MediAI

When a Subtle Cortical Abnormality Explains Years of Seizures A patient in her 30s with a history of drug-resistant seizures undergoes a non-contrast brain MRI. The images reveal a subtle abnormality involving the right frontal cortical region. There is no dramatic mass. No major edema. No obvious contrast-enhancing tumor. Yet this apparently modest MRI abnormality may represent the structural substrate of years of disabling epilepsy. The diagnosis is focal cortical dysplasia (FCD) . Focal cortical dysplasia is one of the most important structural causes of drug-resistant focal epilepsy. It is particularly important in epilepsy imaging because the abnormality can be extremely subtle, sometimes approaching the limits of conventional MRI detection. The uploaded case demonstrates this diagnostic challenge. MRI shows loss of the normal cortical architecture over the right frontal cortical surface, with an adjacent linear cortical/subcortical abnormality demonstrating T2 and FLAIR h...