

 

IMPRESSION: 

 

1.  MRI findings most consistent with choroid plexus origin neoplasm, papilloma versus carcinoma. Other considerations include meningioma, germ cell tumor, embryonal neoplasm (PNET, ATRT), or ependymoma, associated with marked hydrocephalus and edema.