PMC8327331_01
EEG in bipolar montage sensitivity 10microv, HF- 70 Hz, LF-1.0 Hz, NF-50 Hz. (A) Frontally dominant 3-3.5 Hz generalized spike- and polyspike-and-wave discharges (B) Generalized frontally dominant spike wave discharges (C) Myoclonic jerk (arrow) correlating with burst of frontally dominant spike, polyspike wave discharge (D) Bilateral occipital spikes and rthymic spikes.
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Multiple myoclonic jerks were recorded with EEG showing frontally dominant generalized discharges (see Fig. 1).
Follow up EEG Bipolar montage sensitivity 10microv, HF- 70 Hz, LF-1.0 Hz, NF-50 Hz A) Bilateral occipital fast activity B) bilateral occipital delta rhythm intermixed with fast activity and spikes C) Generalized delta activity predominantly over occipital region D) sleep record with vertex waves.
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His repeat MRI brain showed caudate and lentiform nuclei atrophy with FLAIR hyperintensity as well as cerebral and cerebellar atrophy (Fig. 2).
A) T2 W axial image showing caudate and lentiform nuclei atrophy with lentiform nuclei hyperintensity as well as cerebral atrophy B) T1 W axial image showing caudate and lentiform nuclei atrophy with corresponding lentiform nuclei hypo intensity C) FLAIR coronal image showing diffuse brain volume loss involving both grey and white matter along the cerebral hemispheres, including marked bilateral caudate and putaminal atrophy with bilateral putamen FLAIR hyperintensities and mild dilated 3rd ventricle.
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His follow up EEG, ten months later, showed significant slowing of background activity with bilateral occipital delta intermixed with fast activity and focal occipital discharges without any generalized discharges as compared to the first EEG (Fig. 3).