Friday, 7 October 2011

All hemiatrophies are not Rasmussen's

A 14yo female with seizures, poor school performance.
Present MRI study shows moderate left hemi atrophy.
Previous CT study of Brain done 5 year back noted and is normal. 
The striking feature of this MRI study is left hemi atrophy.
Imaging wise Rassmussen’s Encephalitis was suggested at first. But.........!!!

Detailed history and history of previous hospital admission reviewed again which revealed, her previous hospital admission for fever and loss of consciousness 5 year back.
The CT which was at that time was normal.
MRI not done.
Csf findings and discharge summery mentions clinical diagnosis of Encephalitis.
After that till now hardly had 2 or three episodes of seizures. Is under treatment of anti epileptics and responding well to medication. There is no clinical worsening or progression in seizures so far. 

In Rasmussen’s, hemi atrophy is rapidly progressive, an associated progressive clinical worsening, intractable seizures which are non responsive to medications.  

Now as per the clinical details and imaging finding left Hemi atrophy as a sequel of previous Encephalitis is more likely than Rasmussen’s among the two.
Peri natal hemispheric infarction (Dyke Davidoff Masson syndrome) is unlikely as there is no history of significant perinal insult, no associated compensatory ipsilateral bony calvarial thickening, hyper pneumatisation of paranasal sinuses, elevation of petrous ridge.  

Conclusion : All hemiatrophies are not Rasmussen’s. Clinical course is equally important. Better to give DDs. 

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