what causes hemosiderin staining in the brain

10.1). In patients with medication-refractory epilepsy, structural abnormalities can be seen in up to 85% of cases when employing a dedicated MR imaging protocol and when being read by trained Neuroradiologists. 10.2) will probably further increase the detection rate of epileptogenic substrates such as mesial temporal lobe sclerosis (MTS), focal cortical dysplasia (FCD), and polymicrogyria [811]. The junction between cortex and white matter is indistinct and the cortical gray matter may be focally thickened (Fig. In contrast to the other malformations of abnormal migration, the periventricular nodular heterotopia may exhibit quite mild symptoms with normal development and late onset of seizures. (a, b) Right lateral precentral gyrus type II FCD. Amyloid-Related Imaging Abnormalities with Emerging Alzheimer Disease Therapeutics: Detection and Reporting Recommendations for Clinical Practice. Indistinct gray/white (more). As a result, you may notice yellow, brown, or black staining or a bruiselike appearance. State of the art epilepsy imaging an update. Cerebral microhemorrhages have been noted in healthy elderly, ischemic cerebrovascular disease, intracerebral hemorrhage (ICH), cerebral amyloid angiopathy (CAA), and in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. A multidisciplinary approach that involves close communication between epilepsy neurologists, neuroradiology, EEG, nuclear medicine, neuropsychology, and neurosurgery is an important feature of modern epilepsy management. Hemosiderin staining can occur in people with venous ulcers, which are slow-healing or non-healing wounds caused by blood pooling in the veins. Since hypertension was also found in all subjects who experienced stroke after presenting with MBs, such patients should be treated with, Cerebral microbleeds (MBs) are small chronic brain hemorrhages, likely caused by, Cerebral microbleeds (CMBs) are increasingly recognized neuroimaging findings, occurring with cerebrovascular disease, dementia, and aging. Microbleeds in the Corpus Callosum in Anoxic Brain Injury. Submitted comments are subject to editing and editor review prior to posting. Permanent Bruises (Hemosiderin Stain): Causes, Risks, and Treatment (2023) Before Save my name, email, and website in this browser for the next time I comment. 10.19). There are skin creams that can lighten dark spots, such as creams containing hydroquinone. The blood pools under the skin and leave a residue of hemoglobin that settles in the tissue there. National Library of Medicine Imaging abnormalities encountered in patients experiencing their first-ever seizures include (but are not restricted to) virtually all diseases affecting the brain. 10.9) [16]. If you do notice leg discoloration, or hemosiderin staining, take action. Neonatal anoxic ischemia or hypoxemia can cause ulegyriai.e., a scar/defect of the cerebral cortex that mainly involves the cortex in the depth of the sulcus whereas the cortical crowns remain relatively unaffected. Please enable it to take advantage of the complete set of features! The cortex lining the defect is polymicrogyric with ill-defined margins to the white matter. Application of diffusion tensor imaging and tractography of the optic radiation in anterior temporal lobe resection for epilepsy: a systematic review. In the early stages of MTS the imaging findings are subtle with loss of the internal architecture of the hippocampus with or without associated FLAIR signal changes. Your email address, e.g. (For instructions by browser, please click the instruction pages below). Identifying a T1 hyperintense transmantle sign may have clinical relevance. (more). The analysis of the BAL revealed an increased number of total cells, with an acute inflammatory reaction that resolved within 2 weeks. 2015;36:120415. Severe medical condition with expected life expectancy, What causes hemosiderin staining? Lipofuscin or ceroid pigment also is normally present in macrophages scattered throughout the red pulp and can be demonstrated by acid-fast stains. What Is Hemosiderin Staining? - Vein Institute Of Pinellas This susceptibility sensitive sequence shows the classical blooming artifact of the blood products within the cavernoma, Nodular calcified neurocysticercosis in the left hippocampus leading to acquired MTS. (a, b) patient 1; (a) coronal T2 with large subcortical area in the right temporal lobe with prolonged T2. The Importance of Hemosiderin Deposition in the Infant Brain: an From: Human Biochemistry (Second Edition), 2022 Add to Mendeley Download as PDF About this page Bone Marrow, Blood Cells, and the Lymphoid/Lymphatic System1 (a) axial T2 shows the superficial lesion with heterogenous signal; (b) axial T1 with gadolinium shows an associated vascular structure, a DVA; (c) axial SWAN-sequence. (c) Patient 2, pancake view from a 3D T1-sequence gives a very good overview of the migration anomalies in the right hemisphere. The ipsilateral ventricle may be distorted and there can be an associated callosal hypogenesis. 