Case Report Of Polymicrogyria Presenting In Adult Patient

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Objective: Polymicrogyria (PMG) is a malformation of cortical development characterised by excessive small gyri and abnormal cortical lamination. Most cases present in childhood with developmental delay and earlyonset seizures. Adult-onset PMG with new seizures and minimal neurological deficits is rare and often underrecognised. Case Presentation: A 50-year-old right-handed male presented with two episodes of unprovoked, generalised tonic-clonic seizures. Neurological examination was unremarkable with no focal deficits. Electroencephalography (EEG) demonstrated left temporo-occipital epileptiform discharges. High-resolution MRI of the brain with an epilepsy protocol revealed focal, patchy polymicrogyria involving the left medial temporal lobe and adjacent left medial occipital lobe, consistent with a congenital disorder of neuronal migration and cortical organisation. Management and Outcome: The patient was diagnosed with focal epilepsy secondary to unilateral temporooccipital PMG and commenced on appropriate antiseizure medication (ASM). Conclusion: This case illustrates that focal, unilateral PMG can remain clinically silent into late adulthood and present with new-onset seizures. Clinical, electrophysiological, and neuroimaging correlation is essential for accurate diagnosis. Awareness of the broad clinical spectrum of PMG is important for practitioners evaluating adult-onset focal epilepsy.

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