Discussion
Subependymal grey matter heterotopia (SGMH) is a rare neurodevelopmental
disorder resulting from defective neuronal migration during
embryogenesis. This condition leads to ectopic grey matter along the
ventricular walls and has been implicated in various neurological
manifestations, particularly epilepsy [1]. The case of this
6-month-old male with seizures highlights the clinical significance and
diagnostic challenges of SGMH in the context of associated
neuroanatomical abnormalities, such as corpus callosum dysgenesis and
colpocephaly. GMW is genetically heterogeneous, with 146 genes and
chromosomal loci identified as potential causes and is associated with
epilepsy, cognitive deficits, and other neurodevelopmental disorders
[2]. CT is an important modality for diagnosis which reveals ectopic
gray matter in various locations. Interestingly, this case also showed
features suspicious for closed-lip bilateral parieto-occipital
schizencephaly, a structural anomaly characterized by abnormal clefts in
the cerebral hemispheres. While schizencephaly and SGMH are distinct
conditions, their coexistence has been reported in the literature,
likely reflecting a shared disruption in neuronal migration and cortical
organization during fetal development. The dilated cerebrospinal fluid
spaces in the left posterior fossa and benign enlargement of the
subarachnoid spaces are incidental findings that are not uncommon in
infants. These findings do not appear to contribute to the primary
neurological presentation but may warrant monitoring to rule out
progressive hydrocephalus or increased intracranial pressure. The
clinical presentation of seizures in this case is consistent with the
known association between SGMH and epilepsy, attributed to the abnormal
cortical organization and ectopic grey matter’s role in generating
epileptiform activity [2]. Management of such cases typically
involves a multidisciplinary approach, including seizure control with
antiepileptic medications, developmental assessments, and genetic
counseling.