A 26-year-old woman with a history of epilepsy presented with an acute onset of aphasia and vertigo followed by headache and right periumbilical paresthesia. MRI was performed to rule out stroke and revealed subependymal heterotopia1 (figure 1), which is associated with epilepsy. In addition, diffusion-weighted imaging (DWI) showed restricted diffusion in the left occipital cortex and the heterotopic nodules (figure 2). DWI changes completely resolved in 48-hour follow-up imaging.
T1-weighted imaging shows bilateral periventricular nodules, isointense to gray matter (arrows), and a dilated left occipital horn.
Peri-ictal diffusion-weighted imaging (A) shows hyperintensity of the left heterotopic gray matter and the occipital cortex with corresponding decrease in apparent diffusion coefficient map (B). Resolution of signal changes in 48-hour follow-up imaging (C, D).
Whereas the transient cortical and subcortical diffusion restriction is a known signal change in epilepsy,2 this case presents novel peri-ictal restricted diffusion in heterotopic gray matter.
Footnotes
Author contributions: Study concept and design: U. Yilmaz, P. Papanagiotou. Analysis and interpretation of data: U. Yilmaz, P. Papanagiotou, C. Roth, J. Spiegel, S. Kalampokini, W. Reith. Drafting of the manuscript: U. Yilmaz, P. Papanagiotou. Critical revision of the manuscript for important intellectual content: C. Roth, J. Spiegel, S. Kalampokini, W. Reith. Acquisition of data: U. Yilmaz, J. Spiegel, S. Kalampokini. Study supervision: P. Papanagiotou, W. Reith.
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
- Copyright © 2012 by AAN Enterprises, Inc.
References
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