PMC8769486_01
MRI on second admission. Axial T2WI demonstrated high intensity lesions (arrow) in left brain stem (a), right cerebellum (b), left temporal lobe (c), and bilateral basal ganglia (d). Left hippocampus was atrophic (arrowhead) (c). MRI: magnetic resonance imaging, T2WI: T2-weighted image.
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F1
T2WI in the brain stem, cerebellum, right mesial temporal lobe, and bilateral basal ganglia (Fig. 1).
MRI and interictal FDG-PET. Upper row is axial view and lower row is coronal view. At the onset of FIAS, MRI detected left temporal hippocampal atrophy in FLAIR image (upper row) and T2WI (lower row) (a). At the time of presurgical evaluation, left hippocampus showed atrophy with high intensity corresponding to HS in FLAIR image of MRI (b), and FDG-PET using statistical parametric mapping analysis revealed decreased glucose metabolization and perfusion in medial and anterior part of the left temporal lobe (c). FDG-PET: 18F-fluorodeoxyglucose positron emission tomography, FIAS: focal impaired awareness seizure, FLAIR: fluid-attenuated inversion-recovery, HS: hippocampal sclerosis, MRI: magnetic resonance imaging, T2WI: T2-weighted image.
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F2
Electroencephalography (EEG) showed interictal discharge in the left temporal lobe, and MRI showed left hippocampal atrophy (Fig. 2a), which was similar to the previous imaging result (Fig. 1). MRI in T2WI demonstrated shrinking and hyperintensity in the left hippocampus, and no findings were suggestive of NBD (Fig. 2b). 18F-fluorodeoxyglucose-position emission tomography (FDG-PET) showed low metabolism in the left medial and anterior temporal lobe (Fig. 2c).
Ictal scalp EEG on presurgical study. Epileptic discharge started on left SP1. EEG: electroencephalography, SP1: sphenoidal lead.
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F3
This activity evolved and spread to the temporal tip and the contralateral medial temporal lobe (Fig. 3).
Histopathological findings of hematoxylin-eosin staining on resected tissues. CA1 of left hippocampus showed cell loss in the pyramidal cell layer corresponding to HS (a). There were no specific inflammatory findings in hippocampus, parahippocampal gyrus (b) and inferior temporal gyrus (c). Horizontal bar indicates 100 mum. HS: hippocampal sclerosis.
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F4
Histopathological examination revealed left HS and the temporal cortex did not have findings related to NBD or any chronic inflammatory diseases (Fig. 4).