PMC9813516_01
Video EEG: Above: Rhythmic delta activity starting in the left hemisphere and rapidly propagating to the contralateral hemisphere. Below: Electroclinical seizure with spatio-temporal evolution and extended length (not shown here) that fulfills criteria for focal-onset evolving into bilateral convulsive status epilepticus.
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Since the patient persisted with seizures, he was taken to a 24-hour video electroncephalogram (Video-EEG) which concluded a moderately expressed encephalopathy, focal epilepsy and status epilepticus being seizure-free in the last 16 h (Fig. 1).
PET-CT: Above: Hypermetabolism thickening of gastric infiltrative aspect fundocorporal topography accompanied by perigastric adenopathies. Below: Brain hypometabolism, diffusely compromising the right cerebral hemisphere, frontal, occipital, parietal and temporal lobes, generating asymmetry with respect to the left side, accompanied by crossed cerebellar diaschisis with diffuse left cerebellar hypometabolism, diffuse right thalamic hypometabolism and relative sparing of the basal ganglia nuclei, some patches of mild hypometabolism in the frontal region.
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UGE, gastric tumor in the subcardial region.
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Upper gastrointestinal endoscopy (UGE) (Fig. 3) revealed in the subcardial region, including the gastric body, a mass-like lesion with an ulcer-infiltrative appearance highly suggestive of malignancy.
Hematoxylin-Eosin double stain, histologically, the lesion shows a low grade- moderarte differentiated intestinal type adenocarcinoma.
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Pathology (Fig. 4) of this lesion showed a low-grade/moderate differentiated intestinal type adenocarcinoma, Helicobacter pylori: negative, HER-2: negative, immunohistochemical studies show reactivity in tumor nuclei with MSH2, MSH6, MLH 1 and PMS2.