A 4-year-old boy who appeared to be previously healthy presented with new-onset seizure. On admission, his physical examination was unremarkable except for small papules on the forehead and bilateral nasal labial folds. A MRI study was performed and showed multifocal regions of high signal intensity in the cerebral cortex located in the right and left frontal lobes, left parietal lobe, and right occipital lobe. Electroencephalogram (EEG) studies localized seizure activity to the left frontal and parietal lobe lesions. The patient underwent gross total excision of the right frontal and parietal lobe lesions. Two resection specimens measuring 3.3 x 2.6 x 1.8 cm and 3.2 x 1.8 x 0.9 cm were received. Upon inspection, both specimens were firm to palpation. On sectioning, the cortex appeared to be expanded in both specimens with a blurring of the gray-white interface.
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• Cortical dysplasia (malformation of cortical
• Cortical tuber associated with tuberous sclerosis
• Diffuse, fibrillary astrocytoma
• Gemistocytic astrocytoma
• Subependymal giant cell astrocytoma
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• Appropriate diagnosis
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