Tuberous sclerosis (brain)

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Seizures on antiepileptic drugs.

Patient Data

Age: 7
Gender: Female
CT

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 … suggestive of subependymal giant cell astrocytoma

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.   

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, mainfested with multiple subcortical white matter hypodensities and a cystic lesion. Bilateral subependymal frontal lesions are noted with calcifications suggested as Subependymal giant cell astrocytomas. They are benign tumours, seen almost exclusively in young patients with tuberous sclerosis. They classically appear as an intraventricular mass near the foramen of Monro, larger than 1 cm and showing calcifications.

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Case information

rID: 54426
Case created: 9th Jul 2017
Last edited: 30th Jul 2017
Inclusion in quiz mode: Included

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