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Cerebellar Watershed Injury in Children.

J N Wright¹, D W W Shaw², G Ishak²

¹From the Departments of Radiology (J.N.W., D.W.W.S., G.I., F.P.) jnixon@uw.edu.

AJNR. American Journal of Neuroradiology

|April 25, 2020

Summary

This summary is machine-generated.

Cerebellar fissure abnormalities in children can mimic bottom-of-fissure dysplasia but are often caused by watershed injury. This pattern of injury is linked to hypoxic-ischemic events and supratentorial damage.

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Area of Science:

Neurology
Pediatric Radiology
Neuroradiology

Background:

Focal signal abnormalities in cerebellar fissures in children have been identified as a potential indicator of bottom-of-fissure dysplasia.
This study investigates an alternative cause for these findings: watershed injury.

Purpose of the Study:

To describe a series of pediatric patients presenting with cerebellar signal abnormalities.
To differentiate these abnormalities from bottom-of-fissure dysplasia and attribute them to watershed injury.

Main Methods:

Retrospective analysis of MR imaging in 23 children with focal T2 prolongation in cerebellar fissures.
Qualitative assessment of signal abnormality, volume loss, contrast enhancement, and associated supratentorial injury.

Main Results:

All 23 patients showed T2 prolongation at cerebellar fissure depths, consistent with the cerebellar vascular borderzone.
Hypoxic-ischemic injury was the primary cause (17/23), with associated supratentorial watershed injury in most cases (20/23).
Chronic injury showed preserved gray matter volume, mimicking bottom-of-fissure dysplasia.

Conclusions:

Cerebellar fissure abnormalities in children can represent a pattern of watershed injury, not solely dysplasia.
Recognizing this pattern is crucial for accurate diagnosis and understanding the etiology of cerebellar injury in pediatric patients.