MRI-Brain/Stem (W/O Contract)

*Final Report*

Date of Test: 02/09/2006

Exam: MRI OF THE BRAIN WITHOUT CONTRAST

History: A 6 month old male born at 40 weeks gestation with new onset of seizures x2 to 3 weeks

Technique:
1. No comparison
2. MRI of the brain was preformed without contrast with multiplanar, multi sequential imaging
3. Sedation utilizing chloral hydrate per the Sedation Team

Findings: This study is limited secondary to motion artifact. As visualized, there is cortical thickening involving the posterior aspects of the bilateral frontal and temporal lobes and the anterior occipital lobe and the bilateral parietal lobes, predominantly with a perisylvian distribution. There is fine cortical undulation. There is sparing of the anterior aspects of the frontal and temporal lobes. These findings are compatible with cortical dysplasia, specifically polymicrogyria. There is a moderate degree of ventriculomegaly involving the third and lateral ventricles, being less prominent within the bilateral occipital horn which may be secondary to the cortical dysplasia versus less likely hydrocephalus. The cerebellar tonsils are in normal position with normal signal. There is no acute hemorrhage, midline shift, or abnormal extra axial fluid collections. The basal cisterns appear within normal limits. There is no evidence of acute ischemia on diffusion imaging. There are normal flow voids within the anterior and posterior circulations.

Impression:
1. Study limited secondary to motion artifact.
2. Findings compatible with a polymicrogyria, cortical dysplasia in a predominately perisylvian distribution as described above.
3. Moderate degree of ventriculoegaly involving the third and lateral ventricles which is likely secondary to the cortical dysplasia with less likely consideration including hydrocephalus.

24 hr. Video EEG

*Final Report*

Date of Test: 02/07/2006

Procedure: Video Monitor Recording

Clincal History: A 6 month old male who is being evaluated for infantile spasms

Medications: Medications at this time include Topamax

Recording Data: This is a video EEG study using a 32 channel EEg system with simulatneous video recording. An even button was used by the mother to identify suspicious episodes

Findings: background activity: This study lasted 24 hours. The background activity was chaotic with no organization. No definite posterior rhythm could be identified. The amplitude was high ranging between 100 and 400 mcv. Frequent spike wave complexes were seen in a multifocal distribution and generalized polyspike and wave dischanges were also noted. The event button was pressed twice. The fist awas at 21:15 when the patient had woken up from sleep. There was a cluster lasting 3-4 minutes compromising of very mild spasms involving the head, trunk, and the legs. Each spasm was associated with a slow giant wave with superimposed fast wave activity. There were about 20 spasms in this cluster. The event button was pressed again at 2:40 a.m. when an arousal was noted and mild spasms in association with crying and giant waves.

Impression: This is a several abnormal recording. It is significant for a positive diagnosis of infantile spasms, since typical events were captured. However, these spasms were attenuated possibly because of medical treatment. In addition, the chaotic high amplitude background with multifocal spikes is consistent with the electrophysiological diagnosis of hypsarrhythmia