Bilateral mesial temporal sclerosis
History of complex partial seizures, EEG showed bilateral independent epileptogenic foci (R>L)
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There is bilateral hippocampal atrophy with increased T2 signal and digitations are reduced on both sides with prominent temporal horns
Note the mamillary body atrophy on right side.
10-15% of MTS is bilateral, if comparison and primary findings of atrophy are used alone the diagnosis may be missed
Secondary findings will help diagnose more cases. They are:
- mamillary body atrophy,
- temporal horn dilation,
- reduced digitations,
- reduced parahippocampal grey-white matter differentiation and
- decreased thickness of collateral white matter
Secondary findings also help to decide the side to be operated for maximal patient benefit.
if all MRI findings and EEG are equivocal, FDG-PET is used.
- 1. Functional Neuroradiology: Principles and Clinical Applications edited by Scott H. Faro, Feroze B. Mohamed, Meng Law, John T. Ulmer
- 2. Brain Imaging Case Review Series By Arora