Teaching video neuroimages: hypothalamic hamartoma: an overlooked entity.

Neeraj N. Baheti, DM Ajith Cherian, DM Ramshekhar Menon, DM Ashalatha Radhakrishnan, DM A 21-year-old man presented with brief spells of inappropriate laughter since 6 years of age. Three gelastic seizures were recorded during video-EEG monitoring (video on the Neurology Web site at www.neurology. org). MRI revealed a small hypothalamic hamartoma (figure 1). Gelastic seizures can also arise from temporal lobe and mesial frontal regions.1 Meticulous scrutiny of MRI is needed since epileptogenic hamartomas may be small and nonpedunculated, and therefore easily missed. Surgical removal of hamartoma is very effective in controlling seizures.2 Histopathology shows variable-sized nodular foci of neurons as well as areas of diffusely distributed neurons interspersed among glial cells without dysplastic neurons (figure 2).