Case 066

History/Physical

History/Physical:

65-year-old right-handed male.

Difficult to control seizures. Predominantly left temporal spikes on EEG.

There is mild increased signal with volume loss in the posterior left insula (arrow). The left Sylvian fissure is enlarged from atrophy of the adjacent brain (*).

There is cortical volume loss in the insula (arrow) and temporal lobe (arrowhead).

On FLAIR, the parenchymal signal change is easier to perceive in the insula (arrow) and hippocampus (arrowhead). There are scattered small white matter hyperintensities consistent with chronic small vessel ischemic change.

Diagnosis: Hypoxic-ischemic injury (infarct)

The cortical ribbon at the crest of one gyrus is thinned and rarefied (arrow).

The cortex is rarefied and almost completely replaced by a chronic glial scar. Subpial (Chaslin's) gliosis is also present (*).