What is the main differential?
Hypothalamic-chiasmatic glioma, although enhancement is often present and involvement of the chiasm is common.
How do children with hypothalamic hamartomas present?
Gelastic seizures and central precocious puberty are the classical presenting features.
Selected images from an MRI of the brain demonstrate a rounded mass in the region of the hypothalamus, projecting inferiorly, behind the infundibulum of the pituitary gland. It is isointense to grey matter on T1 weighted images, does not enhance and is somewhat hyperintense of T2 weighted images.