Refractory focal epilepsy.
Age: 25 years
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Subtle high FLAIR transmantle band extends to the bottom of a small sulcus arising from the right post central gyrus just behind the central sulcus (best seen on coronal FLAIR image 56/57). This lies 1.5 cm above the Sylvian fissure. Definite cortical thickening or appearing of the grey-white matter interface is not to visualized however the appearances may reflect the possibility of a bottom of a sulcus dysplasia (at the limit of MRI resolution). The site correlates with the focal region of FDG PET hypometabolism.
Case DiscussionThe patient went on to have epilepsy surgery.
Histopathology of the resected lesion as follows:
Sections show portions of cerebral cortex demonstrating dyslamination and frequent dysmorphic neurons with abnormally distributed Nissl substance, vacuolated cytoplasm and enlarged nuclei. Occasional balloon cells are present with glassy eosinophilic cytoplasm. There is background reactive astrocytosis. A few heterotopic white matter neurons are seen. There is no evidence of a neoplastic process.
On immunohistochemistry, maloriented/dysmorphic neurons are highlighted with NeuN, NF and synaptophysin. Reactive astrocytosis is highlighted with GFAP. The ballooned cells are positive for GFAP, NF and synaptophysin.
Right parietal tissue - focal cortical dysplasia, type IIb."
The patient remains seizure free at last follow-up.
- Paul A. M. Hofman, Gregory J. Fitt, A. Simon Harvey, Ruben I. Kuzniecky, Graeme Jackson. Bottom-of-Sulcus Dysplasia: Imaging Features. (2012) American Journal of Roentgenology. 196 (4): 881-5. doi:10.2214/AJR.10.4423 - Pubmed
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