Sagittal T1-W (image 1) and axial T2-W (image 2) MRI show a | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Sagittal T1-W (image 1) and axial T2-W (image 2) MRI show a suprasellar mass (arrow) arising from the tuber cinereum of the hypothalamus. Tumors at this location are associated with gelastic (laughing) seizures and premature puberty.

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Axial FLAIR (image 1) and sagittal T1 FLAIR MRI images show a hypothalamic hamartoma (arrow). Patients with these lesions classically present with gelastic or laughing seizures. Hypothalamic hamartomas may also cause symptoms such as precocious puberty or behavioral and cognitive difficulties. On imaging, hypothalamic hamartomas are isointense to gray matter on T1-weighted images and hyperintense on T2-weighted images, without enhancement after contrast administration.](https://app.figure1.com/case-detail/04bb4529-3517-4a0b-b800-ff5f349700ff)

Sagittal (image 1) and axial (image 2) T1-weighted and coronal T1-weighted postcontrast (image 3) MRI show a hypothalamic hamartoma (arrow). The normal pituitary (arrowhead) is shown nearby. Hypothalamic hematomas are nonprogressive tumors that grow in proportion to the normal brain. Symptoms typically occur in childhood and include central precocious puberty or gelastic seizures.](https://app.figure1.com/case-detail/2d30e7e7-7f2b-426a-a7c4-23d1321fcb9f)

A four-year-old girl is referred to a pediatric neurologist with new-onset generalized tonic-clonic seizures. Her father mentions that she has also had sudden episodes of spontaneous unexplained loud laughter for the past year, and they now occur almost daily. Neurological examination is unremarkable. An MRI reveals the findings seen here. Which of the following other clinical features is commonly associated with this patient’s condition? Image credit: @DrRadioHead](https://app.figure1.com/case-detail/561ff90c-259b-4848-9e43-129ef77b5246)

MRI brain scan. Diagnosis? Thoughts?](https://app.figure1.com/case-detail/6824c18b-368b-41e0-a7bd-bd83c34930b3)