PMC6123859_01
High frequency diffuse beta activity with progressively increasing amplitude, typical of the tonic phase in status epilepticus, was associated in this patient with dystonic posturing and then limb numbness and paralysis.
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EEG patterns were associated with worsening of clinical stiffening bilaterally, consistent with tonic status epilepticus (Fig. 1).
MRI FLAIR sequences demonstrating normal mesio-limbic temporal regions (A and B), with relative hypermetabolism in the left temporoparietal cortex and right cerebellum qualitatively on -inverted dedicated brain FDG-PET/CT images (C and D) and three-dimensional statistical mapping (3D-SSP, E) but with only right cerebellum regional hypermetabolism greater than two standard deviations elevated compared to the Cortex ID (GE, Healthcare, Waukesha, WI) control population (F).
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MRI of the brain showed no structural abnormality, or asymmetry of temporal regions (Fig.2A and B). Dedicated brain FDG-PET showed relatively increased left temporo-parietal and right cerebellar activity (Fig.2C and D), including on three dimensional stereotactic surface projections (Fig.2E), but with only the right cerebellar brain region hypermetabolism > two SDs abnormal compared to the CortexID healthy control database (GE, Healthcare, Waukesha, WI; Fig.2F). CSF anti-NMDAR antibody was 1:8 (normal < 1:2), supporting a diagnosis of new-onset refractory status epilepticus (NORSE) due to anti-NMDAR encephalitis.