Pediatric emergency medicine trisk 2497 2497
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FIGURE 96.19 MRI image showing hemimegalencephaly progression in a 6-month-old child.
Axial (A ) and coronal (B) T2-weighted magnetic resonance imaging (MRI) images show
markedly enlarged left cerebral hemisphere with thickened gyri and smooth surface, consistent
with HME. The left lateral ventricle and caudate head are deformed. White matter is diffusely
hypointense compared with the unaffected right cerebral hemisphere, suggesting accentuated
myelination. C: Intraoperative photograph of the region of HME oriented with the frontal lobe
(F) in the top left and the temporal lobe (T) in the lower middle portions of the image. Notice
the diffuse cortical disorganization of all gyri. This child had a monozygotic twin who was
normal. (Panel A and C: Reprinted with permission from Engel J, Pedley TA, Aicardi J, et al.
Epilepsy . 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007. Panel B: From
Salamon N, Andres M, Chute DJ, et al. Contralateral hemimicrencephaly and clinicalpathologic correlations in children with hemimegalencephaly. Brain 2006;129:352–365; with
permission of the editor of Brain and Oxford University Press.)
