Focal cortical dysplasia - type 2b

Case contributed by Dr David Mitchell

Presentation

Refractory epilepsy

Patient Data

Age: 30

An area of cortical dysplasia is identified at the bottom of the sulcus of the right inferior frontal gyrus. There is cortical thickening, an ill defined margin, dilatation of the sulcus and a tail of signal intensity that extends down to the anterior horn of the right lateral ventricle indicating a transmantle dysplasia. The sagittal reformats shows that the lesion lies at the posterior aspect of the pars triangularis, close to the expected position of Brocas area. No other areas of cortical dysplasia are identified.

Expected post-operative findings.

Case Discussion

On MRI, an area of cortical dysplasia is identified at the bottom of the sulcus of the right inferior frontal gyrus. There is cortical thickening, an ill defined margin, dilatation of the sulcus and a tail of signal intensity that extends down to the anterior horn of the right lateral ventricle indicating a transmantle dysplasia.

DIAGNOSIS: Right brain biopsy: Focal cortical dysplasia - ILAE Type IIB involving full thickness of cerebral cortex.

MICROSCOPIC DESCRIPTION: There is a variable disturbance of normal cortical lamination and disorientation of neurons. Many enlarged dysmorphic neurons are seen in laminae 5 and 6. These extend into underlying white matter. Scattered balloon cells are also seen in underlying white matter. There is moderate reactive gliosis involving both cortex and white matter. No evidence of tumor is seen. The features are of focal cortical dysplasia - ILAE Type IIB. 

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Case information

rID: 62570
Published: 12th Sep 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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