Presentation
Seizures
Patient Data
Mild diffuse uniform atrophic changes of the left cerebral hemisphere manifested as deepening of cortical sulci and mildly decreased volume of cortex and white matter. This is associated with mild ex vacuo dilatation of the left lateral ventricle. Mild diffuse T2 and FLAIR hyperintensity is noted affecting the white matter of the left cerebral hemisphere. Mild attenuation of the left anterior, middle and posterior cerebral arteries. Preserved volume and MRI features of both cerebellar hemispheres and basal ganglia.
Case Discussion
This case represents left cerebral hemiatrophy in a young child with epilepsy. Cerebral hemiatrophy has a variety of causes and is generally associated with seizures and hemiplegia. Imaging features include thinning of the grey matter cortex, reduced volume of the underlying white matter, reduced myelination, enlargement of the lateral ventricle and reduced size of cerebral peduncle. The resultant reduction in cerebral volume, if early enough, can lead to changes in the skull, known as Dyke-Davidoff-Masson syndrome.
Differential diagnosis of similar brain morphology:
- Rasmussen encephalitis
- Dyke-Davidoff-Masson syndrome
- Unilateral megalencephaly
- Sturge-Weber syndrome
- Other causes: idiopathic, post-ictal, post-traumatic, ischemia and hypoxia.
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