Tuberous sclerosis

Case contributed by Dr Dalia Ibrahim

Presentation

Seizures since birth.

Patient Data

Age: 2-year-old
Gender: Male
MRI

Multiple bilateral variable sized subependymal nodules, which elicit high signal at T1 and iso/high signal at T2 and FLAIR WI showing post contrast enhancement.  The largest near the right foramen of Monro appears cystic showing marginal enhancement (subependymal hamartomas).

Bilateral cerebral cortical and subcortical patches of abnormal signal, eliciting low signal at T1 WI and being of high signal at T2 & FLAIR WI , representing (Cortical & subcortical tuberous).

Case Discussion

Subependymal hamartomas.

Visible within the first 6 months of age.

Variable signal,frequently high at T1 and iso/high at T2 WI.

Enhancement is variable and isn't a useful feature in distinguishing them from subependymal giant cell astrocytoma, only serial growth is reliable.

 

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