2013;49:7987. You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid 2013;54:197787. (a) axial T2FLAIR with a small, cortical/subcortical, nodular high-signal area in the right parietal lobe close to the postcentral sulcus; (b) coronal T1 with gadolinium shows contrast enhancement (more), Right superior temporal gyrus ganglioglioma in a middle-aged patient. (a) axial T2; (b) coronal T1. When the ketchup first lands, it is clearly visible, has three dimensional mass and continues to spread. Results: Hemosiderin staining within alveolar macrophages was first detected in the BAL and lung tissue at day 3, peaked at day 7, and persisted through. Superficial siderosis (SS) of the CNS is caused by repeated slow hemorrhage into the subarachnoid space with resultant hemosiderin deposition in the subpial layers of the brain and spinal cord. Hemosiderin or haemosiderin is an iron-storage complex that is composed of partially digested ferritin and lysosomes.The breakdown of heme gives rise to biliverdin and iron. Hemosiderin - the Marker of the Milder Brain Injury Focal deposits of hemosiderin are sometimes associated with a malignant neoplasm that has resulted in areas of hemorrhage. Encephalomalacia: What Causes Softening of the Brain - Doctors Health Press Conclusions: MHs detectable by susceptibility-weighted MRI predominantly in the splenium of the CC are long-lasting footprints of HACE. In addition, callosal hypogenesis. Hsu CCT, Stenberg L, Krings T. Imaging the Patient with Epilepsy. The use of even higher field strengths (7T) (Fig. Note that the signal is identical to that of cortex in all sequences. How do you cure hemosiderin? While cavernomas that are deeply located in the white matter rarely cause seizures, those that are cortically located and have hemosiderin staining reaching the cortex, and in particular the mesial temporal lobe structures, are very often associated with seizures as the hemosiderin stain is believed to have a strong irritative potential for neurons. Bookshelf In addition to epilepsy these patients may have developmental delay and focal neurological deficits. Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment. If the periventricular heterotopia completely lined the walls of both ventricles, a familiar form has to be considered. Cerebral microbleeds (MBs) are small chronic brain hemorrhages, likely caused by structural abnormalities of the small vessels. (c) Patient 2, pancake view from a 3D T1-sequence gives a (more). 2015;36:30916. It is thought that the hemosiderin deposition associated with cavernous angiomas may play a role in triggering seizures. What Causes Hemosiderin Staining? - Mastery Wiki Wellmer pointed out that because even the best focus hypothesis and most profound knowledge of epileptogenic lesions do not permit the detection of lesions when they are invisible on the MRI scan, the starting point for any improvement of outpatient MRI diagnostics should be defining an MRI protocol that is adjusted to common epileptogenic lesions.. Hemosiderin is a form of storage iron derived chiefly from the breakdown of erythrocytes, which normally takes place in the splenic red pulp. New intra-cavernomatous thrombosis or hemorrhage may lead to change in seizure frequency. The atrophy will lead to loss of the pes hippocampi interdigitations, widening of the temporal horn and atrophy of the white matter of the temporal lobe. doi: 10.3171/2012.1.FOCUS11370. Atrophy of the hippocampus and gliosis within the hippocampus will manifest itself as increased signal intensity on T2/FLAIR sequences (Fig. Patients with previous trauma can experience posttraumatic seizure disorder, especially after having sustained contusional hemorrhages of their temporal lobes as gliosis and hemosiderin staining can cause irritation of the surrounding cortex. Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international) 10.5). Brain hemorrhages can cause many signs and symptoms, such as seizures. This pores and skin discoloration stays till the supply (or the diseased veins) is handled. CVI develops when blood flow is compromised due to ineffective blood valves in the legs. Nodular calcified neurocysticercosis in the left hippocampus leading to acquired MTS. what causes hemosiderin staining in the brain Stains most often appear on the lower leg, sometimes covering the space between your knee and ankle. [, Winstona GP, Micallef C, Brian E, Kendell BE, et al. Lissencephaly with agyria more pronounced in the anterior part of the brain. These capillary blood leaks can be caused by a number of things . Hemosiderin Staining: Causes, Symptoms, Treatment, Prevention, & More Save my name, email, and website in this browser for the next time I comment. Cogswell PM, Barakos JA, Barkhof F, Benzinger TS, Jack CR Jr, Poussaint TY, Raji CA, Ramanan VK, Whitlow CT. AJNR Am J Neuroradiol. As pointed out by Wellmer et al. Epilepsy Res. Superficial hemosiderosis of the classical type is a rare but potentially serious condition resulting from leptomeningeal hemosiderin accumulation on the surface of the cerebellum, around the cranial nerves and spinal cord. (a, b) axial and coronal FLAIR images demonstrate focal gyral thickening posteriorly in the left frontal gyrus with an associated curvilinear hypointense band following the bottom of the sulcus. Epileptic Disord. The .gov means its official. They are best visualized on T2 gradient echo or SWI sequences where they demonstrate with the classical blooming artifact (Fig. Well delineated smooth ovoid masses lateral to the trigone and temporal horn of the left ventricle. The iron within the blood leaks by means of the vein partitions and stains the pores and skin, creating what is named hemosiderin staining. We offer this Site AS IS and without any warranties. Hemosiderin is an iron-containing pigment that is formed from the hemoglobin of red blood cells that have disintegrated. Results: Most women aged 2050 years consumed less dietary iron than their recommended dietary allowances. How many calories are in a roll of spicy tuna? [, Gaitanis JN, Donahue J. Focal cortical dysplasia. 10.16). [, Bauer PR, Reitsma JB, Bernard M, Houweling BM, et al. Hemosiderin Staining: Causes, Symptoms, and Treatment - Healthline Hemosiderin is a particle representing an iron storage complex that is formed by the breakdown of hemoglobin or an abnormal metabolic pathway of ferritin. Summary of review: The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unable to load your collection due to an error, Unable to load your delegates due to an error. In the following we will discuss the imaging features of epileptogenic lesions highlighting imaging pearls and pitfalls. This susceptibility (more). Two different types of lissencephaly can be distinguished: the posterior agyria (related to an alteration on Chromosome 17) and the anterior agyria which is an x-linked disease (Fig. (c) T1 inversion recovery reveal (more). In adults, solid appearing ganglioglioma may mimic high grade glioma and advanced imaging techniques such as MR perfusion maybe a useful tool for pre-operative evaluation (Fig. Hemosiderin - an overview | ScienceDirect Topics Go to Neurology.org for full disclosures. [, Strandberg M, Larsson EM, Backman S, et al. Epilepsia. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. MHs remained unchanged in those reexamined after 12 to 50 months. The corresponding (more). Your email address will not be published. Depending on the location of the cavernous malformation in a person's nervous system, CCMs can also cause stroke-like symptoms. [, Wellmer J, Quesada CM, Rothe L, et al. Histologically confirmed hippocampal structural features revealed by 3T MR imaging: potential to increase diagnostic specificity of mesial temporal sclerosis. Hemimegalencephaly. On brain imaging, lesions will be seen in nearly 50% of patients; however, these are non-specific and can encompass a wide variety of underlying conditions that can provoke the recurrent seizure attacks. Hemosiderin is water-insoluble and thermally denatured, but ferritin is water-soluble and heat-resistant up to 75C. Your white blood cells, or immune system cells, can clear up some of the excess. Dedicated MRI showed focal lesions in 85% of patients with non-lesional standard MRI. High Incidence of Intracerebral Hemorrhaging Associated with the Application of Low-Intensity Focused Ultrasound Following Acute Cerebrovascular Injury by Intracortical Injection. Cerebral microhemorrhage - PubMed To prevent stroke, risk factors should be carefully managed in subjects with MBs factors. 