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This is a young child,

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approximately one year of age,

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who had enlarged ventricles and bilateral

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schizencephalic clefts.

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A shunt was placed, so you can see this

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ventriculostomy catheter that goes

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into this large CSF space.

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And we can see a large left-sided open lip

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schizencephalic cleft, or what looks like that.

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We can confirm that on MRI when we confirm that

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it's lined by gray matter.

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And also, a right-sided schizencephalic cleft.

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Once the shunt was placed,

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we can see the CSF space decreased in size.

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There's been decreased mass effect upon the

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remaining parenchyma of the left frontal

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lobe and the left occipital lobe.

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Here is the MRI appearance

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of the shunt apparatus.

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And notice that the right-sided schizencephalic cleft,

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you barely can see CSF going through it.

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So this now is closer to what people would refer to

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as a closed lip schizencephaly.

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You can see in this patient,

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there's abnormal sulcation lining the margins

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of the schizencephalic cleft.

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So, it's gray matter with polymicrogyria.

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If we go to the right side,

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we also see areas of polymicrogyria that shows

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up better on this axial T1-weighted image,

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where you have polymicrogyria lining this cleft.

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Now, this also brings about the challenges

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in pediatric imaging,

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where due to their small size

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and due to some movement,

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even sometimes if they're getting sedated,

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it can be difficult to get pristine images like

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you see in a textbook on every single case.

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But you don't need it.

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You don't need to prolong sedation in a child to

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get an image for a textbook

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as long as you can make a diagnosis.

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So if you know what you're looking for,

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if you make your diagnosis,

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all you need is images that can

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help you make your diagnosis.

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And so,

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this patient has bilateral schizencephaly,

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a large open-lipped left-sided

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schizencephalic cleft,

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and a very narrow open lip versus closed

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lip right-sided schismus. schizencephalic