PMC8720448_01
(a) Preoperative fluid-attenuated inversion recovery magnetic resonance imaging (FLAIR-MRI) revealing a high-intensity area with a cyst component in the left temporal lobe. (b) Preoperative contrast-enhanced T1-weighted (T1WCE) MRI revealing no enhancement. (c) Postoperative FLAIR-MRI indicating the partial removal of the tumor. (d) Postoperative T1WCE-MRI. Note that the inferior horn of the left lateral ventricle is enlarged. This may be explained by a reduction in the mass effect and hippocampal volume loss [Table 1]. (e) The hematoxylin-andeosin-stained specimen is consistent with an astrocytic glioma. (f) Genomic analysis indicates that the IDH gene and TERT promoter are wild type.
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F1
Magnetic resonance imaging (MRI) revealed a high-intensity lesion of the temporal lobe on fluid-attenuated inversion recovery-weighted images, and a noncontrast-enhanced cyst appeared inside the temporal lobe at the 1-year follow-up, suggesting the presence of a low-grade brain tumor [Figure 1a and b]. As a Wada test revealed that the left hemisphere was dominant in terms of language and memory, the medial temporal structures were reserved for functional preservation by performing a partial resection [Figure 1c]. TERT promoter were wild type, and the MGMT promoter was unmethylated. Therefore, we diagnosed this tumor as a diffuse astrocytoma, IDH-wild type, according to the 2016 World Health Organization classification [Figure 1e and f]. FreeSurfer software suite (http://surfer.nmr.mgh.harvard.edu), revealed an approximate decrease of 20% on the diseased side on MRI 3 months after surgery [Figure 1d]. Five months after the initial diagnosis, the patient died because of tumor progression.
(a) An electroencephalograph (EEG; longitudinal bipolar montage), taken 4 days after the focal to bilateral tonic-clonic seizure, reveals 1.5 Hz periodic discharges with a maximum amplitude in the left temporal area. (b) An EEG revealing spatiotemporal evolution of epileptic discharges, indicating nonconvulsive status epilepticus (blue: periodic discharges, yellow: temporal evolution, green: spatial evolution). Lt: Left, Rt: Right, Fp: Front polar, F: Frontal, C: Central, P: Parietal, O: Occipital, pT: Posterior temporal, mT: Mid-temporal, aT: Anterior temporal, Md: Midline.
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F2
Four days after the FBTCS, EEG revealed 1.5 Hz left-sided periodic discharges (PDs) and ictal spatiotemporal evolution of rhythmic activity, which demonstrated that the ASE persisted [Figure 2].