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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Child Has Developmental Delays, MRI Shows Demyelinating Process. What Does It Suggest ?

Hello, I have an 18 month old daughter who has developmental delays (not walking or talking) and is seeing a neurologist because they think she may have had a seizure at birth. They cannot confirm this. She's had an EEG which did not show any seizure activity. She also had an MRI which is very confusing as our neurologist did not give us much info, and when we ask questions she acts like she's too busy, frustrated, etc to answer.
Here's the MRI results:
MRI of the brain w/out contrast. Exam performed on a 3.0 Tesla Philips Achieva MRI Scanner. Multiple pulse sequences used, images were obtained in the acial, sagittal and coronal planes.
FINDINGS: There is a band of increased T2 signal in the deep white matter of the cerebral hemispheres bilaterally. This is most prominent in the parietal lobes where it measures up to 5mm in thickness. On the T2 weighted sequence, this band has the same signal as the gray matter. It is slightly higher than gray matter on the FLAIR sequence and the T1 weighted sequence. In addition, there are nonspecific scattered high T2 signal changes in the deep white matter of the frontal lobes bilaterally and in the peritrigonal region bilaterally. The subcortical white matter of the frontal and parietal lobes demonstrates immature myelination signal.
IMPRESSION: Possibly gray matter heteropia, however on the FLAIR sequence and T1-weighted sequence it demonstrates signal that is higher than the peripheral gray matter, which suggests that this could represent a demyelinating or dysmyelinating process such as metachromatic leukodystrophy. In addition there are patchy nonspecific high T2 signal changes in hte deep white matter of the frontal lobes bilaterally and in the peritrigonal region bilaterally. Location suggest terminal zones of myelination although leukomalacia or demyelination cannot be entirely excluded????
Thank you
Tue, 16 Jul 2013
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Pediatrician 's  Response
Hi,

Thank you for your query.

Thanks for sharing the information and I can understand your concern. MRI findings do suggest that there is leukodystrophy which is responsible for the developmental delay. However the findings will not affect the management of the developmental delay for which you need to pursue with a developmental/physical therapist. MRI does not reveal any treatable cause for the delay.

I hope I have answered your query to your satisfaction.

Wishing your daughter all the best.

Regards,

Rajiv K Khandelwal
http://goo.gl/SuCjl
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Child Has Developmental Delays, MRI Shows Demyelinating Process. What Does It Suggest ?

Hi, Thank you for your query. Thanks for sharing the information and I can understand your concern. MRI findings do suggest that there is leukodystrophy which is responsible for the developmental delay. However the findings will not affect the management of the developmental delay for which you need to pursue with a developmental/physical therapist. MRI does not reveal any treatable cause for the delay. I hope I have answered your query to your satisfaction. Wishing your daughter all the best. Regards, Rajiv K Khandelwal http://goo.gl/SuCjl