Brain malformations are rare, difficult to diagnose and have unpredictable evolution. They are the major causes of epilepsy, psychomotor development abnormalities and other neurological disorders. The neuroimaging technique of choice for diagnosis of these malformations is magnetic resonance imaging (MRI), but unfortunately MRI is expensive, and is not available in a poor resource country like Cameroon. CT scan associated to clinical signs can help to suspect or to confirm a malformation. The authors report here three cases of malformations discovered during cranial CT scan at the regional hospital of Ngaoundéré. They are Dandy Walker malformation, Sturge Weber’s disease and hemimegalencephaly. These cases contribute to the knowledge of this rare event, and emphasize the importance of CT scan on their diagnosis in the absence of MRI.
Brain malformations (BMs) are congenital damage or abnormal development of the brain. These BMs are due to a halt or a modification of brain development during intrauterine life, regardless of the etiology. Sometimes it’s a genetic problem. In other cases, exposure to certain medicines, infections, or radiation during pregnancy interferes with brain development; something damages the developing nervous system or causes it to develop abnormally [
A two month-old boy was admitted in our hospital because of macrocephaly, diarrhea, vomiting and fever evolving since one week. As first care, oral salt rehydration has been managed. The interrogation revealed that the delivery has been made at home after an unfollowed pregnancy and vaccines were adminstered in retrospect at the refugee’s camp. Physical examination on admission revealed a very irritable child with a general lethargic state. The head circumference measured 50 cm with the shape of the head in dome (
A two days old boy had been admitted for consultation for bursts of flexion spasm (start-up type). The interview revealed no history of fetal distress, pregnancy and delivery were normal, the Apgar score was 9/10 and the birth weight was 3500 g. The child presented at birth a large depigmentation-like spot (
The cranio-encephalic CT performed in a 2.5 mm contiguous helix, without injection of contrast agent, showed gyriform calcifications, showing posterior right parietal cerebral convolutions associated with sub-cortical and cortical atrophy and enlargement of the ventricular system and tanks from the base of the skull (
A four month old boy was admitted to a pediatric consultation for epileptic seizures. The interrogation found a notion of recurrent convulsions since the age of 4 weeks. At the age of one month, the parents noticed a reduction in the mobility of the right hemi-body. Pregnancy and delivery were normal. Physical examination revealed cranial asymmetry, increased head circumference, sutural separation, and prominent fontanels. The neurological examination revealed a left hemi-corporeal motor deficit with spasm and left facial palsy, suggesting an epileptic state on cerebral malformation. A CT scan was performed demonstrating cerebral hemisphere asymmetry with hypertrophy of the right hemisphere with deviation of midline structures to the left, thickening of the right frontal cerebral cortex, and moderate enlargement of the right lateral ventricle consistent with hemimegalencephaly (see
Most central nervous system malformations begin long before a baby is born. The human brain is a complex organ and its development involves many interactions. Several events are responsible for the formation of a mature brain such as: neurulation, neurogenesis, migration of neural crest cells, neurotransmitter
biosynthesis and myelination. Alteration of only one of these processes, at the molecular or cellular level, can lead to the appearance of a wide variety of malformations. Most birth defects happen during the first 3 months [
Ophtalmologic involvement which is present in 30% - 70% of SWS [
Plain X-ray is not a technique of choice, it is possible to observe the classical gyriform cortical calcifications also known as railroad track appearance, which affect the intimal layer of the meningeal arteries in SSW [
MRI can best define the relationship between the cyst and the fourth ventricle and can detect vermian rotation and the presence of signs of vermian dysgenesis and allows surgeons to view the cerebellum and associated structures accurately and to determine which form the malformation has taken and to what extent the DWM has progressed [
Brain CT scan is a technique used frequently to assess children who present with hemiparesis or seizure. In DWM, CT scan can distinguish hydrocephalus associated with Dandy-Walker and hydrocephalus with other etiologies, despite the fact that clearly distinguishes subtypes of the Dandy-Walker complex on axial CT images is difficult and it exposes the infant to ionizing radiation [
Brain malformation remains a rare case. The clinical manifestations of brain malformations are variable and depend on the type. Their diagnosis is difficult and base on imaging. These cases illustrate that in a poor-country resource like Cameroon, where MRI is not available, computed tomography combined to clinical symptoms can help to diagnose the brain malformations for early referral to better equipped centers for a good care. These cases contribute to the knowledge of this rare case, and emphasize the importance of CT scan on their diagnosis in absence of MRI.
The authors declare that they have no conflicts of interest.
Mathurin, N.G., Florent, A. and Héléne, D.K. (2018) CT-Scan Presentations of Brain Malformations in Children: About Three Cases in Regional Hospital of Ngaoundere-Cameroon. Open Journal of Radiology, 8, 74-83. https://doi.org/10.4236/ojrad.2018.82009