14-year old child presented with right focal motor with secondary generalized seizures of six months duration. He had a total of three episodes of seizures during this period. There was mild right hemiparesis, however, speech was not impaired.
MRI brain showed features of left cerebral hemiatrophy- widened sulci, thinning of gyri and ex-vacuo dilatation of left lateral ventricle. Hyperintense lesions on FLAIR MRI were also noted in left parieto-occipital regions. MR angiogram showed paucity of branches of left middle cerebral artery.
A possible diagnosis of left cerebral hemiatrophy with epilepsy was made. In view of paucity of left MCA branches, the likely etiology was cerebral ischemia.
Differential diagnosis of cerebral hemiatrophy
- Rasmussen’s encephalitis
- Sturge Weber syndrome
- Birth trauma
- Perinatal intracranial hemorrhage
- Postictal cerebral hemiatrophy
- post-infectious such as after herpes simplex, TORCH, HIV
- Dyke Davidoff Mason syndrome
- Perinatal asphyxia
- HHE (Hemiconvulsion-Hemiplegia-Epilepsy) syndrome