Mesial temporal sclerosis (right)

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

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

T2w/FLAIR hyperintensities consistent with small vessel changes. 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 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 generalisation, surgery is being considered for symptomatic relief.

PlayAdd to Share

Case information

rID: 56215
Case created: 18th Oct 2017
Last edited: 18th Oct 2017
Tag: 3t
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.