 So, good morning sir. Good morning sir. My name is Dr. Pungaj Pandia, junior resident in the data department, government medical college, Kota. Today my paper presentation is rare case report of tuberous sclerosis complex in the day-to-day patients after tuberous sclerosis complex also known as monomal disease, Pringle disease, is a heritable relatively rare autosomal dominant neurocrutanger disorder characterized by triad of epilolium, epilepsy, low intelligence, and idioma civation, including involvement of multi-system brain, kidney, heart, lung, and eyes, secondary to mutation in TSC1 and TSC2 tumor suppressor gene. We described tuberous sclerosis in nine years, child with importance of dermatological and radiological examination to find asymptomatic renal and central nervous system reason. Case report, we are reporting the case of tuberous sclerosis in children which involved multiple organ, skin, brain, kidney, and heart, comprehensive evolution of clinical features of tuberous sclerosis in conjunction with radiological assessment is a critical for diagnosis and management. Nine-year-old 19 kg weight female child present to OPD with complaint of recurrent loss of consciousness with seizures and chronic headaches since two years. She had no medical history of not and was taking no medication, no medications before. Physically and intellectually she was okay and our IQ test was normal. On investigation her complete blood count, seroactive protein levels, sedimentation rate, urea, creatinine, alienium amino transfer, and exparded amino transfer level but normal in limits of thermological examination, X-ray of hand birth, normal. On physical and clinical examination, she has a hyperpigmentation of skin with facial angiomers, which were multiple from discreet, down-shape, red-brown, teleinjected crepele, and makes it size of 1 to 500 in diameter, symmetrically extending from nebilebial forward to cheek and chin, characteristic butterfly distribution on patients face with relatively sparing of upper lip and lateral face, which is described in image number 1. And image number 2A and 2B, she has a shy green page, which is irregularly thickened, slightly elevated, salt-ish colored late measuring photos, 2.2 centimeter, and 3.5 cross 2 centimeter in the lumbocetral region. And then next, image number 3, she has a coin and tumor, periocular fibroma, smooth form, flesh-skinned colored excretion emerging from the nail fold of index and middle finger with 7mm and 4mm length respectively with secondary nail dystopia, which is shown in image number 3, is the histology of nail fold, lumbocetral region face respectively with consistent with angiophibroma, periocular fibroma, and shy green page. Then next one is radiological examination in B-mode ultrasonography, image number 4A and 4B, longitudinal ultrasonic image of right and left kidney, shows multiple hyper-equic masses, suggestive of renal angioma, myo lipoma. Then 2D eco-examination, image number 5 shows 11 cross 15mm size single mass, originated from the lateral wall of left or integral, suggestive of cardiac rendome, myomas. On the radiological examinations in MRI, image number 6A, 6B and 6C, T2, a flare image of brain at multiple levels shows extensive cortical, sub-cortical white metal regions, hyperintensity, largest in the right central lobe, consistent with cortical tibras, with radial linear hyperintensity with white matter extending from cortex, suggestive of white matter, hetero-topia, along with nodulatory of bilateral ventricular margins, suggestive of sub-apendimals, nodules. Then radiological examination, non-contrast, CT scan of head and abdomen, image number 7A is non-contrast, NCT image of head, so multiple irregular hyper-dense nodules along sub-apendimal lining of bilateral lateral ventricular, suggestive of sub-apendimal nodules, image number 7B shows the hyper-dense patchy areas, hyper-dense patchy areas in HE unit in 50, liglo fatty infiltration, suggestive of renal angioma, myo lipoma. Discussion, tuberous sclerosis, known as a Pringle disease, is a heritable, relatively rare orthoformal, bovid and neuropytonia disorder characterized by triad of epilovine, epilepsy, low intelligence and adenoma sedation, including the involvement of multisystems, brain, kidney, heart, lung, and eyes, secondary to mutation in TSC1 and TSC2 tumor suppressor gene, tumor suppressor gene TSC1 located on commas number 9, which encode for the protein-harmadine and TSC2 gene on commas number 60 encodes for 14 degrees. Loss of the function, germ, and mutation of this gene can lead to rapamycin, M2 inhibition, and abnormal excessive proliferation of tissue resulting in hamartomas. The incidence of tuberous sclerosis complex in 1 in 6,000 libres, which is equivocal occurrence in male and female, approximately one-third patient exhibit a heritable transmission and two-third of patients have a sporadic disease caused by denominal mutations. The clinical walk stride sees an intellectual disability in facial engeoma seen in less than 50% of cases. The diagnosis of tuberous sclerosis betterment by the clinical and radiological criteria catalyzed as measure and minor features. On basis of international tuberous sclerosis consistent concerns revived the diagnostic criteria for tuberous sclerosis complex in 2012, a TSC diagnosed with, define a TSC either two measure features here, one of one measure features with two minor features, probable TSC one measure and one minor features, and possible TSC either one features, either one measure features we have two, we have more minus features. International TSC consensus, concepts, concerns, results, diagnostic criteria for tuberous sclerosis complex in 2012. The measure features are facial engeoma, engeoma of your forehead, legs, non-traumatic, umbolyperium, the fibromas, shaggul, sph, cortical, tuberous, sub-apendymal nodules, cardiac, cardiorectomyoma, singular multiple, renal engeoma, lipoma, hypomilagotin, macules, more than three, sub-apendymal, genital astrophytoma, astrophytoma, lymphengeal, biometasis, and multiple renal tetanil nodule hamartoma. Minor features of multiple renal hamartoma, hamartoma, rectal polys, bone seeds, cerebrovide, metamark, migration lines, contract risk 11, retinal, echomic patient, genital pyromas, multiple random distributants in dental, in the body. Complusion, the expectation of life for very severely affected infant is over, approximately 3% dies in first three, first year, 28%, under 10 years, and 75% before the age of 25 years. The cause of death is usually epilepsy or intramural infection, but occasionally it can be caused by tumor, cardiac failure, massive hemorrhage from AML, and regular failure of permanent psychosis. And older child they are younger adults with epilepsy and cutaneous stigmatitis have erratic prognosis. To attain decent quality of life and better prognosis, each case has to be truly studied and evaluated since variable complications may be often found at an early stage. There are my references. Thank you so much.