Presentation
Epilepsy with fresh episode of seizure
Patient Data
Coronal T2w, axial T2w, and FLAIR images of temporal lobes show volume loss of the right hippocampus with T2 & FLAIR hyperintense signals. There is a loss of right hippocampal digitations. These features are consistent with right mesial temporal sclerosis.
The left hippocampus appears normal in volume and shows normal signals.
No other epileptogenic lesion was seen in the rest of the brain parenchyma.
Case Discussion
Mesial temporal sclerosis (MTS) is one of the common causes of intractable epilepsy. Patients often present with seizures, predominantly complex partial seizure patterns. MRI brain with epilepsy protocol should be done in all patients with seizures.
MRI shows classical features of mesial temporal sclerosis in the form of volume loss, loss of hippocampal digitations, and T2w & FLAIR hyperintense signals.
MTS can be bilateral in up to 3-10% of patients. Always look for a dual epileptogenic lesion in the rest of the brain, as 10-15% of patients with seizures can have dual pathology.
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