Abstract: Neuronal migration disorders (NMDs) are congenital brain malformations caused by disrupted neuronal development and often lead to epilepsy and other neurological deficits. These conditions are rare, occurring in approximately one in every 2,500 live births. Early detection through prenatal and neonatal imaging is crucial for prompt genetic counselling, testing, and neurosurgical intervention. In Ghana, limited access to advanced medical imaging services such as magnetic resonance imaging (MRI) and computed tomography complicates the diagnosis of NMD. This medical imaging case report describes a 39-year-old Ghanaian woman with a 24-year history of epilepsy. Although the patient had a CT scan 15 years before the current hospital visit, a definitive diagnosis was not achieved until now through MRI. The MRI findings revealed a hypoplastic cerebellum, heterotopia, lissencephaly, expansion of the fourth ventricle, and a dilated cisterna magna, in keeping with NMD. The discussion focuses on the diagnostic capabilities of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) in identifying congenital brain malformations. It emphasises their respective advantages and limitations, while also highlighting the urgent need to enhance neuroimaging accessibility and to develop specialised radiological training programs in Ghana. The case underscores the paramount importance of MRI in accurately delineating cerebral anatomy and offers valuable insights into the detection and management of neuronal migration disorders.