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controls cell growth and differentiation, metabolism, and autophagy. In the brain, this yields developmental hamartomatous malformations including cortical/subcortical tubers, radial migrational lines, and Page 297subependymal nodules which can develop into giant cell astrocytomas. Epilepsy is the most common neurological manifestation, occurring in 80% to 90% of patients with

controls cell growth and differentiation, metabolism, and autophagy. In the brain, this yields developmental hamartomatous malformations including cortical/subcortical tubers, radial migrational lines, and Page 297subependymal nodules which can develop into giant cell astrocytomas. Epilepsy is the most common neurological manifestation, occurring in 80% to 90% of patients with

controls cell growth and differentiation, metabolism, and autophagy. In the brain, this yields developmental hamartomatous malformations including cortical/subcortical tubers, radial migrational lines, and Page 297subependymal nodules which can develop into giant cell astrocytomas. Epilepsy is the most common neurological manifestation, occurring in 80% to 90% of patients with

control. She also received a diagnosis of attention deficit/hyperactivity disorder (ADHD). Dermatology evaluation performed at 9 years of age detected facial plexiform neurofibroma, right lower limb neurofibroma, multiple café-au-lait spots of varying sizes (Fig. 57.1A), axillary and inguinal freckling (Fig. 57.1B). Ophthalmologic evaluation showed

control. At 3-month follow up, his residual deficits were mild intrinsic hand weakness, mild decreased sensation to temperature in the lower extremities, hyperreflexia, and bilateral ankle clonus. Clinical Differential Diagnoses Rapidly progressive mental status changes and cranial nerve deficits can be seen in infectious, rheumatologic, and autoimmune

control. At 3-month follow up, his residual deficits were mild intrinsic hand weakness, mild decreased sensation to temperature in the lower extremities, hyperreflexia, and bilateral ankle clonus. Clinical Differential Diagnoses Rapidly progressive mental status changes and cranial nerve deficits can be seen in infectious, rheumatologic, and autoimmune

control. She also received a diagnosis of attention deficit/hyperactivity disorder (ADHD). Dermatology evaluation performed at 9 years of age detected facial plexiform neurofibroma, right lower limb neurofibroma, multiple café-au-lait spots of varying sizes (Fig. 57.1A), axillary and inguinal freckling (Fig. 57.1B). Ophthalmologic evaluation showed

control. She also received a diagnosis of attention deficit/hyperactivity disorder (ADHD). Dermatology evaluation performed at 9 years of age detected facial plexiform neurofibroma, right lower limb neurofibroma, multiple café-au-lait spots of varying sizes (Fig. 57.1A), axillary and inguinal freckling (Fig. 57.1B). Ophthalmologic evaluation showed

control. At 3-month follow up, his residual deficits were mild intrinsic hand weakness, mild decreased sensation to temperature in the lower extremities, hyperreflexia, and bilateral ankle clonus. Clinical Differential Diagnoses Rapidly progressive mental status changes and cranial nerve deficits can be seen in infectious, rheumatologic, and autoimmune