Porencephaly: Report of a case in an older adult

Abstract

Introduction: Porencephaly, as a rare imaging finding, occurs mostly in pediatric patients, causing seizures, motor and behavioral deficits. In some exceptional cases, it is an asymptomatic entity affecting other age groups.

Case presentation: 79-year-old patient with a history of arterial hypertension, who was admitted in the context of a de novo ictal crisis, associated with severe hyponatremia that was corrected and an incidental finding of porencephaly by computed tomography (CT). For the evidence of structural brain damage and the recurrence of the seizure during hospitalization, it was considered a remote symptomatic seizure and, given the high risk of new seizures, anticonvulsant treatment was initiated with a satisfactory evolution until discharge.

Results: At the home visit, the patient was found to be independent to carry out activities of daily living and without recurrence of seizure events, despite discontinuation of anticonvulsant therapy.

Discussion: In this case, the finding of porencephaly was incidental, at an advanced age and with the simultaneous presentation of severe hyponatremia, which could be the cause of the ictal crisis and neurological deficit, without ruling out a remote crisis due to structural alteration.

Conclusions: Porencephaly is difficult to diagnose due to its low frequency and atypical characteristics, as in the case presented. Therefore, the registration and follow-up of cases of porencephaly, both prenatal and postnatal, should be promoted, taking into account the possible differential diagnoses, to facilitate detection and timely medical treatment.