title: A distinct asymmetrical pattern of cortical malformation: large unilateral malformation of cortical development with contralateral periventricular nodular heterotopia in three pediatric cases.
abstract: OBJECTIVE
  To describe a distinct asymmetrical pattern of cortical malformation with large focal malformations of cortical development (MCDs) and contralateral periventricular nodular heterotopia (PNH).
  
  
  METHODS
  We identified three patients with epilepsy and focal EEG abnormalities. Each patient underwent 1.5-Tesla magnetic resonance imaging (MRI) to obtain sagittal T1-weighted, axial fluid-attenuated inversion recovery (FLAIR), fast spin-echo (FSE) T2-weighted, and coronal fast spin-echo inversion recovery (FSEIR) T2-weighted images; coronal spoiled gradient recalled (SPGR) T1-weighted images were obtained in two cases.
  
  
  RESULTS
  Patient 1, an 18-year-old right-handed man, had a 4-year history of intractable seizures. MRI revealed a right frontal subcortical heterotopia (SH) and a single left anterior PNH. Patient 2, a 10-year-old left-handed boy, had a 4-year history of epilepsy. MRI revealed a large region of SH in the left temporal, parietal, and occipital lobes and three right-sided PNH. Patient 3, a 16-month-old girl, had medically refractory infantile spasms. MRI revealed a large MCD in the left parietal lobe with contiguous underlying periventricular heterotopia as well as a small contralateral PNH.
  
  
  CONCLUSIONS
  These cases together illustrate a distinct asymmetrical pattern of a large focal MCD with small contralateral PNH. The asymmetrical involvement of the two hemispheres suggests that the stage of maximal disruption of cortical development may differ between the two hemispheres. Further study into the mechanisms underlying such asymmetrical patterns of cortical malformation should enhance our understanding of cortical development as well as hemispheric lateralization.
authors.affiliation: Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Children's Hospital Boston, Boston, Massachusetts 02115, USA. annapurna.poduri@childrens.harvard.edu
authors.forename: Annapurna
authors.initials: A
authors.lastname: Poduri
authors.forename: Anna
authors.initials: A
authors.lastname: Golja
authors.forename: James J
authors.initials: JJ
authors.lastname: Riviello
authors.forename: Blaise F D
authors.initials: BF
authors.lastname: Bourgeois
authors.forename: Frank H
authors.initials: FH
authors.lastname: Duffy
authors.forename: Masanori
authors.initials: M
authors.lastname: Takeoka
mesh_terms: D000293:Adolescent; D002540:Cerebral Cortex / Q000002:abnormalities* / Q000473:pathology; D002552:Cerebral Ventricles; D002648:Child; D002828:Choristoma / Q000175:diagnosis / Q000473:pathology*; D004569:Electroencephalography; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male