Plain MRI study of the brain shows "hour-glass configuration" of the brain with signs of incomplete cortical gyri formation involving the fronto-temporal and slightly the parietal lobe regions while the corresponding coritcal thickness is prominent, the visualized WM segments are relatively thin; in fact, "sparse" and non-myelinated. The body segments of corpus collosum are thinned out to some degree.
The Sylvian fissure sulci are relatively shallow particularly in the left side.
Basal ganglia, internal capsule, thalamus, midbrain, pons and cerebellum appear well-formed.
Foci of what appears like GM heteretopia are also seen along the temporo-parietal subcortices right side more than the left.
Multivaxel MR spectroscopy focused to the fronto-parietal supraventricular levels demonstrates elevated lactate/lipid peak along the right parietal periventricular T2W1 and FLAIR hyperintensity changes (vaxel 1 & 4 on the film #5). There are normal Choline, NAA and Creatine levels in the rest of the area of study.
The ventricles are moderately enlarged (even in this age group) with a cavum septum pelluciclum; temporal horns are commensurately dilated but fairlt symmetrical.
A large cisterna magna is seen appearing 'incompetent'.
The underlying vermis and cerebellum show no mass effect and the cerebellar tonsils are above the foramen magnum line.
The aqueduct of Sylvius and IV ventricles are patent, remaining in normal position.
The rest of the superior convexity including the lateral cerebellar sulci are relatively thinned-out.
The C-P angles petromastoids, sella, extrasellar and visualized retro-orbital structures are not remarkable.
IMPRESSION: Above findings are consistent with lissencephaly type I, a form of neuronal migration disorder.
Hydrocephalus with components of shallow Sylvian fissure, incompetent cisterna magna and what appears like GM heteretobia as described above.
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