Cortical Lipoma

This is a patient with seizure disorder. On MRI a T1 hyperintense lesion was noted in the left frontal region with associated cortical dysplasia. Signal suppresion was noted on Fat-sat T1 weighted images. Fat density on confirmed on CT scan.

Intracranial lipomas are rare lesions, assumed to be resulting from abnormal persistence and maldifferentiation of the meninx primitiva. The majority of the lesions occur at or near midline, mostly in the pericallosal cistern. Other locations include the quadrigeminal/superior cerebellar, suprasellar/interpeduncular, cerebellopontine angle, and sylvian cisterns.

Gray Matter Heterotopia

This is a 21 year old female presenting with history of seizure. MRI shows subependymal heterotopic band like gray matter heterotopia lining the lateral ventricles seen isointense to the gray matter on all sequences. She was apparently normal before this episode of seizure.

Gray matter heterotopia are common malformations of cortical development. From a clinical perspective, affected patients are best divided into three groups: subependymal, subcortical, and band heterotopia (also called double cortex). Symptomatic women with subependymal heterotopia typically present with partial epilepsy during the second decade of life; development and neurologic examinations up to that point are typically normal. Symptoms in men with subependymal heterotopia vary, depending on whether they have the X-linked or autosomal form. Nearly all affected patients that come to medical attention have epilepsy, with partial complex and atypical absence epilepsy being the most common syndromes.

Reference and detailed review in Neurology 2000;55:1603-1608 by Barkovich and Kuzniecky.

Case by-Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences)