Tuberous sclerosis (brain)

Case contributed by Dr Mostafa Mahmoud El Feky


Seizures on antiepileptic drugs.

Patient Data

Age: 5~10
Gender: Female

CT brain.

Cortical lesion: Small calcific densities are also noted at the left choroid fissure and left cerebellar hemisphere (cortical tubers).

Subependymal Lesions: Multiple subependymal foci of calcifications at the left lateral ventricle (subependymal nodules). Heterogenous soft tissue lesions are noted at the frontal horn of both lateral ventricles bilaterally with marginal coarse calcifications. It measured 12 x 12 x 13 mm at the right side and 6.5 x 5.7 x 6.5 mm at the left side. No evidence of hydrocephalic changes.

White matter lesions: Bilateral subcortical white matter hypodensities are noted, notably at right frontal, right parietal and left temporal regions. Intra-axial cystic lesion is noted at the right frontal white matter, related to the frontal horn of right lateral ventricle measuring 1.5 x 1.6 cm (cystoid degenerations). 

Left-sided extra-axial fusiform fluid density is noted at the middle cranial fossa measuring 2.5 x 1 cm in dimensions in keeping with arachnoid cyst.

Case Discussion

This case is known for multiple sclerosis on antiepileptic treatment presented for follow up. Cortical tubers and subependymal nodules are noted. White matter changes are also noted, manifested with multiple subcortical white matter hypodensities and a cystic lesion (cystoid degeneration). Small subependymal nodules with calcifications at both lateral ventricles mostly representing subependymal hamartomas.

Bilateral subependymal lesion at the frontal horn of the lateral ventricles larger than 1 cm with calcifications, could suggest the possibility of being subependymal giant cell astrocytomas. They are benign tumors, seen almost exclusively in young patients with tuberous sclerosis. They classically appear as an intraventricular mass near the foramen of Monro.

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Case information

rID: 54426
Published: 28th Jul 2017
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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