# Tuberous sclerosis complex

Axial T2 (image 1) and T1 FLAIR (image 2) MRI in a patient with tuberous sclerosis complex show multiple subependymal nodules (arrowhead) and subcortical tubers (arrow). Subependymal giant cell astrocytomas affect up to 15% of patients with tuberous sclerosis and can lead to obstructive hydrocephalus. The classic triad of tuberous sclerosis includes seizures, intellectual disability, and adenoma sebaceum. Diagnosis requires either a genetic confirmation or the presence of two major or one major and two minor features. Major features identifiable on imaging include multiple cortical tubers, subependymal nodules, cardiac rhabdomyomas, lymphangiomyomatosis, and angiomyolipomas.

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##### Similar cases  
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Axial chest CT of the chest in a patient with tuberous sclerosis shows multiple pulmonary nodules (arrow) consistent with multifocal micronodular pneumocyte hyperplasia. Multifocal micronodular pneumocyte hyperplasia is a hamartomatous lesion of the lung that is frequent in patients with tuberous sclerosis complex. The nodules can measure 1 to 10 mm in diameter and occur randomly throughout the lungs.](https://app.figure1.com/case-detail/2317381e-7788-4b36-a979-58ee57d6106b)  
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Axial T1 FLAIR MRI shows subependymal gray matter heterotopia (arrowhead), the most commonly observed form of gray matter heterotopia. The differential diagnosis for this finding includes subependymal nodules that occur in tuberous sclerosis complex. Gray matter heterotopia is distinguished from subependymal nodules of tuberous sclerosis by the signal intensity of the nodule; in tuberous sclerosis, the T2 signal of subependymal nodules is higher than that of normal gray matter while nodules in gray matter heterotopia are isointense to gray matter. Patients with tuberous sclerosis may also have additional stigmata such as subcortical tubers and subependymal giant cell astrocytomas.](https://app.figure1.com/case-detail/32fdc2df-2998-4f2e-a189-f735e7634bde)  
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#Tuberous-sclerosis #Giant-cell-subependymal astrocytoma](https://app.figure1.com/case-detail/335f131e-35d8-480c-877d-aa81d22a07d2)  
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Newborn infant with multiple brain findings of tuberous sclerosis complex (TSC) including large subependymal lesions (yellow arrows), likely subependymal giant cell astrocytomas (SEGAs), radial migration lines (blue), and parenchymal tubers (red). Many young infants with TSC present with seizures or infantile spasms, although the diagnosis can be made in utero. TSC can be inherited as an autosomal dominant disorder with hamartomatous lesions affecting multiple organ systems, but many cases also result from de novo mutations. #NeuroWednesday](https://app.figure1.com/case-detail/3a5596c5-1da8-40bc-887e-91fe2d116af3)