Brain Abnormalities and Epilepsy in Patients with Parry-Romberg Syndrome

A, Axial FLAIR MR imaging in a patient with epilepsy shows severe, confluent left hemisphere white matter hyperintensity with extensive areas of punctate susceptibility artifacts throughout the left hemisphere on susceptibility-weighted imaging (B). Most of the hypointense foci on susceptibility-weighted imaging are hypointense on the matching phase image (C), consistent with prior microhemorrhages; however, few show hyperintense signal on the phase image (arrows in B and C), consistent with calcifications (confirmed by CT, not shown).

A, Axial FLAIR MR imaging in a patient with epilepsy shows severe, confluent left hemisphere white matter hyperintensity. B, Postcontrast T1-weighted MR imaging reveals leptomeningeal enhancement and sulcal effacement with decreased perfusion to the same area on arterial spin-labeling perfusion MR imaging (C).

A, Initial head CT in a patient with epilepsy reveals effacement of the sulci over the left parietal high convexity. B, Subsequent T1-weighted MR imaging performed 10 months later shows improvement in sulcal effacement, but with diffuse left hemisphere white matter hyperintensity on double inversion recovery MR imaging (C, arrow). D, Sagittal postcontrast T1-weighted MR imaging shows faint periventricular and perivascular enhancement (arrowheads). E, Concomitant FDG-PET shows left parietal hypometabolism in the affected area.

Spectrum of unilateral sulcal effacement. In 1 patient with epilepsy, axial T2-weighted MR imaging (A) shows right hemispheric sulcal effacement affecting the right frontal and parietal lobes, which remained unchanged on MR imaging performed 1 year later (B). C, Coronal FLAIR MR imaging in a second patient with epilepsy shows diffuse right hemisphere sulcal effacement with hyperintensity in the right hippocampal head, with resolution of sulcal effacement and development of right mesial temporal sclerosis on MR imaging approximately 6 months later (D).