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This is an MRI scan of the brain in a one-year-old

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child with seizures and developmental delay.

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One of the first things that

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we see is this diffuse,

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bright signal on T2-weighted imaging in the

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deep juxtacortical and juxtaventricular white

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matter of both cerebral hemispheres.

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We see it in the frontal lobes.

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It's a little bit patchy, slightly asymmetric.

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We see it in the temporal lobes,

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occipital lobes, parietal lobes.

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Within that,

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we see in the temporal poles,

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we see a cystic change here on the left

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and suggestion of a smaller cystic

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change here on the right.

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The lateral ventricles are larger than

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typically expected for this age,

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and this is likely related to ex vacuo enlargement

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from decreased volume of the cerebral white matter.

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So all of these are signs of diffuse bilateral

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white matter injury

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and decreased white matter volume.

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In addition to that white matter injury,

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we're seeing an abnormal sulcation pattern.

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We're seeing shallow, narrowly spaced gyri.

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This is polymicrogyria.

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Now, it's a little more challenging to see in

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this case where there's, first of all,

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demyelination in a one-year-old is not

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as much as it was in the other cases.

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Secondly, there's diffuse white matter injury.

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So that makes seeing the polymicrogyria

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a little bit more challenging.

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But if we use all the images

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we have available to us,

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we can see here on this sagittal T1-weighted image

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along the inferior aspect of the inferior frontal gyrus,

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we can see some narrowly spaced gyri.

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This is polymicrogyria.

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Then, one additional thing that we see

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in addition to the polymicrogyria

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and diffuse white matter injury,

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white matter volume loss

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and temporal poles cystic changes,

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is on the susceptibility-weighted image,

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we're seeing areas of susceptibility

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hypointensity in the periventricular white matter

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here in the right inferior parietal lobe,

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and here in the left occipital lobe.

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These are likely related to dystrophic mineralization.

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Collectively,

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these findings are very suggestive of

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in utero cytomegalovirus infection.

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One of the other clinical presentations of

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children with in utero cytomegalovirus infection

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is congenital sensorineural hearing loss.