MRI of the brain demonstrating bilateral perisylvian polymicrogyria

A 15-year-old boy presented with five years of refractory focal seizures with four to six episodes per day. The seizure semiology was described as numbness of the left half of the body followed by tonic posturing and head version to left with loss of awareness lasting for 30 seconds. Additional symptoms included cognitive impairment with delayed and dysarthric speech. Neuropsychological assessment revealed impaired intellectual and cognitive ability. MRI of the brain demonstrated bilateral perisylvian polymicrogyria. Axial (A), coronal (B), and sagittal (C) T1-weighted images show undulations and irregularity of the cortical surface along bilateral sylvian fissures and superior temporal sulci. Apparent thickening of polymicrogyric cortex and stippling and irregularity at the gray-white matter junction (arrowheads) are also seen compared with frontal polar gray matter (arrows).