BILATERAL NEUROPATHOLOGIC CHANGES IN A CHILD WITH HEMIMEGALENCEPHALY

Evaluation of a 7-month-old girl with developmental delay and intracta ble seizures revealed hemispheric asymmetry and an enlarged right cere bral hemisphere, Because of a history of seizures refractory to medica l therapy, she was admitted for right hemispherectomy, but died of com plications of surgery. Postmortem brain examination revealed asymmetri c enlargement of the right cerebral hemisphere but no gross abnormalit ies in the left hemisphere, Microscopic examination demonstrated bilat eral neuropathologic changes consistent with severe cortical dysplasia in the right cerebral hemisphere and mild cortical dysplasia in the l eft, Although white matter abnormalities in the unaffected hemisphere have been reported in hemimegalencephaly, bilateral cortical abnormali ties, not reported previously in patients with hemimegalencephaly, may account for the varied clinical outcome with medical therapy or after hemispherectomy. (C) 1997 by Elsevier Science Inc. All rights reserve d.