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Cortical laminar necrosis

Case contributed by Maxime St-Amant
Diagnosis probable

Presentation

History of stroke.

Patient Data

Age: 75 years

Brain

ct

Head NECT shows gyriform hyperdensity in the right anterior frontal upper convexity region, of uncertain etiology. Subarachnoid hemorrhage seems less plausible since the hyperdensity is intra-axial. Subtle partly calcified neoplasm (oligodendroglioma)? Cortical laminar necrosis? Further investigations recommended with MRI.

Brain

mri

Not shown here but T2*GRE sequences showed blooming in the corresponding anterior frontal upper convexity and in the left parietal region.

The gyriform hyperdensity seen on the CT-scan is rather subtle on the T1 & T2 ponderation. The FLAIR sequence shows gyriform intra-cortical hypersignal in the corresponding territory. In combination with blooming seen on T2*GRE, this is compatible with cortical laminar necrosis.

Otherwise, there is mixed supratentorial brain atrophy with moderate leucoaraiosis.

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