PMC4307873_01
Coronal T1 image showing blurring of the gray-white matter interface at the left precentral gyrus suspicious for focal cortical dysplasia.
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Follow-up MRI 2 months postseizure onset demonstrated blurring of the gray-white junction in the left precentral gyrus and was concerning for a cortical dysplasia (Fig. 1).
Leptomeningeal and cortical lymphocytes.
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Biopsy subsequently showed a mild to moderate T lymphocyte predominant inflammatory infiltrate in the cortex and white matter with microglial nodules, which was consistent with Rasmussen's encephalitis, but the overall pathological picture was mild (Fig. 2, Fig. 3).
a. CD45: lymphocytes, slightly more numerous than those seen on H&E.. b. CD3: virtually all T-cells (no B-cells).. c. GFAP: reactive gliosis.. d. Rare SMI31 positive neurons of unclear significance.
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In addition, rare dysplastic neurons were seen, suggesting a possible cortical dysplasia (Fig. 3d).