Morgenstern, Jason D.

Neufeld, Andrea

Ranger, Adrianna

Staudt, Michael D.

English

Scholarship@Western

Western University Scholarship@Western Paediatrics Publications Paediatrics Department 12-1-2016 Macrocephaly and right arm disuse in a 7-month-old boy Michael D. Staudt Western University Jason D. Morgenstern Western University Andrea Neufeld Western University, andrea.neufeld@lhsc.on.ca Adrianna Ranger Western University, adrianna.ranger@lhsc.on.ca Follow this and additional works at: https://ir.lib.uwo.ca/paedpub Citation of this paper: Staudt, Michael D.; Morgenstern, Jason D.; Neufeld, Andrea; and Ranger, Adrianna, "Macrocephaly and right arm disuse in a 7-month-old boy" (2016). Paediatrics Publications. 2163. https://ir.lib.uwo.ca/paedpub/2163 Images in Neuroscience: QuestionMacrocephaly and right arm disuse in a 7-month-old boyMichael D. Staudt ⇑, Jason D. Morgenstern, Andrea Neufeld, Adrianna RangerDepartment of Clinical Neurological Sciences, London Health Sciences Center, Western University, 339 Windermere Road, London, Ontario N6A 5A5, Canada1. Clinical backgroundA 7-month-old boy presented with macrocephaly (head circum-ference of 52 cm, 2.5 standard deviations above the 98th per-centile). An examination of his cranial contour demonstratedprominent dilated scalp vessels, an elevated and full anterior fon-tanelle, and mild splaying of the coronal and sagittal sutures. Hemaintained his right hand in a fisted position, and would not reachtowards objects or faces with his right hand; his right upperextremity was also significantly hypertonic. A neurological exami-nation of his cranial nerves and other limbs was otherwise normal.His medical history was unremarkable. A cranial ultrasound scandemonstrated a markedly enlarged left lateral ventricle with around, well-defined hyperechoic structure (Fig. 1A). Contrast-enhanced MRI was then performed (Fig. 1B, D–G).2. The most likely diagnosis isA. Atypical teratoid/rhabdoid tumorB. Desmoplastic infantile gangliogliomaC. Supratentorial primitive neuroectodermal tumorD. TeratomaAnswer on page 304.Conflicts of Interest/DisclosuresThe authors declare that they have no financial or otherconflicts of interest in relation to this research and its publication.http://dx.doi.org/10.1016/j.jocn.2016.06.0160967-5868/ 2016 Elsevier Ltd. All rights reserved.DOI of answer: http://dx.doi.org/10.1016/j.jocn.2016.07.004⇑ Corresponding author. Tel.: +1 519 685 8500.E-mail address: michael.staudt@londonhospitals.ca (M.D. Staudt).Fig. 1. (A) Ultrasound imaging demonstrates a markedly enlarged left lateralventricle with a well-defined hyperechoic nodular lesion. (B) Axial and (D, E)coronal T1-weighted MRI demonstrates a large complex cyst within the leftcerebral hemisphere. (F) This cyst is isointense compared to cerebrospinal fluid onT2-weighted MRI, and (G) Diffusion-weighted imaging does not demonstraterestricted diffusion. There is an avidly enhancing lesion attached to the dura with anadditional cystic component: (D) pre-contrast, (B, E) post-contrast, (C) intraoper-ative visualization following large cyst drainage.Journal of Clinical Neuroscience 34 (2016) 207Contents lists available at ScienceDirectJournal of Clinical Neurosciencejournal homepage: www.elsevier .com/ locate/ jocn

Macrocephaly and right arm disuse in a 7-month-old boy

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Macrocephaly and right arm disuse in a 7-month-old boy

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