Seizures and Skin Lesions

Seizures and Skin Lesions
A 54-year-old man presents with chronic partial onset convulsive seizure disorder. Physical examination is unremarkable except for a pink to red skin lesion on the right forehead, which has been present since birth. MRI of the head is shown in Figure 1.


(Enlarge Image)

MRI of the brain, representative images are shown; arrows denote the pertinent findings.(A-B) Noncontrast T2-weighted (A) and T1-weighted (B) images are shown (C-D) Postcontrast T1-weighted images are shown.
Reprinted with permission from: Bakshi R, Lindsay BD, Kinkel PR. Brain magnetic resonance imaging in clinical neurology (revision). In: Joynt RJ, Griggs RC, eds. Baker's Clinical Neurology. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998;1(4A):1-203.


True or false? The lesions in A-C are consistent acute/subacute infarction.

1. 
   True
   
2. 
   False
   

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<p>False</p>


True or false? The lesions are associated with mass effect.

1. 
   True
   
2. 
   False
   

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<p>False</p>


The hypointense tubular lesions in images A and B (straight arrows) are most consistent with:

1. 
   Melanin
   
2. 
   Calcium
   
3. 
   Manganese
   
4. 
   Methemoglobin
   
5. 
   Gliosis
   

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<p>Manganese</p>


True or false? The lesions in the right occipital lobe appear chronic.

1. 
   True
   
2. 
   False
   

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<p>True</p>


True or false? The enhancement in image D on the right (arrow) is consistent with normal anatomy.

1. 
   True
   
2. 
   False
   

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<p>False</p>


True or false? The enhancement in image D on the right (arrow) is consistent with a choroid plexus angioma.

1. 
   True
   
2. 
   False
   

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<p>True</p>


The most likely diagnosis is:

1. 
   Infection
   
2. 
   Neoplasm
   
3. 
   Inflammatory syndrome
   
4. 
   Toxin exposure
   
5. 
   None of the above
   

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<p>None of the above</p>


The imaging findings combined with the right facial skin lesion makes which of the following most likely?

1. 
   Tuberous sclerosis
   
2. 
   Ataxia telangiectasia
   
3. 
   Neurofibromatosis
   
4. 
   Sturge-Weber syndrome
   
5. 
   Von Hippel-Lindau disease
   
6. 
   Neurocutaneous melanosis
   
7. 
   Klippel-Trenaunay syndrome
   

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<p>Sturge-Weber syndrome</p>