Presentation
Refractory epilepsy
Patient Data
An area of cortical thickening is identified at the bottom of the sulcus of the right inferior frontal gyrus. It has ill-defined margins with dilatation of the overlying sulcus ( the ascending ramus of the lateral sulcus, best identified on sagittal imaging) and a tail of high signal intensity that extends down to the anterior horn of the right lateral ventricle. Slightly elevated DWI signal is noted without reduction in ADC values. No calcification of blood products.
Conclusion:
A cortical lesion, almost certainly representing focal cortical dysplasia, lies at the depths of the ascending ramus of the lateral sulcus at the junction between the pars triangularis and pars opercularis of the inferior frontal gyrus, and thus close to the expected position of Brocas area. No other areas of cortical dysplasia are identified.
The patient went on to have a resection.
Histology:
There is a variable disturbance of normal cortical lamination and disorientation of neurons. Many enlarged dysmorphic neurons are seen in laminae 5 and 6. These extend into the underlying white matter. Scattered balloon cells are also seen in underlying white matter. There is moderate reactive gliosis involving both cortex and white matter. No evidence of tumor is seen. The features are of focal cortical dysplasia - ILAE Type IIB.
Final diagnosis:
Focal cortical dysplasia - ILAE Type IIB involving full thickness of cerebral cortex.
Expected post-operative findings with margins of the resection encompassing the expected extent of the lesion.
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