Previous history of a neonatal right MCA territory infarction. Now left hand numbness and seizure. No other neurological deficit.
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Generalised assymetry (reduced size) of the right hemicranium and brain with more focal atrophy in the right middle cerebral artery territory with adjacent gliosis. Right cerebral peduncle is also smaller. Brain otherwise is normal.
Remarkably due to the plasticity of the brain, this patient had no discernible neurological deficit. The area of atrophy and gliosis fits with old MCA territory infarction yet the whole right cerebral hemisphere is smaller than the left. The cranium on the right has also not grown to the size of the left as its contents are smaller.