A 6-month-old boy with infantile spasms and tuberous sclerosis complex (TSC) was treated with the antiepileptic drug Vigabatrin for 1 month. A routine follow-up MRI demonstrated asymptomatic diffusion abnormalities in bilateral thalami (Fig. 1, diffusion, Fig. 2, ADC map, arrows). Similar abnormalities were identified in globi pallidi and brainstem. Also note multiple cortical tubers from the child’s TSC in Fig. 2 (asterisks).

Fig. 1
figure 1

Axial diffusion weighted MRI

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Fig. 2
figure 2

Axial apparent diffusion coefficient (ADC) map MRI

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Recent studies in the pediatric population show Vigabatrin is associated with reversible diffusion abnormalities in globi pallidi, thalami, brainstem and dentate nuclei. The risk was greater in younger infants [1, 2]. Signal abnormalities were not associated with any symptoms and were reported to be transient and dose dependent, with the majority demonstrating spontaneous resolution, even without the discontinuation of Vigabatrin [2]. Although the action mechanism isn’t completely understood, the possibility of Vigabatrin causing myelin edema has been proposed [1].