PMC8810502_01
(A) EEG in wakefulness with left temporal sharp- and spike-wave (SW) complexes with maximum and phase reversal on T1-T3 (red arrow). Individual seizures occurring at fairly regular interval and high frequency (blue arrow). (B) Ictal EEG epoch from the clinical seizure onset (red arrow) demonstrating the evolution of the left temporal ictal discharge consisting of rhythmic SW with an increasing amplitude and a spread mostly to the central region.
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F1
They lasted 40-60 s and correlated to left temporal ictal change of initial attenuation and subsequent rhythmic epileptiform discharge (Figure 1A). In wakefulness, seizures occurred at fairly regular intervals of 3 to 4 per hour (Figure 1B).
(A) Coronal FLAIR MRI with bi-mesiotemporal hyperintensity, more prominent on the left, with increased volume of left amygdala (white arrow). (B) Axial PET-CT scan with hypermetabolic left mesiotemporal spot(white arrow). (C) PET-T1 MRI co-registration with clear hyperactivity in the left amygdala (crossed lines' center).
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F2
Brain MRI demonstrated bilateral mesiotemporal hyperintensity with clear left predominance and enlarged left amygdala (Figure 2A). Control brain MRI did not show progression of mesiotemporal abnormalities but fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed very restricted hypermetabolism in the left amygdala correlating to an ictal event during the examination, as reported by the patient (Figures 2B,C).
(A) Axial FLAIR MRI with left HS (red arrow). (B) Sagittal FLAIR MRI scan demonstrating the postoperative defect (blue arrow) and the left HS (red arrow). (C) Sagittal FLAIR MRI without obvious signs of cerebellar and brainstem atrophy.
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F3
Brain MRI did not reveal obvious signs of cerebellar atrophy but only progress in left HS (Figure 3).
PMC8810502_02
Timeline with diseases' onset and course, the diagnostic work-up, relevant results and therapeutic management.
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F4