Bilateral mesial temporal sclerosis

Case contributed by Dr Prashant Gupta

Presentation

History of complex partial seizures, EEG showed bilateral independent epileptogenic foci (R>L)

Patient Data

Age: 30
Gender: Female
Modality: MRI

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.

Case Discussion

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.

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Case Information

rID: 17976
Case created: 29th May 2012
Last edited: 15th Dec 2015
Inclusion in quiz mode: Excluded

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