Structural Abnormalities in Patients with Insular/Peri-insular Epilepsy: Spectrum, Frequency, and Pharmacoresistance

Coronal FLAIR and axial T2 MR imaging scans of a 19-year-old woman with epilepsy with polymicrogyria in the right insula and postcentral gyrus.

Axial and sagittal T2 MR imaging scan of a 2-year-old girl with tuberous sclerosis in whom right insular epilepsy (definite) developed. Cortical tuber involving the short posterior and long anterior gyri of the insula. Note the white matter abnormalities of tuberous sclerosis.

Angiography of the left carotid artery with sagittal T1 MR imaging scan of a 54-year-old man with left fronto-insular epilepsy (probable). Angiography shows an arteriovenous malformation fed by the left middle cerebral artery and a left supraclinoid internal carotid artery aneurysm. MR imaging scan reveals the arteriovenous malformation centered on the left frontal operculum with mass effect on the anterior short gyrus of the insula.

Sagittal T1 and gradient-echo MR imaging of a 64-year-old man with a left insular cavernoma in whom left insular epilepsy (definite) developed. Round, hypointense T1, T2, and T2* lesion involves the anterior and posterior long gyri of the insula.