PMC4060958_01
(A) Axial Non enhanced CT shows hypodense lesion in right temporal region, lobulated that shapes the adjacent bone tissue (yellow arrow). MRI axial sequences of: (B) T1w, (C) T2w, (D) FLAIR (Fluid-Attenuated Inversion Recovery), (E) diffusion weighted, and (F) T1w + gadolinium which identifies an image (white arrows) hyperintense on T2w, hypointense on T1w, and FLAIR and does not restrict diffusion w; it is located at the level of the second right temporal gyrus in its portion with discrete anterior subcortical gliosis and lateral enhancement after gadolinium administration (red arrow).
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figure1
A simple axial tomography was performed on her and a hypo-dense lesion that shapes the temporal internal table was observed, subsequent to this, a nuclear magnetic resonance was ordered for better characterising of a lesion in the second right temporal gyrus with a cystic appearance (see Figure 1).
Axial T1w MRI + gadolinium, follow-up of two and a half years; (A) 2008, (B) 2009, and (C) 2010, which showed the temporal injury (white measurements) had grown 2 mm. This lesion measured 9 x 15 x 8 mm and currently measures 11 x 17 x 10 mm along its longest axis.
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figure2
This lesion grew slowly (about 2 mm) in the last six months (see Figure 2); because of this, a PET was carried out (see Figure 3) to see the behaviour of the injury; there is no uptake of radiopharmaceutical (5-deoxy Fluoride glucose).
PET (5-FDG) in (A) axial (B) coronal, and (C) sagittal projections that show no uptake in the injury at the right temporal level (white arrow).
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figure3
This lesion grew slowly (about 2 mm) in the last six months (see Figure 2); because of this, a PET was carried out (see Figure 3) to see the behaviour of the injury; there is no uptake of radiopharmaceutical (5-deoxy Fluoride glucose).
(a) Functional BOLD-MRI shows areas of motor cortex and somato-sensory activation during the bilateral motor palmar paradigm. (b) Areas of activation for the first left temporal girus with participation of the ipsilateral frontopercular region during the paradigm of processing words in silence observing areas of activation in the contra-lateral hemisphere (red circle). (C) 32 directions tractography, shows association fibres of association, demonstrating moved fascicle arcuate (white arrows).
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figure4
Due to the fact that the seizures could not be controlled with medication alone and the increase in the lesion of 2 mm in diameter, a functional magnetic resonance blood-oxygen-level dependence (BOLD) was requested to determine the somato sensory and motor hemispheric dominance, as well as the DTI with 32 directions to define the degree of injury of the white matter tracts, in particular, the tract associated with the speech centre (see Figure 4).
(A) SAGITTAL T1w MRI + contrast: temporal lesion (white arrow). (B) Transoperatory photography (50x) that shows cystic grey lesion and whitish edges. (C) Microscopic photograph (600x) US that shows uniform core astrocytes (70%) immersed in a fibrillar matrix, as well as compact nests of oligodendrocytes (30%) with clear perinuclear halos and a capillary mesh between them, compatible with hamartoma.
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figure5
This systematic analysis allowed us to decide on the surgical treatment where the benign nature of this lesion is confirmed by histopathology (see Figure 5).