Case Series of Radiographic Progression of Focal Cortical Dysplasia Type Iib in the Pediatric Population
Abstract number :
2.308
Submission category :
5. Neuro Imaging / 5A. Structural Imaging
Year :
2024
Submission ID :
562
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Jaime Shoup, MD – University of Louisville School of Medicine/Norton Children's Hospital
Sydney Speed, MS1 – University of Louisville School of Medicine
Cemal Karakas, MD – University of Louisville School of Medicine/Norton Children's Hospital
Ian Mutchnick, MD, MS – University of Louisville School of Medicine
Robert Debski, MD – Norton Children's Hospital
Jeetendra Sah, MD – University of Louisville School of Medicine
Rationale: This case series of two patients aims to present novel findings demonstrating significant radiographic progression of a later pathologically confirmed focal cortical dysplasia (FCD) type IIb in two pediatric patients. Although MRI appearance of FCD can change with age, being reported in both pediatric and adult patients, our case series adds to the literature consideration of FCD in patients with initially negative MRI and rapidly progressing MRI changes in lesions mimicking progressive neoplasia.
Methods: A comprehensive chart review was conducted.
Results:
The first case is a 2-year-old female and the second is a 13-year-old male. In both cases, an initial brain MRI obtained at 5 and 11 months old respectively was normal. Significant radiographic progression on follow-up imaging at 35 months (about 3 years) and 13 years 2 months respectively. Full details of each case are presented in Table 1 and refer to Figure 1 for MRI images.
In both instances, there was evidence of neurocognitive decline, and seizures eventually became medially refractory. Following phase II invasive monitoring (sEEG) in the first case and phase I presurgical workup in the second case with concordance of data, they underwent craniectomy and focal resection of affected left fronto-central lobe and left occipital lobe respectively. The details of the specific surgery and outcomes are presented in Table 1. The pathology of both resected lesions revealed prominent cortical dyslamination, dysmorphic neurons, and occasional balloon cells consistent with FCD type IIb.
Conclusions: These cases highlight the novel finding of radiographic progression over time in pathologically confirmed FCD type IIb in the pediatric population. Clinicians should consider FCD type IIb in such radiographic progressive lesions with ongoing refractory focal seizures. These cases underscore the importance of serial MRI in focal epilepsy, even with an initially negative MRI.
Funding: There was no funding source for this research.
Neuro Imaging