Encephalomalacia

Diagnosis
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  • Encephalomalacia (literally, “softening of the brain”) is a nonspecific term for the end result of liquefactive necrosis of brain parenchyma; it can be focal or diffuse, and can be seen in adults, children and even in utero
  • Encephalomalacia can occur anywhere in the brain; after trauma, characteristic locations are anteroinferior frontal and temporal lobes
  • The most common causes are hemorrhage or infarction; other causes include trauma (including surgery), neoplasm, infection, inflammation, and numerous other insults to the brain
  • Leukoencephalomalacia refers to encephalomalacia of the white matter
  • Areas of encephalomalacia are often surrounded by a rim of gliosis, which is the proliferation or hypertrophy of glial cells in response to injury
  • Encephalomalacia and gliosis are high signal on T2-weighted images and often indistinguishable; on T2 FLAIR images, encephalomalacia is low signal and gliosis is high signal.
  • The area/s of encephalomalacia should follow CSF on all pulse sequences (because it is a CSF filled cavity) and should demonstrate volume loss (as opposed to mass effect that would be seen with a space occupying cystic lesion)
  • A key finding in encephalomalacia is adjacent sulcal or ventricular enlargement with “negative” mass effect
  • Areas of encephalomalacia can be asymptomatic, result in motor or sensory deficits, or represent a seizure focus
  1. Provenzale JM. Imaging of traumatic brain injury: a review of the recent medical literature. AJR AM J Roentgenol. 2010; 194(1):16-19
  2. Huang BY, Castillo M. Hypoxic-Ischemic Brain Injury: Imaging Findings from Birth to Adulthood. RadioGraphics 2008; 28:417-39