10.6). In all other subjects, MHs were unequivocally absent. (e) patient 3, boy, 3months old, axial T1IR shows a region with thickened cortex in the right frontal lobe. Following resection of the abnormal brain tissue seizure freedom can be obtained in a very large proportion of cases. Hemosiderin a protein compound that stores iron in your tissues can accumulate under your skin. 2016 Aug 15;367:89-94. doi: 10.1016/j.jns.2016.05.040. Particular emphasis should be paid upon the T2/FLAIR signal within the cortex and hippocampus, its similarity to other regions of neo- and archicortex, the internal architecture of the hippocampus, the indentations of the pes hippocampi, the fornix and mammillary bodies, and the grey-white matter interface of the neocortex (blurring, gray matter thinning or thickening). It's caused by blood leaking out of the tiny vessels called capillaries. Research on hemosiderin deposits in autopsies of organs such It is only found within cells (as opposed to circulating in . More recently a study by Kumura et al. What causes hemosiderin staining in the brain? - Daily Justnow Correlation of lipoprotein-associated phospholipase A2 and cerebral microbleeds in patients with acute ischaemic stroke. Hemosiderin staining is a condition that can cause brown or red patches on the skin. Viswanathan A, Gschwendtner A, Guichard JP, Buffon F, Cumurciuc R, O'Sullivan M, Holtmannsptter M, Pachai C, Bousser MG, Dichgans M, Chabriat H. Neurology. Aetiologically a haemorrhage (acute or chronic) is present in the subarachnoid space. on the prevalence of epileptogenic lesions among 2740 patients the following pathologies were found: mesial temporal lobe sclerosis (32%), tumors (including low and high grade tumors as well as malformative tumors and benign epilepsy associated tumors) in approximately 17% of patients, cortical dysplasias in 11%, glial scars (including posttraumatic, post-ischemic, post-hemorrhagic, postinfectious/abscess, ulegyria, and postsurgical scars) in 11%, vascular diseases (cavernoma AVM, pial angiomatosis) in 5%, malformations of cortical development including nodular heterotopia, subcortical band heterotopia, polymicrogyria, lissencephaly, pachygyria, agenesis of corpus callosum, craniocephalic malformations, hemiatrophy, lobar dysgenesis, hemimegalencephaly, or hamartomas in 3%, and sequelae of encephalitis in 1% while in approximately 20% no lesion could be detected. 10.20). In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Cavernomas may be multiple and they can be associated with developmental venous anomalies (DVA). Thus, the combination of dedicated MRI protocols and dedicated radiologists trained in evaluating patients with medication refractory seizures increases significantly the sensitivity of MRI in this subgroup of patients. In CAA, microhemorrhages predict both the risk of recurrent lobar ICH and future clinical decline. Hemosiderin is a stain, left behind after a brain bleed, even after though the blood is reabsorbed into the blood system. 10.17). In addition, patients may develop subependymal calcification as well as a subependymal giant cell astrocytoma; however, the latter two lesions are not believed to be epileptogenic. Traditionally transmantle sign appears T2-weighted and FLAIR hyperintense and T1-weighted hypointense. Laz Haque T, Miki Y, Kanagaki M, et al. (a, b) patient 1; (a) coronal T2 with large subcortical area in the right temporal lobe with prolonged T2. What Causes Encephalomalacia? Hemosiderin and ferritin are iron-containing proteins with magnetic susceptibility. Although the exact role of balloon cells remains uncertain, some studies have suggested a protective role in reducing spread of the epileptogenic activity. 2012;135:134869. ), and Department of Neurology, Division of Neuroradiology (K.L. Epilepsia. It also shows up in people who have inflammation in the layer of fat beneath the skin of the lower legs (lipodermatosclerosis). [, Kimura Y, Shioya A, Saito Y, et al. (ac) Coronal T2 images show a small circumscribed hypointense lesion in the left hippocampal head with associated significant volume of the left hippocampus (more). Neurosurg Focus. The corresponding area has decreased signal on T1-weighted image. (6) It causes considerable lysis of red blood cells and removes much iron from hemosiderin. Hemosiderin staining usually happens on the lower leg, near the ankles, or on your feet. official website and that any information you provide is encrypted Gangliogliomas occur in young adults and older children, when present under the age of 10 they are often larger with more cystic components. Imaging findings in patients with seizures include but are not restricted to: vascular conditions such as microangiopathy, previous ischemia, vascular malformations, previous hemorrhage or cavernomas, tumors (metastases, primary tumors), remote infections (encephalitis, abscess), previous head injury, congenital malformations, or toxic metabolic conditions. [, Tllez-Zentenoa JF, Hernndez Ronquilloa L, Moien-Afshari F, et al. Discover the common causes of headaches and how to treat headache pain. Brain. The body then traps the released iron and stores it as hemosiderin in tissues. Superficial Siderosis - an overview | ScienceDirect Topics Hemosiderosis treatments focus on respiratory therapy, oxygen, immunosuppression, and blood transfusions to address severe anemia. For women over 50 years, serum ferritin was negatively associated with severe headache or migraine. Which of the following structure contains osteocytes? When blood leaks from capillaries, it collects under the skin and the red blood cells break down. CVI can be treated at its source, Hemosiderin is a particle representing an iron storage complex that is formed. It also increases the chance to detect subtle changessee small area with polymicrogyria in the left hemisphere! This peculiar pattern can be explained by the vascular supply of the gyri in the newborn that leads to a better perfusion of the apices of the gyri as compared to the depth of the sulci. [, Sato N, Ota M, Yagishita A, Miki Y, et al. Individual access to articles is available through the Add to Cart option on the article page. 2007 Jul 10;69(2):172-9. doi: 10.1212/01.wnl.0000265221.05610.70. Unfortunately, there are many different encephalomalacia causes. Most patients will go to a dermatologist or primary care physician for the skin condition, not the underlying vein disease of hemosiderin staining. While virtually all tumors may cause epilepsy, there are certain tumors that have a very high propensity of eliciting medication refractory seizures. Epub 2020 Aug 3. However, in clinical practice, their diagnostic value, associated risk, and prognostic significance are often unclear. In essence, hemosiderin staining is an extreme form of bruising. Identification of the stratum lacunosum as a landmark provides an imaging reference point for qualitative and quantitative analysis of tissue loss in MTS. (a) coronal T2; (b) sagittal T1 with gadolinium; well delineated cortical/subcortical bubbly mass in the right frontal lobe with prolonged T2 and no contrast enhancement typical of a DNET. Lesions that are often involved in medication refractory epilepsy are: mesial temporal lobe sclerosis (MTS) (primary or secondary to a long standing seizure disorder), malformations of cortical development, certain epileptogenic tumors (e.g., dysembryoplastic neuroepithelial tumors (DNET), temporal lobe gliomas gangliogliomas), vascular malformations, trauma, remote infection, and certain phakomatoses. Purchase High resolution T1-weighted sequences with isotropic voxel sizes allow for multiplanar reformation and further evaluation (including 3D reformats, pancake views, surface rendering, and volumetric assessments). Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis. Hemosiderin is a particle representing an iron storage complex that is formed by the breakdown of hemoglobin or an abnormal metabolic pathway of ferritin. Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage. Conclusions: 2013;54:759. Cerebral Infarction and Ischemia A cerebral infarction is a technical term for what we generally refer to as a stroke. Hemosiderin staining usually happens on the lower leg, near the ankles, or on your feet. Nat Rev Neurol. Imaging features are very subtle and only mild focal blurring of the graywhite matter junction may be present. Your last, or family, name, e.g. Overall, 15.3% of all subjects had at least 1 CMB. 1.Can be. Hemosiderin staining typically does not go away without specific treatments, such as laser treatments and chemical peels. [, De Ciantis A, Barkovich AJ, Cosottini M, et al. [2], the sensitivity of non-expert reports of standard MRI reports for focal lesions was 39%, while sensitivity of expert reports of standard MRI increased to 50%. (c, d) The mother of the boy in (a, b) female carrier. Patients experience seizures and a progressive hemiparesis. 10.7). We strongly recommend these imaging sequences to be done on a 3T scanner given the higher spatial resolution [6, 7]. