PMC6050350_01
Preoperative EEG(A-B). A: Continuous generalized spike-wave discharges with left frontal secondary bilateral synchrony and high amplitude. B: Left frontal discharges antecedent and extending to the right hemisphere when amplitude is decreased. C: Postoperative EEG showed no epileptiform discharges.
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His EEG was recorded during wakefulness and showed almost continuous generalized spike-wave discharges compatible with left frontal secondary bilateral synchrony, consistent with NCSE (Fig. 1A-B). His awake and sleep EEG showed no spike discharges interictally (Fig. 1C).
Preoperative fluid attenuated inversion recovery (FLAIR) axial (A) MRI image showing increased signal, cortical focal thickening, blurring of the gray-white matter junction, an abnormal sulcal and gyral pattern in the region of anterior cingulate gyrus of the left frontal lobe compatible with focal cortical dysplasia. Postoperative T2 weighted axial (B) MRI image showing that the lesion has been totally removed. (C) Cortical dysplastic neurons and ballon cells at abnormal locations. HE X200. (D) Neurofilament accumulation in cytoplasms of the abnormal neuronal cells. Neurofilament, immunoperoxidase X200.
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His MRI demonstrated a lesion suggestive of FCD in the anterior cingulate gyrus of the left frontal lobe (Fig. 2A). After preoperative evaluations, he underwent complete lesionectomy (Fig. 2B). Immunohistochemically, using the neurofilament (NF) antibody, dense accumulation of NF was observed in these large neurons (Fig. 2C-D).