Answer for CoW 05 March 2017
Focal cortical dysplasia
Findings
Cortical thickening in right temporal lobe. blurring of white matter–grey matter junction with abnormal architecture of subcortical layer. T2/FLAIR signal hyperintensity of white matter.
Discussion
Focal cortical dysplasias (FCD) represent a heterogeneous group of disorders of cortical formation, which may demonstrate both architectural and proliferative features. They are one of the most common causes of epilepsy and can be associated with hippocampal sclerosis and cortical glioneuronal neoplasms. Type I location type Ia: usually confined to temporal lobes 4 if associated with hippocampal atrophy (as is common), it is now classified as type IIIa in the Blumcke classification type Ib: more frequently seen outside of the temporal lobes structure blurring of grey/white matter junction (less marked than with Type II FCD) prominent segmental or lobar atrophy/hypoplasia with loss of regional white matter volume signal white matter moderately increased T2/FLAIR signal decreased T1 signal Type II location commonly found in frontal lobes less likely to be in the temporal lobes compared to Type I FCD structure abnormal gyri and sulci marked blurring of grey/white matter junction cortical thickening signal white matter moderately increased T2/FLAIR signal, typically brighter than adjacent cortex decreased T1 signal focal signal abnormality may extend from cortex to ventricle (transmantle sign): not seen in type I grey matter some increase in T2 signal despite increase in T2 signal, cortex remains hypointense to much brighter adjacent white matter 4 more evident than in type I.
Findings
Cortical thickening in right temporal lobe. blurring of white matter–grey matter junction with abnormal architecture of subcortical layer. T2/FLAIR signal hyperintensity of white matter.
Discussion
Focal cortical dysplasias (FCD) represent a heterogeneous group of disorders of cortical formation, which may demonstrate both architectural and proliferative features. They are one of the most common causes of epilepsy and can be associated with hippocampal sclerosis and cortical glioneuronal neoplasms. Type I location type Ia: usually confined to temporal lobes 4 if associated with hippocampal atrophy (as is common), it is now classified as type IIIa in the Blumcke classification type Ib: more frequently seen outside of the temporal lobes structure blurring of grey/white matter junction (less marked than with Type II FCD) prominent segmental or lobar atrophy/hypoplasia with loss of regional white matter volume signal white matter moderately increased T2/FLAIR signal decreased T1 signal Type II location commonly found in frontal lobes less likely to be in the temporal lobes compared to Type I FCD structure abnormal gyri and sulci marked blurring of grey/white matter junction cortical thickening signal white matter moderately increased T2/FLAIR signal, typically brighter than adjacent cortex decreased T1 signal focal signal abnormality may extend from cortex to ventricle (transmantle sign): not seen in type I grey matter some increase in T2 signal despite increase in T2 signal, cortex remains hypointense to much brighter adjacent white matter 4 more evident than in type I.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!