# Multicystic encephalomalacia

## Metadata
- Content type: Blog
- Canonical URL: https://123sonography.com/blog/case/multicystic-encephalomalacia
- Published: December 29, 2025
- Last updated: February 19, 2026

## Overview
In part 4 of our Neonatal Brain Ultrasound Series, solve a case of a 1-month-old, born full-term, now admitted for poor feeding, seizures, and profound developmental delay. Look at the sweeps from the brain ultrasound exam.

## Snapshot
- Category: Case

## Authors
- [Sophie Wieser, MD](/speaker/159)
- [Andrei Satsuk, MD](/speaker/179) - Medical Doctor (MD); Sonographer; cardiac, abdominal and brain ultrasound imaging

## Tags
- Ultrasound Loop

## Related Courses
- [Neonatal and Pediatric Ultrasound BachelorClass](/neonatal-pediatric-ultrasound-bachelorclass)

## Content
This is part 4 of our Neonatal Brain Ultrasound Series!

## Case:

A 1-month-old, born full-term, now admitted for poor feeding, seizures, and profound developmental delay. At birth, the infant suffered severe hypoxic-ischemic encephalopathy following placental abruption and was treated with therapeutic hypothermia.

Here are the sweeps from the brain ultrasound exam:

### Coronal Sweep:

### Coronal zoomed:

### Sagittal swipe:

The brain US study reveals severe, bilateral multicystic encephalomalacia.

### **What are the sonographic features of this disease entity?**

A) Several big cysts with regular margins

B) multiple irregular, fluid-filled cysts and septations (honeycomb appearance)

C) increased periventricular echogenicity

## **Explanation:**

The study reveals severe, bilateral multicystic encephalomalacia. The normal brain architecture of the cerebral hemispheres has been replaced by multiple, irregular anechoic (fluid-filled) cysts separated by echogenic septae, creating a "honeycomb" or "swiss cheese" appearance.

### **Prevalence and Etiology**:

Multicystic encephalomalacia is a very rare but devastating end-stage manifestation of massive brain insult. The location of the lesions varies with the nature of the insult. While [leukomalacia](https://123sonography.com/blog/case/subcortical-leukomalacia?utm_source=website&utm_medium=blogpost&utm_campaign=multicystic-encephalomalacia) typically targets specific white matter zones, MCE reflects a global "liquefactive necrosis" that consumes both the white matter and the overlying cortex. It is most commonly the result of profound Hypoxic-Ischemic Encephalopathy (HIE) in term infants, often triggered by events like the placental abruption seen in this case. Other rare causes include severe neonatal infections or head trauma.

### **Prognosis**:

Due to the selective vulnerability of brain tissue, the basal ganglia, thalami, and brainstem are occasionally spared from the initial hypoxic-ischemic insult; this allows for the preservation of basic vegetative functions (such as breathing and heart rate), meaning these infants may survive for years while remaining at a neonatal developmental level. Palliative care is the standard of practice for MCE, as there is currently no neuroregenerative therapy capable of restoring the destroyed parenchymal architecture.

### **Imaging:**

**Ultrasonography** is the most sensitive modality for detecting **glial septa**, but it is less useful for comprehensive assessment of the brain; therefore, **MRI is required to evaluate the extent of parenchymal destruction**. An important differential diagnosis of **multicystic encephalomalacia (MCE)** is **subcortical and/or periventricular leukomalacia**, which can appear similar. However, ultrasound and MRI help distinguish these entities. **Multicystic encephalomalacia** demonstrates **diffuse replacement of brain tissue by multiple large, irregular cysts**, with **severe loss of normal architecture** and **passive ventricular enlargement**, involving both gray and white matter. In contrast, **periventricular leukomalacia** is **confined to the periventricular white matter**, initially appearing as **persistent increased echogenicity** and later evolving into **small cysts adjacent to the lateral ventricles**, while overall brain structure remains relatively preserved.

Don't forget to read our previous blog posts on sonoanatomy with a focus on [**midline structures**](https://123sonography.com/blog/case/midline-structures-neonatal-brain-ultrasound?utm_source=website&utm_medium=blogpost&utm_campaign=subcortical-leukomalacia), [**subependymal pseudocysts**](https://123sonography.com/blog/case/subependymal-pseudocysts?utm_source=website&utm_medium=blogpost&utm_campaign=subcortical-leukomalacia) and [**subcortical leukomalacia**](https://123sonography.com/blog/case/subcortical-leukomalacia?utm_source=website&utm_medium=blogpost&utm_campaign=multicystic-encephalomalacia).