PMC4389206_01
A. The FLAIR MRI showed a high-signal lesion on the contralateral superior parietal cortex (white arrows) and an encephalomalacia of the ipsilateral occipital lobe. The MR angiography showed a complete obstruction of the right proximal internal carotid artery. B. The EEG showed several interictal spikes in the left temporal area (red arrow). C. The ictal SPECT analyzed using SISCOM imaging showed an increased signal in the contralateral temporal cortex (red arrow), the contralateral mesial frontal cortex, which lies in the supplementary negative motor area (white arrowhead), and the contralateral superior parietal cortex, which lies in the somatosensory area (red arrowhead). The arrow shows the SNMA and PNMA that possibly became activated and caused the atonia. In addition to the above SNMA and PNMA, the activation of the functionally related areas on the horizontal level can be observed, which leads to a descending activated lesion on the ipsilateral side. Moreover, a related lesion can also be observed on the contralateral side where they are connected through the commissural fiber.
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In addition, a high-signal lesion on the left superior parietal cortical area was observed on the fluid-attenuated inversion recovery (FLAIR) MRI (Fig. 1A). Her electroencephalogram (EEG) showed several interictal spikes in the left temporal area (T3 maximum) (Fig. 1B). An ictal single-photon emission CT (SPECT) combined with an MRI (SISCOM) analysis showed an increased signal in the contralateral superior parietal area, which correlated well with a high-signal lesion in the FLAIR and mesial frontal area (Fig. 1C).