Parry Romberg syndrome with intracranial manifestations
A 45-year-old female with a history of localization-related epilepsy and prior surgical intervention for facial asymmetry presents for imaging evaluation.
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Multiple axial MR images demonstrate pronounced atrophic changes of the left face in addition to abnormal hyperintense FLAIR signal, foci of susceptibility artifact, and nodular enhancement within the left cerebral and cerebellar white matter.
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The parenchymal enhancement seen in the presented case has not been described in the setting of Parry Romberg syndrome, however, the supra and infratentorial white matter signal abnormalities and microhemorrhages or calcifications are in keeping with previously reported findings.
Our patient underwent a brain biopsy which yielded non-specific findings of a lymphoplasmacytic infiltrate. The enhancement and parenchymal signal changes have remained stable over a 3 year follow-up period.
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