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Updated: Nov 27, 2025

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Published on: September 20, 2024
A Rare Congenital Cause of Epilepsy
Neethu Gopal1, Ayushi Jain2, Sukhwinder Johnny S Sandhu3
1Neurology, Mayo Clinic, Jacksonville, USA.
Insights
Enlarged parietal foramina (PFM) are skull defects. This case highlights rare brain malformations, including polymicrogyria, linked to PFM and ALX4 gene mutations.
Area of Science:
- Medical Genetics
- Developmental Biology
- Neurology
Background:
- Enlarged parietal foramina (PFM) are congenital calvarial defects.
- While typically lacking intracranial abnormalities, PFM can rarely coexist with brain malformations.
- Genetic factors are increasingly implicated in specific PFM subtypes.
Abstract:
Enlarged parietal foramina (PFM) are congenital calvarial defects characterized by bilateral parietal bone defects (>5 mm), occurring on each side of the sagittal suture along its posterior aspect. While often lacking underlying intracranial malformations, there has been increasing recognition of coexisting brain malformations in certain subtypes. We present a case of a 12-year-old girl presenting with new-onset grand mal seizure with developmental delay and a known family history of epilepsy. Brain MRI revealed large, bilateral parietal bone defects with underlying cortical malformation (polymicrogyria and ulegyria) and vascular abnormalities (persistent falcine sinus), related to PFM. This case report describes the genetic basis for recognized subtypes of PFM and the rare association of brain malformations associated with PFM due to mutations in the ALX4 homeobox gene.
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