Radiological Significance of Symmetric Central Tegmental Tract Hyperintensity in Pediatric Patients

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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.