Cerebral hemiatrophy: Classification on the basis of MR imaging findings of mesial temporal sclerosis and childhood febrile seizures

PURPOSE: To classify cerebral hemiatrophy on the basis of childhood febrile seizures and magnetic resonance (MR) imaging findings of mesial temporal sclerosis. MATERIALS AND METHODS: Medical records and brain MR images obtained in 23 patients aged 1-64 years with cerebral hemiatrophy were retrospectively reviewed. Age, neurologic deficit, and history of childhood febrile seizures were recorded and correlated with MR findings of mesial temporal sclerosis, focal cortical or white matter signal intensity abnormalities, ipsilateral thalamic or contralateral cerebellar atrophy, and compensatory calvarial changes. RESULTS: Eleven patients had MR mesial temporal sclerosis findings. Of these, nine had a history of childhood febrile seizures. Of the other 12 patients, only one had a history of childhood febrile seizures. All patients without mesial temporal sclerosis had focal parenchymal lesions in the distribution of the middle cerebral artery. CONCLUSION: Two patterns of central nervous system involvement in cerebral hemiatrophy are suggested: (a) MR mesial temporal sclerosis findings and a history of childhood febrile seizures and (b) no MR mesial temporal sclerosis findings and rarely a history of childhood febrile seizures. This correlates with previous descriptions of cerebral hemiatrophy (a) with multifocal neuronal loss after seizures and (b) with a more focal cerebral hemisphere abnormality usually due to vascular insult.