Cerebral Hemiatrophy in a Child with Epilepsy

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

  1. Rasmussen’s encephalitis
  2. Sturge Weber syndrome
  3. Birth trauma
  4. Perinatal intracranial hemorrhage
  5. Postictal cerebral hemiatrophy
  6. post-infectious such as after herpes simplex, TORCH, HIV
  7. Dyke Davidoff Mason syndrome
  8. Perinatal asphyxia
  9. HHE (Hemiconvulsion-Hemiplegia-Epilepsy) syndrome
  10. Neurofibromatosis

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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