Mesial temporal sclerosis

Case contributed by Dr Derek Smith

Presentation

Referred from neurology with episodes of a rising sensation and with "out of body" awareness. History of generalised tonic-clonic seizures controlled on phenytoin, last about 2 years ago. Febrile convulsions before the age of 5 years. Recent normal CT head.

Patient Data

Age: 35 years
Gender: Female
MRI

Asymmetry of the mesial temporal and hippocampal structures. Loss of bulk and internal architecture of the right hippocampus. Normal temporal neocortex and amygdala.

T2W/FLAIR hyperintensities consistent with chronic small vessel ischemic disease. Right parafalcine ossification.

MRI

Manipulated images

Exaggerated windowing of the axial FLAIR sequence demonstrating increased signal in the right hippocampus.

Zoomed sections of the coronal T2W sequence better demonstrating the loss of internal architecture and grey/white matter differentiation in the hippocampus.

Case Discussion

There is loss of internal architecture, with increased FLAIR signal, of the right mesial temporal lobe and hippocampal structures. With the patient's history of complex partial seizures and secondary generalization, surgery is being considered for symptomatic relief.

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Case information

rID: 56215
Published: 18th Oct 2017
Last edited: 14th Oct 2019
Tag: 3 t
Inclusion in quiz mode: Included

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