Evaluation of different ulegyria patterns with magnetic resonance imaging

•The largest series of ulegyria were reported and relevant literature reviewed.•Ulegyria is characterized by mushroom-shaped gyri in the watershed areas on magnetic resonance imaging.•Clinical findings and appearance of ulegyric lesions could vary depending upon the size of involved area. Ulegyria is a parenchymal sequel of hypoxic ischemic encephalopathy causing mushroom-like appearance in gyri. Aim of the present study was to evaluate clinico-radiological findings of patients who applied with different clinical features, predominantly epilepsy, and who were found to have ulegyria formations in MRI examinations. The study included a total of 30 patients (12 female and 18 male) who applied with different types of seizures in February 2011–August 2016 period and had brain MRI examinations using 1.5T MRI scanner. Mushroom-shaped gyri accompanied by gliosis and atrophy in subcortical white matter were considered ulegyria. Locations, MRI features and accompanying pathologies of ulegyria formations were studied. Age of the patients ranged from 4 to 62 (mean 26.0 ± 13.8). Both cerebral lobes were involved in 18 patients. In terms of involved area, symmetrical or asymmetrical involvements were observed in occipital lobes in 26 patients, parietal lobes in 19, frontal lobes in 12 and temporal lobes in 4. The most common involvement type was bilateral occipital and bilateral parieto-occipital lobe involvements with five patients each. Lesions were symmetrical in 11 patients. Six patients had cingulate gyrus atrophy. Nineteen patients had different levels of symmetrical or asymmetrical ventricular dilatation. Cranial asymmetry was observed in six patients with unilateral involvement and in one patient with generalized involvement. Although ulegyria predominantly involves parasagittal watershed areas in MRI examinations of patients applying with epilepsy, clinical manifestations and appearance of lesions could vary depending upon the size of involved area and level of injury.