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Hemosiderin staining is caused by varicose vein disease as well as its treatment. How long does it take to form hemosiderin? In up to 20% of cases additional epileptogenic pathology is found in patients with mesial temporal lobe sclerosis. Note also hypertrophy (more). Is Chinese Chicken chop suey Keto friendly? In normal animals, hemosiderin deposits are small and commonly inapparent without special stains. [, Barkovich AJ, Guerrini R, Kuzniecky RI, et al. The amount of time needed to resolve a hemosiderin stain depends on the size and intensity of the stain, as well as the type of treatment used to resolve it. Do not be redundant. Brain tissue can extend into the pterygopalatine fossa through the bony defect at the base of the greater sphenoid wing in the region of the foramen rotundum and pterygoid process. Hemosiderin collects in the skin and is slowly removed after bruising; hemosiderin may remain in some conditions such as stasis dermatitis. You will be redirected to a login page where you can log in with your AAN ID number and password. Thank you! This protocol should take into account thatas small epileptogenic lesions are usually those that provide the best chance for postoperative seizure freedomslice thickness should be adjusted to detect small lesions and multiple (coronal, axial, sagittal) cut planes are acquired to ensure that physiologic structures or partial volume effects within the folded cortex are not taken for pathology and vice versa. A conceptual framework for the use of neuroimaging to study and predict pharmacoresistance in epilepsy. in 2013 [4, 5], the possible reasons for undetected epileptic lesions in standard outpatient MRI are insufficient clinical information from the referring clinician, routine MR protocols not optimized for the spectrum of epileptogenic lesions, and unfamiliarity with the spectrum of epileptogenic lesions. Specifically, mutation in the FLNA gene is inherited in an X-linked dominant pattern with male offspring experiencing more severe symptoms of the disorder than females, and in most cases die before birth. The increased signal stretches in to the temporal horn of the right ventricle; (b) coronal T1 with gadolinium. These characteristic differences were used for the fractionation of ferritin and hemosiderin. (a) Coronal T2 with a lobular mass close to the left wall of the third ventricle. If hemosiderin is present in increased amounts without an obvious explanation, further investigation is warranted. 2022 Sep;43(9):E19-E35. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. (a, b) axial and coronal FLAIR images demonstrate focal gyral thickening posteriorly in the left frontal gyrus with an associated curvilinear hypointense band following the bottom of the sulcus. It is characterized by deafness and cerebellar ataxia. Your email address will not be published. Sci Rep. 2022 Oct 19;12(1):17423. doi: 10.1038/s41598-022-21475-y. Results: Hemosiderin staining within alveolar macrophages was first detected in the BAL and lung tissue at day 3, peaked at day 7, and persisted through 2 months. Pre-operative detailed clinical and radiologic assessment is required to determine if there are co-existing abnormalities in the contralateral hemisphere. Pharmaceutics. It is often seen in people with chronic . 2004 Jun;35(6):1415-20. doi: 10.1161/01.STR.0000126807.69758.0e. 2008;29:8237. You quickly wipe it off, stop the spreading. Microbleeds are associated with subsequent hemorrhagic and ischemic stroke in healthy elderly individuals. HACE was defined as ataxia necessitating assistance with walking and/or decreased consciousness. (a, b) Patient 1. Mesial temporal lobe sclerosis is the most commonly seen cause for medication refractory epilepsy and is characterized by an indistinct graywhite matter differentiation, abnormal high signal on T2/Flair sequences, and atrophy. Hemosiderin: Potential Impacts - Neurology - MedHelp Hemosiderin is a brown iron-containing pigment usually derived from the disintegration of extravasated red blood cells (1.40). Cavernous malformations - Symptoms and causes - Mayo Clinic Unauthorized use of these marks is strictly prohibited. Patients present with global developmental delay and seizures. In our practice, we employ this coronal angulation for both T2FLAIR and T1 IR sequences. MR contrast of ferritin and hemosiderin in the brain: comparison among gradient-echo . 2014;13:111426. (f) CT scan confirms the calcification, (ac) Tuberous sclerosis; (a) axial T2 and (b) coronal T2FLAIR show subependymal hamartomas and widespread cortical and subcortical signal changes; (c) axial T1 with gadolinium with a large giant cell astrocytoma in a classical position, close to the foramen of Monroe in the left lateral ventricle, (ac) SturgeWeber syndrome; (a) axial CT shows curvilinear cortical calcifications in the right occipital lobe; (b) axial T1 without and (c) with gadolinium shows contrast enhancement caused by pial angiomatosis.

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