Related Experiment Videos
[A patient with gigantic heterotopic gray matter with epileptic seizures]
T Hisano1, S Takashima, T Onuma
1National Center Hospital for Mental, Nervous and Muscular Disorders, Tokyo, Japan.
Insights
This case study details a young man with partial seizures and psychiatric symptoms due to gigantic heterotopic gray matter. Imaging revealed polymicrogyria, suggesting the lesion
Area of Science:
- Neurology
- Neuroscience
- Medical Imaging
Background:
- Epilepsy and psychiatric symptoms can manifest in individuals with brain malformations.
- Heterotopic gray matter, a developmental abnormality, involves misplaced gray matter tissue.
- Polymicrogyria is characterized by excessive small gyri on the brain surface.
Observation:
- A 23-year-old male presented with frequent partial seizures and psychiatric disturbances.
- Cranial CT and MRI revealed a large heterotopic gray matter lesion adjacent to the right lateral ventricle, associated with polymicrogyria in the right parietal lobe.
- Histopathology confirmed the presence of neurons within the lesion.
Findings:
- The patient experienced complex partial seizures with characteristic eye deviation.
- Interictal electroencephalography (EEG) indicated epileptic foci in the right temporal, fronto-temporal, and parieto-occipital regions.
- The findings suggest a correlation between the brain malformation and the observed epileptic activity.
Implications:
- This case highlights the diagnostic challenges and clinical manifestations of gigantic heterotopic gray matter.
- Understanding the relationship between cortical malformations and epilepsy is crucial for effective patient management.
- Advanced neuroimaging and electrophysiological studies are essential for localizing epileptic foci in complex neurological cases.
Abstract:
We report a patient with partial seizure and gigantic heterotopic gray matter. A 23-year-old young man was admitted to our hospital with complaints of frequent epileptic seizures and psychiatric symptoms. There was psychomotor delay in infancy. At the age of 4 years, afebrile convulsions appeared on several occasions. Seizures characterized by a lapse of consciousness started at the age of 13 years. He often stayed in a fantasy world and became very emotional at such time. Cranial CT demonstrated an irregularity in the wall of right lateral ventricle and disappearance of the posterior horn on the same side. This lesion, adjacent to that wall, had a signal intensity that was similar to that of the gray matter on each sequence in MRI. Histopathology of this lesion showed a number of large and small neurons. Therefore, heterotopic gray matter was diagnosed. MRI demonstrated wide cortices suggesting polymicrogyria in the right parietal lobe. Complex partial seizures with eye deviation to the left were recognized. Interictal EEG showed frequent high voltage spikes in the right temporal, fronto-temporal and parieto-occipital areas independently. Therefore, epileptic foci were thought to exist in or around those lesions.