Posterior Quadrantic Dysplasia: MRI Diagnosis of a Lesser Known Cause of Pediatric Intractable Epilepsy

Posterior quadrantic dysplasia (PQD) is a rare cause of pediatric intractable epilepsy. It is a sporadic cortical development malformation that involves the posterior three lobes of a single hemisphere and spares the frontal cortex. Very few cases have been reported in the literature, mostly as anecdotal reports or as a part of large series of refractory epilepsy. It is essential to know about this lesser known entity and differentiate it from other more common similar anomalies such as multilobar cortical dysplasia and hemimegalencephaly as new motor-sparing neurosurgical disconnective procedures have led to dramatically reduced mortality and morbidity rates, apart from gifting the affected children a better quality of life. Magnetic resonance imaging (MRI) is pivotal in astute diagnosis of the condition and accurate delineation of boundaries of the lesion to aid in neurosurgical management. We report one such case of PQD presenting with refractory epilepsy, which was diagnosed on MRI.