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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: Focal cortical dysplasia Dear Doctors, My son is four years and nine-month. He is slow in developing ( walking, talking and ect) but he has a fantastic memory. He is judged to have a chronological age of 38 months when he is 4 year 5 month. I had 3 children and his boy is second. Both of my other sons are normal and consider intelligent. I had never take any drugs at all (other than pain killer during fever). During pregancy, I do not take liquor nor smoke. I had a very healthy and unevenful pregnancy. He is the only son that is delivered by ' meville Barnes Forceps delivery'. He had undergoes an MRI examination and below is the report. As a medical-idiot mother, I'm very helpless in understanding what is he sufferring and whether it is incurable. Please interprate the report. Thank you. --------------------------------------------------------------------------- Clinical History : Big head. Delay development. CT showed megalencephaly. Imaging Protocol: SE T1 sagittal 5/1.5; SE T1 axial 5/1.5; FSE PD/T2 axial 5/1.5; FSE T2 coronal 5/1.5 Imaging Findings: Thickened cortex with relative paucity of underlying white matter was noted over the temporo-parietal regions bilaterally. Suspicious hyperintensity was noted in the posterior white matter bilaterally; ?gliosis. Otherwise, no abnomal signal intensity lesion or mass lesion was noted in the brain. No obvious cleft to suggest the presence of schizencephaly was noted. The corpus callosum was well formed. No midline shift was detected. The lateral ventricles were mildly prominent. Prominence of the nasopharyngeal soft tissues was noted which probably represents enlarged adenoids. Signal intensities were noted within the right mastoid and right maxillary sinus, ?inflammatory changes. Impression: Thickened cortex with relative paucity of underlying white matter over both temporo-parietal regions. Features could represent some form of bilateral focal cortical dysplasia. --------------------------------------------------------------------------- = When a child has delayed development and/or motor problems, one of the first questions is whether the problem occurred during pregnancy, around birth, or in infancy. The MRI suggests the problem is one of proper formation of part of the brain. That usually occurs while the child is in the womb. Even though you took proper care of yourself during pregnancy (no alcohol, etc), it is still possible for improper development to occur with no fault of your own. Is it a hereditary or genetic problem? I don't know. Sometimes this happens to just one child in a family, and all others are perfectly normal. The diagnosis is usually a bit easier when more than one person is affected. Even if just one child has the problem, it still can be genetic. If you have not yet seen a pediatric neurologist or a genetics expert, you may find some answers. You may be able to learn the name of your child's disorder, though sometimes a precise diagnosis is not found. Treatment is focused on practical issues. If your child has seizures, proper medication can be prescribed. Sometimes guidance can be given about educational strategies. Sometimes physical therapists can help your child get around motor difficulties. You mentioned that your child is smart, so he sounds like he has a lot of potential. So it's important to do as much to get around the motor problems as possible. Incidentally, the ?inflammatory changes found in the sinuses have nothing to do with the brain. If your child had a stuffy nose or if he has a lot of allergies, that would explain it. The MRI takes pictures not only of the brain, but also of the eyes, mouth, throat, nose, and nasal sinuses. I hope this helps. If you are interested in a pediatric neurologist at Cleveland Clinic, you are welcome to call 800 223-2273 and ask for neurology appointments at 4-5559. If you are too far away, look for a large academic medical center (usually affiliated with a medical school in a large city) closer to you. CCF MD mdf. |
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