PMC5459970_01
Serial EEGs performed during hospitalization. A) Day 1: EEG shows a normal background at 9 Hz. Use an arrow/circle to identify the 9 Hz normal background. B) Day 5: there is emergence of EDB pattern with diffuse delta slowing at 1.5-3 Hz with overriding, high frequency activity. Use an arrow to definite the site where the seizure emerges from the EDB. C) Ictal recording showed ictal onset from the high frequency activity overriding the delta activity and generalizes. D) Day 44: EEG recorded choreoathetoid movements that did not have electrographic correlates. E) Day 66: persistent EDB pattern.
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Her routine EEG (Fig. 1) and MRI brain with and without contrast were both normal (Fig. 2). On day 5, she was placed on continuous EEG (cEEG) that showed emergence of EDB pattern triggering anti-NMDA encephalitis workup (Fig. 1).
A) MRI brain with and without contrast that was unremarkable. B) PET scan performed after the resolution of the status epilepticus while having persistent EDB pattern that showed hypometabolism in the bilateral parietal and occipital areas. Pace arrows at the parietal-occipital regions of maximal hypometabolism.
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Her repeat MRI brain with and without contrast was unremarkable (Fig. 2). On day 20, repeat PET scan showed hypometabolism in bilateral parietal and occipital areas (Fig. 2) as well as normal MRI brain with and without contrast (Fig. 2).
A) A photomicrographic section of the right ovary that reveals microscopic evidence of the teratoma including B) a single focus of mature brain tissue which is associated with perivascular chronic inflammation and an adjacent prominent inflammatory infiltrate in the stroma of the 3.5-cm mature cystic teratoma.
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On day 10, she was taken emergently for oophorectomy, and the pathology revealed ovarian teratoma with mature cortical tissue (Fig. 3).