Neuro_MR_Brain: 6 mo F, concern for encephalomyelitis.

CLINICAL HISTORY: 7 months of age, Female, with history of Leigh's disease and concern for encephalomyelitis.
There is symmetric diffusion restriction in the middle cerebellar peduncles extending into the bilateral cerebellar hemispheres, superior cerebellar peduncles, tectum, cerebral peduncles, periaqueductal gray matter, medial thalami, fornices, caudate, and basal ganglia. There is associated T2/FLAIR signal abnormality in these regions compatible with swelling. There is increased cerebral blood flow on ASL images in all of these regions. There is patchy parenchymal enhancement within the periaqueductal gray matter and portions of the basal ganglia. This appearance is new compared to the prior exam.

There is no mass or acute hemorrhage.

There is a small region of restricted diffusion in the high parasagittal left parietal lobe (series 3, image 22) concerning for acute infarct.

No abnormal extracerebral collections are present.

The orbital contents are without abnormality. 

Bilateral mastoid effusions. 
1.  Symmetric diffusion restriction within the brainstem and deep gray nuclei with associated T2/FLAIR signal abnormality, increased cerebral blood flow, and patchy parenchymal enhancement. These findings are in keeping with reported history of Leigh's disease and are new compared to the prior exam from August 9, 2016. 
2.  Small region of restricted diffusion in the high paramedian left parietal lobe concerning for a small acute infarct.

(Leigh's disease)

Accession: CL27388651

Study description: MRI BRAIN W AND WO CONTRAST