Non-contrast MR head with TOF MRA, performed 2 days after CT, 3 days efter seizures.
Sulcal effacement of the left hemisphere with slight grey-white dedifferentiation on T1, sparing deep nuclei. Associated diffuse panhemispheric hyperintense left WM-changes on DWI with signal loss on ADC and slightly increased signal on T2FLAIR, indicating diffusion restriction consistent with cytotoxic edema. No significant mass effect. The affected areas are independent of vascular territories and there is striking sparing of deep nuclei including basal ganglia. No cerebellar involvement.
No gross or petechial intracranial hemorrhages. No vessel or flow abnormalities on TOF angiography, no evidence of dissection. No focal abnormalities or atrophy including contralateral cerebellar atrophy.
Patient history, clinical picture and imaging findings suggest hemiconvulsion-hemiplegia-epilepsy syndrome in acute phase (hemiconvulsion hemiplegia, HH).