Heterotopia

Clinical:

  • A 19 years old boy
  • No known medical problem
  • Presented with generalized tonic clonic seizure
  • No neurological deficit
MRI coronal plane in IR sequence

MRI findings:

  • Bilateral hippocampus are symmetrical with normal signal intensity (images not shown).
  • The amygdalar grey matter shows normal signal intensity. No evidence of significant alteration in size or focal asymmetry.
  • There are multiple subependymal grey heterotopia seen along¬† occipital horns of bilateral lateral ventricle (white arrows). They follow grey matter signal on T1 and T2 sequences. They do not show enhancement in post contrast sequences.

Diagnosis: Subependymal grey matter heterotopia 

Discussion:

  • Heterotopias represents rest of neurons along migration pathways (anywhere from ventricular walls to subcortical regions)
  • Most common presentation: intractable seizures
  • Most heterotopias are of the nodular types which is seen as foci of gray matter along ependymal surface of ventricles (differential diagnosis: tuberous sclerosis)
  • Multiple heterotopias may be considered diffuse disease and surgery is not indicated
  • Heterotopias may also be subcortical and mass-like, may involve the entire thickness of white matter and be transmantle
  • Hetrotopias do not enhance
Author: radhianahassan