Images below require Macromedia's Flash Player to view

Neuroradiology Case of the Week

Case 398

April 2009

Chandler Shyu, MD, MPH, and PL Westesson, MD, PhD, DDS

Clinical Presentation: Patient is a 5-year-old child with history of seizure disorder and developmental delay. MR study was requested to evaluate for intracranial abnormality.

Imaging Findings: Axial flair MR images demonstrate a circumferential low-signal band around the periventricular white matter in a "double cortex" appearance. No abnormal enhancement is seen in this band post-contrast.

Diagnosis: Band heterotopia

Discussion: Heterotopia is a congenital migration disorder due to disruption of gray matter migration from the periventricular germinal zone to the cortex. Two distinct forms are seen, it can be band like as in this case, or it can have an nodular appearance. The nodular form is frequently seen in the subependymal space.
     The ectopic tissue will follow cortical gray matter signal on all sequence. Clinically these patient present with development delay and seizure of varying penetrance depending on the amount and location of the ectopic gray matter.

References:

1. Osborn A, Blaser S, Salzman K, et al. Diagnostic Imaging: Brain. Amirsys 2004. Section 1-1; pgs 58-60.