Male, 4 years old, with seizures. Assess for intracranial anomaly. The perisylvian cortex on the right is asymmetrically thickened with areas of subtle blurring of the cortex-white matter junction. Portions of the insular cortex as well as the frontal and temporal opercular cortex are involved. In addition, the involved temporal opercular region also shows significant subcortical T2 hyperintensity which extends to involve the far anterior temporal lobe.More posteriorly, there is a relatively focal region of cortical distortion and marked cortical and white matter T2 hyperintensity involving the inferior temporal gyrus. Also noted is subtle abnormal elevated T2 signal involving the right occipital cortex.None of these areas demonstrate any pathologic enhancement. There is no significant generalized mass effect. No discrete lesions or areas of definite cortical irregularity are seen in the left hemisphere.No restricted diffusion is detected. There is no evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricular system is normal in size and morphology. An incidental left parietal developmental venous anomaly is observed.
Right perisylvian cortical thickening is seen with additional areas of involvement in the anterior and inferior right temporal lobe and in the right occipital lobe. In some areas, the cortical abnormalities are associated with T2 hyperintensity.The morphology and distribution of these findings is very suggestive of cortical dysplasia. Lack of enhancement and multiplicity of involved regions argue strongly against a neoplastic process. Apparent sparing of the left cerebral hemisphere likewise argues against a systemic or metabolic process.