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PubMed This is a summary of 9 peer-reviewed journal articles Updated
Neurology

Diagnosis and Understanding Brain Scans

At a Glance

MRI is the gold standard for diagnosing porencephaly. Scans help identify the cyst's location, its connection to the brain's fluid system, and whether it is lined with scar tissue or shows signs of old bleeding (hemosiderin).

An MRI report can feel like it is written in a different language. While words like “encephalomalacia” or “gliosis” may sound frightening, they are simply descriptors that help your child’s neurology team understand the history and structure of the brain [1][2]. Understanding these terms can help you feel more prepared for your next appointment.

Why MRI is the Gold Standard

While ultrasound or CT scans are sometimes used for a quick look (especially in newborns), Magnetic Resonance Imaging (MRI) is the gold standard for diagnosing porencephaly [3][4].

  • Precision: MRI provides the clearest picture of brain tissue (parenchyma), allowing doctors to see exactly where the cyst is and what kind of tissue surrounds it [5].
  • Finding “The Why”: Special MRI sequences, such as SWI (Susceptibility-Weighted Imaging) or T2*, are designed to find hemosiderin [6][7]. Hemosiderin is a leftover iron deposit from old blood. If a doctor finds it, they know the cyst was likely caused by a previous bleed (hemorrhage) [7].

Decoding Your Child’s MRI Report

You may see these common technical terms on a radiology report:

  • Encephalomalacia: This simply means “softening of the brain tissue.” It is the term used for the area where brain tissue was lost and replaced by fluid [8][1].
  • Gliosis: This is the brain’s version of a scar. It is a reactive change in the cells surrounding the cyst that shows the brain has tried to heal after an injury [3][9].
  • Ventriculomegaly: This means the ventricles (the fluid-filled “rooms” in the center of the brain) are larger than normal. This often happens because the cyst has taken up space, or because the brain tissue around the ventricles is thinner [5].
  • Communication: If a report says the cyst “communicates with the ventricles,” it means there is an open pathway between the cyst and the brain’s natural fluid system [1].

Differentiating Porencephaly from Other Conditions

One of the radiologist’s most important jobs is to make sure the diagnosis is truly porencephaly and not a similar-looking condition.

Feature Porencephaly Schizencephaly
Lining Usually lined with gliosis (scar tissue) [3]. Lined with gray matter (normal brain cells in the wrong place) [7].
Origin Caused by an injury or destruction of tissue [2]. Caused by a failure of the brain to form properly during development [7].
Blood Clues May show hemosiderin (old blood) [7]. Usually does not show signs of old blood [7].

A “Complete” Diagnostic Checklist

When you review the report with your doctor, ensure these details are included, as they help predict what kind of support your child might need:

  1. Size and Location: Which lobes of the brain (frontal, parietal, etc.) are involved? [1]
  2. Lining: Is the cyst lined with gray matter or scar tissue (gliosis)? [3]
  3. Communication: Does it connect to the ventricles or the space around the brain? [1]
  4. Blood Staining: Is there any evidence of hemosiderin or calcification? [7]
  5. Surrounding Brain: Is the rest of the brain tissue developing normally? [5]

Having a clear, detailed MRI report is the first step in creating a roadmap for your child’s development and care.

