Radiological Significance of Symmetric Central Tegmental Tract Hyperintensity in Pediatric Patients

Background]The central tegmental tract (CTT) is an extrapyramidal tract between the red nucleus and the inferior olivary nucleus which is part of the Guillain-Mollaret triangle (dentato-rubro-olivary system). Symmetric central tegmental tract hyperintensity (CTTH) is a pediatric brain magnetic resonance imaging (MRI) finding with an unclear clinical and radiological significance.[Objectives]The aim of this retrospective study is to determine the radiological significance of CTTH on magnetic resonance imaging (MRI) in children.[Patients and Methods]Pediatric patient’s MRI from January 2015 to January 2017 were retrospectively reviewed in this case series study. Patient records with presence of CTTH in their MRI were evaluated.[Results]There were 39 out of 2981 brain MRIs with CTTH with a prevalence of 1.3%. Some CTTH lesions disappeared on follow-up. In two patients, the disappearance of CTTH temporally corresponded to clinical improvement. Also we had patients with hemolytic uremic syndrome, autoimmune hemolytic anemia, Wilson’s disease, combined immunodeficiency, Bartter syndrome, and autism.[Conclusion]CTTH could be caused by a physiological maturation process or a physiological response of the cells in the central tegmental tract to a more widespread toxic/metabolic or ischemic insult in the brain. CTTH also appears to have a transient nature in some cases. Further research elucidating the pathophysiology of CTTH is needed.