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Focal Cortical Dysplasia — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersFocal Cortical DysplasiaSCE Neurology

A 28-year-old woman presents with recurrent episodes of tingling in her right arm followed by twitching of her right hand, each lasting 30–60 seconds without loss of awareness. Between episodes she is neurologically normal. EEG shows left central sharp waves. MRI brain shows a small left precentral gyrus cortical lesion with T2 hyperintensity and no enhancement. What is the most likely underlying pathology?

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Correct answer: E — Focal cortical dysplasia

Focal cortical dysplasia (FCD) is the most common cause of drug-resistant focal epilepsy in young adults undergoing epilepsy surgery. It presents with focal seizures localising to the dysplastic cortex. MRI findings may be subtle — a small cortical/subcortical T2/FLAIR hyperintensity with cortical thickening, blurring of the grey-white matter junction, and sometimes a transmantle sign. It does not enhance and does not show mass effect. A: Low-grade gliomas are typically in the white matter. C: Cavernomas have a characteristic 'popcorn' appearance with haemosiderin rim. D: Meningiomas are extra-axial. E: Neurocysticercosis shows cystic lesions with a scolex.

Reference: NICE NG217 (2025); ILAE FCD Classification