NEURORADIOLOGY


Case 36 :
Serial CT scans available. H/o right sided hemipareisis in 1984. Subsequently, readmitted with history of convulsions on Nov 2, 2002. No focal neurological deficit at that stage. Patient then re-developed a mild hemipareisis on Nov 9, 2002. CT has been performed.
What is the diagnosis?
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Fig 1.
Fig 2.
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Imaging Diagnosis

Findings revealed an acute left MCA territory infarct in 1984. Subsequently, patient developed atrophic changes with a porencephalic cyst (as seen on Fig 2), that then ruptured into the left subdural space, giving rise to a hygroma with mass effect, leading to the mild right hemipareisis.

Discussion

Porencephaly is defined as a fluid-filled cavity (presumably CSF) usually secondary to infarction within the brain parenchyma. The cavity may communicate with the ventricle, in which case it is defined as porencephalic dilatation of the ventricle. The cyst can enlarge with time, and can act as a cystic mass, necessitating decompression. Sudden rupture of a porencephalic cyst into the subdural space, though unlikely has been frequently reported.

Dr. Nikhil Cunha, Mumbai