Cases reported "Encephalomalacia"

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1/4. The cortical form of subacute necrotizing encephalopathy of the Leigh type. A light- and electron-microscopic study.

    The present paper is a clinico-pathological study of a 14-year-old boy with a chronic, progressive occipital syndrome for which he was operated upon. Postoperatively, metabolic acidosis developed. Pathological anatomy revealed spongy necrosis of the thalamus and corpora quadrigemina with the typical histological features of Leigh's necrotizing encephalopathy. Similar necrotic lesions had developed in the occipital cortex. At this level apart from the typical foci, cavitating necrosis was found as well as involvement of the smaller vessels of the pial circulation. Electron microscopy revealed vascular and glial changes suggestive of primary mesenchymoglial dystrophy. The histiocytes presented intracytoplasmic multiplication of lysosomes and their transformation into lipofuscin pigment. The changes demonstrate a juvenile cortical form of Leigh's subacute necrotizing encephalopathy.
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2/4. Atypical manifestation of dural arteriovenous fistula.

    A case of secondary dural arteriovenous fistula presenting as infantile stroke, in a fifteen month old boy, is reported. The initial impression on CT scan in this case was misleading, due to the atypical appearance of the pathological periventricular blood vessels, interpreted as periventricular calcification.
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3/4. Web-like malformation of the carotid artery and multicystic encephalomalacia.

    Multicystic encephalomalacia and hydranencephaly lie within a spectrum of brain lesions linked to ischemic cerebral damage. Causes include vascular malformation, thrombosis, embolism, infection, and toxins. We describe an infant with multicystic encephalomalacia associated with a peculiar web-like malformation of the right common carotid and left subclavian arteries. We postulate that this luminal bridging is a congenital malformation resulting from defective canalization of the medium-sized blood vessels but could represent organized and recanalized thrombi, the etiology of which remains unknown.
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4/4. Congenital microcephaly due to vascular disruption: in utero documentation.

    death in utero of one member of a monozygotic twin pair has been associated with vascular disruptive phenomena in the surviving twin. It has been hypothesized that this event initiates clot formation in the surviving twin with consequent necrosis of tissues distal to the occluded vessels. This case report describes onset in utero of multicystic encephalomalacia and microcephaly in a surviving twin whose brain appeared normal on ultrasound scanning before death of the cotwin at 21 weeks' gestation. The case provides further support for the hypothesized pathogenetic sequence and illustrates the importance of reviewing all prenatal ultrasound scans in infants with congenital microcephaly.
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