Abstract
A 12-year-old adolescent presented with refractory seizures and was found to have a mesial temporal lobe lesion. The patient underwent biopsy and was diagnosed with an arteriovenous malformation. Supratentorial lesions in the pediatric population can have a large variety of underlying etiologies, which can be challenging to differentiate on neuroimaging. In this report, we discuss the key features on MRI of several neoplastic, vascular, and infectious processes that can aide in the diagnosis.
Highlights
At the time of presentation, the episodes were occurring daily. He was initially started on carbamazepine by his primary care physician who thought the episodes were consistent with seizures and he was referred to neurology
Mesial temporal lobe lesion hemiplegia with left-sided intraventricular hemorrhage and an ischemic stroke affecting the left thalamus and left middle cerebral peduncle. Pathology from this biopsy was consistent with a congenital arteriovenous malformation (AVM) with secondary leptomeningeal fibrosis
He was discharged to an inpatient rehabilitation facility and he had partial recovery of strength on his right side to the point and he was able to ambulate with a cane. He was seen in follow-up and at 28 months post-surgery his levetiracetam was discontinued over 6 weeks and at 34 months post-surgery the carbamazepine was discontinued over 12 weeks
Summary
A 12-year-old adolescent presented to his primary care physician with new onset staring episodes. At the time of presentation, the episodes were occurring daily He was initially started on carbamazepine by his primary care physician who thought the episodes were consistent with seizures and he was referred to neurology. There was concern that this lesion was consistent with an underlying neoplasm, a glial tumor, ependymoma, or dysembryoplastic neuroepithelial tumor (DNET) He underwent a left pterional craniotomy with partial resection of the left temporal lobe lesion. Five years after the initial surgery, the patient continued to have seizures (approximately 2–3/month) and repeat surgery was discussed for possible better seizure control He underwent a second left temporal craniotomy for resection of the remaining mesial temporal lobe lesion. His immediate post-operative course was complicated by right-sided
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