Answer for CoW 30 July 2017
Focal cortical dysplasia
Findings
Focal cortical thickening right frontal lobe Distortion of Gyral architecture & overlying T2 Flair hyperintensity in right frontal lobe Subcortical white matter T2 /Flair Hyper intentensities in right frontal lobe.
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. Types of FCD Type I : mild symptomatic expression and late onset, is more often seen in adults, with changes present in the temporal lobe. Findings - 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 Ia: usually confined to temporal lobes 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 Type II : usually seen in children - 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, 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) New type III is one of the above dysplasias with associated another principal lesion as hippocampal sclerosis, tumor, vascular malformation or acquired pathology during early life.
Findings
Focal cortical thickening right frontal lobe Distortion of Gyral architecture & overlying T2 Flair hyperintensity in right frontal lobe Subcortical white matter T2 /Flair Hyper intentensities in right frontal lobe.
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. Types of FCD Type I : mild symptomatic expression and late onset, is more often seen in adults, with changes present in the temporal lobe. Findings - 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 Ia: usually confined to temporal lobes 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 Type II : usually seen in children - 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, 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) New type III is one of the above dysplasias with associated another principal lesion as hippocampal sclerosis, tumor, vascular malformation or acquired pathology during early life.
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!