Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Richard Bronen

Abstract

Objective: Encephaloceles are difficult to detect on imaging, leading to missed diagnosis for many years. Herein, we aim to describe encephalocele MR characteristics to enhance detection and interpretation of an abnormality that underlies intractable temporal lobe epilepsy of approximately 10% of patients. We postulate that some MR features that are easier to visualize than encephaloceles, such as CSF clefts or cortical distortions, along with MR signs of increased ICP such as empty sella and Meckel’s cave dilation, should raise neuroradiologists’ suspicion of potential encephaloceles, and hence improve their detection.

Subjects and Methods: We performed a retrospective study on consecutive patients between June 2017 to September 2019 who underwent MRI including T2-weighted imaging and high-resolution CT scans. Demographics, clinical features, radiologic findings, and encephalocele location data were collected for all patients. Two neuroradiologists reviewed all cases with particular emphasis on morphological features of encephaloceles and MR signs of increased ICP. Stratified analysis was used to control for confounding by age, gender, and body mass index.

Results: We included initial 93 patients in our study. Encephaloceles were found in 50 of these patients, with left temporal lobe and bilateral encephaloceles being the most common at 18%, and 23%, respectively. MR image characteristics of IIH were found in approximately 25% of patients. Thirteen of 15 patients found with empty sella or partially empty sella or Meckel’s cave dilation were obese (BMI > 30 kg/m2) compared to patients with normal BMI (Pcorr = 0.0028).

Conclusion: We describe the various MR morphological features of encephaloceles and correlate those findings to improved detection of encephaloceles.

Comments

This is an Open Access Thesis.

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