Presentation
Uncontrolled convulsions since childhood.
Patient Data
The current MRI shows diffuse atrophy of entire left cerebral hemisphere and crossed right cerebellar hemisphere with volume loss and massive ex vacuo dilatation of left lateral ventricle. Associated FLAIR hyperintensities of white matter without diffusion restriction.
CT of the brain performed 5 years previously was normal. Physiological asymmetry of lateral ventricles.
MRI of the brain performed 7 years previously was normal.
Case Discussion
The patient has a longstanding history of generalized tonic-clonic convulsions since his childhood, not controlled by antiepileptics. Normal brain parenchyma was seen in a CT study done 5 years previously whereas the current study shows gross hemispheric atrophy, both cerebral and cerebellar. A presumptive diagnosis of Rasmussen encephalitis has been made. The patient is currently on high-dose steroids and immunoglobulins.
The radiographic differential diagnosis here is Dyke-Davidoff-Masson syndrome, Sturge-Weber syndrome, unilateral megalencephaly and hemiconvulsion-hemiplegia epilepsy syndrome.
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