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A 35-year-old female presents to the neurology clinic with a history of seizures starting at age 3. She also has a history of developmental delay and behavioral issues. On physical examination, she has multiple hypopigmented macules on her skin and exam reveals multiple hypomelanotic macules on the skin, as well as renal angiomyolipomas and multiple cortical tubers on brain MRI. Which finding is NOT typically associated with tuberous sclerosis?
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E