Pediatric Pachygyria

  • Etiology: Incomplete lissencephaly
  • Imaging:
    — Classically smooth thickened cerebral cortex
    — Focal to diffuse, if diffuse often a spectrum from pachygyria to agyria
    — Broad gyri and shallow sulci
    — Thickened cortex – sometimes thinner outer layer and thicker inner layer separated by thin white matter layer – cell sparse zone
  • DDX: Smooth gray-white junction differentiates pachygyria from irregular gray-white junction in polymicrogyria
  • Complications:
  • Treatment:
  • Clinical: More common than classic lissencephaly

Radiology Cases of Pachygyria

Radiology Cases of Pachygyria Due to Cytomegalovirus Encephalitis

MRI of CMV / cytomegalovirus encephalitis
Axial T1 MRI without contrast of the brain (left) shows gyral thickening compatible with pachygyria and ventriculomegaly. Axial T2 MRI (right) shows increased bright signal throughout the white matter, compatible with delayed myelination. There are also several areas of punctate low signal along the periphery of the lateral ventricles posteriorly, compatible with foci of calcification, which were confirmed on GRE images (not provided).