JOURNAL OF NEUROSCIENCE AND NEUROSURGERY (ISSN:2517-7400)

Human cerebrum has four lobes in each side. Generalised cerebral atrophy is common with senile degeneration but unilateral or hemiatrophy of cerebrum is rare condition in any age group. There are few reported cases where one or more lobe of one sided cerebrum has undergone atrophic change and most of the reported cases were of younger age group. Seizure, limb weakness or sensory abnormalities are common presenting features of these cases. We are presenting a lady of occipital hemiatrophy who was presented with convulsion and limb sensory problems. Magnetic Resonance Imaging (MRI) of brain revealed unilateral occipital lobe atrophy. Features of this participant were compared with other international reported cases.

Cerebral lobe; Magnetic Resonance Imaging (MRI); Atrophy

Cerebral hemiatrophy is irreversible atrophy of partial or full cerebral hemisphere. It may involve all lobes or a single lobe of cerebral hemisphere. Cerebral hemiatrophy (CHA) is infrequently encountered in paediatric clinical practice [1]. However it exists and could be primary or secondary as defined by Alpers and Dear in 1939 [2]. The primary (congenital) CHA could be interwoven or aptly called cerebral hemi-hypoplasia or unilateral cerebral hypoplasia as it could actually be de-novo lack of cerebral development [2]. Here, the insult occurs in-utero, with consequent shift of midline structures towards the side of the disease and absence of sulcal prominence [3]. These features differentiate it from secondary CHA which could originate from cerebrovascular lesion, inflammatory process, or cranial trauma. In most of the cases the etiology is idiopathic [4]. Other possible causes are intrauterine vascular injury, birth trauma, ischemia, radiation, tumour, head trauma, prolonged seizure etcetera [5]. Convulsion is the commonest presentation among all the presented cases but patient may present with cognition impairment, behavioural change, limb weakness, headache or symptomless [5]. Magnetic Resonance Imaging (MRI) of brain and Computed Tomography (CT) scan of brain helpful in diagnosing the condition. Cerebral hemiatrophy may be accompanied by change in sizes of sulci and gyri, enlargement of intracranial paranasal sinuses, facial hemiatrophy or calvarial (skull bone) hypertrophy [6]. The management of the condition is according to the presentation and findings. So far only few such cases have been presented. We are taking the opportunity to present a case of right sided occipital lobe hemiatrophy which is a rarely diagnosed neurological case. Informed consent was taken from the patient for participating in this study. The objective and purpose of the case report is to present the unusual presentation of this case and to compare the clinical findings of the other reported cases.

This 61 year lady was presented to this hospital with the complaint of left sided burning sensation for 2 years. She is a known case of diabetes mellitus and her blood sugar is controlled by oral hypoglycemic agents. She does not know any abnormal event of her intrauterine life or her childhood neurological disease. There was no medical record available regarding her birth or vaccination. She had a complaint of left upper limb occasional abnormal movement which was diagnosed as a focal seizure disorder 3 years ago. For which anti convulsion medication (Tablet Levetiracetam 500 mg twice a day) was started and as off now the focal seizure was in controlled. She denied any head trauma or intracranial infection. On examination her cognition was normal. Mini Mental Score (MMS) was 28 out of 30 which was in normal limit. Ophthalmological examination revealed distance vision power was 6/9 in both eyes and near vision power was plus 1.5 in both eyes which were corrected by glasses, which indicates that the visual centers of occipital lobes were normal. There was no field or colour defect. All other cranial nerves were normal. There was no motor deficit. Sensory modules were also in normal limit. Cerebellar signs including finger-nose and heel-shin tests were normal. MRI of brain was performed. It showed atrophy of right occipital lobe (Figure 1) with right sided calvarial hypertrophy (Figure 2). Other cerebral lobe and cerebellar volume were symmetrical in both sides. There was also hyperpneumatization of sphenoid (Figure 3) and maxillary sinuses. Facial muscles and bones were symmetrical in both sides. Electroencephalogram (EEG) of brain didn’t reveal any epileptogenic foci. She was treated conservatively by over the counter analgesics (tablet Paracetamol 500 mg PRN) for her limb pain. At the time of two months follow up the patient was seizure free without any neurological deficit.