Winner of CoW 17 July 2016
Tuberous sclerosis.
Findings
Multiple calcified subependymal nodules are noted in both sides. Few calcified cortical tubers are noted in the right occipital region and left superior cerebellar hemisphere. Few hyperdense cutaneous are noted in the right occipital and left superior parietal region. Multiple focal cortical FLAIR hyperintensities , suggestive of Tubers are noted in both cerebral hemispheres, appearing hyperintense in FLAIR images Few radial bands are also noted.
Discussion
In a patient presenting with seizures , the presence of multiple gyral FLAIR hyperintensities should lead one to suspect Tuberous Sclerosis. Cortical tubers may be of two types gyral core and sulcal island. A gyral core appears hyperintense on T2-weighted images and hypointense on T1-weighted imaged, located in the inner core of an expanded (widened) gyrus, with a cortex of normal thickness Sulcal islands are lesions in which the subcortical white matter appears hyperintense on T2-weighted images and iso-hypointense on T1- weighted images, involving two adjacent gyri. The radial bands sign refers to linear bands seen on MRI, radiating from the periventricular white matter to the subcortical region, considered specific for Tuberous Sclerosis.
Findings
Multiple calcified subependymal nodules are noted in both sides. Few calcified cortical tubers are noted in the right occipital region and left superior cerebellar hemisphere. Few hyperdense cutaneous are noted in the right occipital and left superior parietal region. Multiple focal cortical FLAIR hyperintensities , suggestive of Tubers are noted in both cerebral hemispheres, appearing hyperintense in FLAIR images Few radial bands are also noted.
Discussion
In a patient presenting with seizures , the presence of multiple gyral FLAIR hyperintensities should lead one to suspect Tuberous Sclerosis. Cortical tubers may be of two types gyral core and sulcal island. A gyral core appears hyperintense on T2-weighted images and hypointense on T1-weighted imaged, located in the inner core of an expanded (widened) gyrus, with a cortex of normal thickness Sulcal islands are lesions in which the subcortical white matter appears hyperintense on T2-weighted images and iso-hypointense on T1- weighted images, involving two adjacent gyri. The radial bands sign refers to linear bands seen on MRI, radiating from the periventricular white matter to the subcortical region, considered specific for Tuberous Sclerosis.
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!