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Case Reports
. 2013 Apr;28(2):93-5.
doi: 10.4103/0972-3919.118257.

Hemimegalencephaly: A rare cause of hemihypoperfusion on 99m technetium-ethyl cysteinate dimer brain perfusion single-photon emission computed tomography

Nishikant A Damle  1 , Abhinav Singhal, Anirban Mukherjee, Manas Kumar Sahoo, Madhavi Tripathi, Chandrasekhar Bal
Affiliations
Case Reports

Hemimegalencephaly: A rare cause of hemihypoperfusion on 99m technetium-ethyl cysteinate dimer brain perfusion single-photon emission computed tomography

Nishikant A Damle et al. Indian J Nucl Med. 2013 Apr.

Abstract

Hemimegalencephaly is a rare congenital neuronal migration disorder that can presents with the equally rare finding of hemihypoperfusion on brain perfusion single-photon emission computed tomography (SPECT). It is an extremely rare cause of intractable epilepsy. Technetium-99m ethyl cysteinate dimer (ECD) brain perfusion SPECT is useful in excluding other foci of hypoperfusion in the contralateral since hemispherectomy has been suggested to be the treatment of choice. Furthermore, hemimegalencephaly may present with hyper as well as hypoperfusion on ECD SPECT. We present the case of an 11-year-old male child with intractable seizures who showed hemihypoperfusion in the hemimegalecephalic hemisphere.

Keywords: 99m technetium-ethyl cysteinate dimer brain single-photon emission computed tomography; hemihypoperfusion; hemimegalencephaly.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Non-contrast computed tomography of head (a) Axial shows diffuse enlargement of left cerebral hemisphere (*) with midline shift towards right while the right hemisphere is normal. Non-contrast magnetic resonance imaging T2W (b) Images (axial) show diffuse gyral thickening (thin arrow) in the left cerebrum causing midline shift and scalloping of inner table (arrow head) of left calvarium. White matter in both cerebral hemispheres show normal myelination. Linear hyperintensities involving the subcortical U fibers of left fronto-parietal region seen on fluid attenuation inversion recovery image (c) Post-gadolinium T1W image in axial plane (d) shows no abnormal enhancement
Figure 2
Figure 2
99m technetium-ethyl cysteinate dimer brain perfusion single-photon emission computed tomography transaxial, coronal and sagittal images reveal diffusely decreased tracer uptake in the left cerebral hemisphere (arrow), with normal uptake in the right hemisphere. Findings are suggestive of left cerebral hemihypoperfusion
See this image and copyright information in PMC

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