Lopsided brain: a case of hemispheric dysplasia with cortical malformation in an infant

Cortical development malformations result from disruptions in neuronal migration, leading to a spectrum of brain abnormalities with significant clinical implications. This case report presents a 1-year-old male with hemiplegic cerebral palsy, without a history of seizures, an atypical presentation for cortical migration disorders. Brain magnetic resonance imaging revealed extensive cortical abnormalities, including features of focal cortical dysplasia (FCD), polymicrogyria, and subcortical heterotopia, along with asymmetric hemispheric changes suggestive of hemispheric dysplasia (HD) rather than classical hemimegalencephaly (HME). The imaging findings were crucial in differentiating between overlapping entities such as HME and HD. This case emphasizes the pivotal role of early neuroimaging in evaluating infants with neurological deficits, even when seizures are not present, and highlights the importance of a detailed and individualized approach to diagnosing intricate cortical malformations.