Return to Home | Previous: Symptoms and Development | Next: Treatment Options

Common questions in this guide

What is the best scan to diagnose porencephaly?
Magnetic Resonance Imaging (MRI) is the gold standard for diagnosing porencephaly. It provides the clearest picture of brain tissue and can identify old blood deposits that indicate the cause of the cyst.
What does encephalomalacia mean on an MRI report?
Encephalomalacia means softening of the brain tissue. It describes an area where brain tissue was lost after an injury and subsequently replaced by fluid.
How is porencephaly different from schizencephaly on an MRI?
Porencephaly cysts are typically lined with scar tissue resulting from an injury. Schizencephaly is a developmental condition where the cleft is lined with normal brain cells (gray matter) in the wrong location.
What does it mean if a porencephalic cyst communicates with the ventricles?
If an MRI report notes that a cyst communicates with the ventricles, it means there is an open fluid pathway between the cyst and the brain's natural fluid spaces.
Why do doctors look for hemosiderin on a brain scan?
Hemosiderin is an iron deposit left over from old blood. Finding it on an MRI helps doctors confirm that a previous brain bleed likely caused the cyst to form.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Does the report mention 'hemosiderin' or 'T2* signal loss'? Does that mean there was a previous bleed in the brain?
  2. 2.Is the cyst lined with gray matter? If not, does that confirm it is porencephaly rather than schizencephaly?
  3. 3.The report mentions 'gliosis'—how much of the tissue surrounding the cyst is affected by this scarring?
  4. 4.Is the cyst 'communicating' with the ventricles? Does that affect the pressure or risk of the cyst getting larger?
  5. 5.Do we need to do another MRI in 6 or 12 months to see if the size of the cyst or the 'ventriculomegaly' is changing?

Questions For You

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References

References (9)
  1. 1

    Porencephalic cyst: a rare cause of new-onset seizure in an adult.

    Qureshi A, Jehangir A, York EP

    Journal of community hospital internal medicine perspectives 2018; (8(2)):92-93 doi:10.1080/20009666.2018.1454788.

    PMID: 29686797
  2. 2

    Porencephaly and Psychosis: A Rare Case of Neurological and Psychiatric Intersection.

    Gupta T, Suresh S, Chadha Y, et al.

    Cureus 2024; (16(9)):e69486 doi:10.7759/cureus.69486.

    PMID: 39416588
  3. 3

    A Giant Porencephaly: A Rare Etiology of Pediatric Seizures.

    Alzahrani RA, Alghamdi AF, Alzahrani MA, et al.

    Cureus 2021; (13(11)):e19623 doi:10.7759/cureus.19623.

    PMID: 34926080
  4. 4

    Post-traumatic cysts detected by ultrasound in infant presented with first-time seizures: Case report.

    AlGoraini Y, AlJohani H, AlSaegh A, AlSadhan N

    Radiology case reports 2022; (17(11)):4128-4131 doi:10.1016/j.radcr.2022.08.042.

    PMID: 36111183
  5. 5

    Progressive cerebral atrophies in three children with COL4A1 mutations.

    Nakamura Y, Okanishi T, Yamada H, et al.

    Brain & development 2021; (43(10)):1033-1038 doi:10.1016/j.braindev.2021.06.008.

    PMID: 34281745
  6. 6

    Comparative Diagnostic and Prognostic Performance of SWI and T2-Weighted MRI in Cerebral Microbleed Detection Following Acute Ischemic Stroke: A Meta-Analysis and SPOT-CMB Study.

    Tan R, Spring KJ, Killingsworth M, Bhaskar S

    Medicina (Kaunas, Lithuania) 2025; (61(9)) doi:10.3390/medicina61091566.

    PMID: 41010957
  7. 7

    Schizencephaly and Porencephaly Due to Fetal Intracranial Hemorrhage: A Report of Two Cases.

    Harada T, Uegaki T, Arata K, et al.

    Yonago acta medica 2017; (60(4)):241-245 doi:10.24563/yam.2017.12.005.

    PMID: 29434494
  8. 8

    New-Onset Complex Partial Seizures Progressing to Intractable Epilepsy in a Young Female With Bifrontal Encephalomalacia and a Remote History of Traumatic Brain Injury.

    Villegas KJ, Sorathia A, Salib M, et al.

    Clinical case reports 2026; (14(1)):e71830 doi:10.1002/ccr3.71830.

    PMID: 41531676
  9. 9

    Surgical outcomes and prognostic factors of drug-resistant epilepsy secondary to encephalomalacia.

    He X, Zhai F, Guan Y, et al.

    Epilepsia 2019; (60(5)):948-957 doi:10.1111/epi.14733.

    PMID: 30980678

This page explains porencephaly MRI terminology for educational purposes. Your pediatric neurologist or radiologist is the best source for interpreting your child's specific scan.

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