PMC5645166_01
A: Scalp EEG showing mild left temporal slowing without evidence of epileptiform discharges.. B: Axial MRI brain T2 FLAIR image indicating a left temporal mass lesion with no significant mass effect or edema.. C: Axial and coronal T1 post-gadolinium MRI brain images demonstrating a left temporal mass lesion with contrast enhancement.. D: Sagittal MRI brain T2 FLAIR image indicating scattered periventricular hyperintensities.. E: MR spectroscopy showing elevated choline to creatine peaks as well as decreased N-acetyl aspartate, consistent with neoplasm.. F: Intracranial EEG demonstrating a focal electrographic seizure arising from a single contact of the depth electrodes.. G: Pathology indicating cellular atypica, endothelial proliferation, and necrosis consistent with a diagnosis of glioblastoma multiforme.
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Outpatient electroencephalogram (EEG) revealed mild left temporal slowing without evidence of epileptiform discharges (Fig. 1A). Brain MRI demonstrated a T2 hyperintense lesion in the left temporal lobe that enhanced with gadolinium (Fig. 1B, C). T2 hyperintensity were also noted (Fig. 1D). There were no diffusion weighted imaging (DWI) or apparent diffusion coefficient (ADC) changes. MRS performed over the left superior temporal gyrus showed elevated choline to creatine peaks with decreased N-acetyl aspartate (Fig. 1E), a pattern suggestive of neoplastic etiology. Electrocorticography demonstrated lateralized periodic discharges over the temporal lobe lesion with a focal electrographic seizure arising from a single contact of the depth electrode (Fig. 1F). On histopathological analysis, the surgical specimen was consistent with an isocitrate dehydrogenase (IDH) wild-type GBM (Fig. 1G).