PMC6475548_01
Plain CT of the brain at presentation to the hospital showing patchy and gyriform calcification in bilateral temporoparietal occipital corticosubcortical areas. Abbreviation: CT, computed tomography.
CRINM2019-5247961.001.jpg
PMC6475548_01_CRINM2019-5247961.001.jpg
fig1
The computed tomography (CT) of the patient's brain showed bilateral scattered corticosubcortical parietooccipitotemporal calcification with no oedema or mass effect (Figure 1).
Periictal brain MRI DWI showing gyriform hyperintense signal over the left occipital cortex. Abbreviations: DWI, diffusion-weighted image; MRI, magnetic resonance imaging.
CRINM2019-5247961.002.jpg
PMC6475548_01_CRINM2019-5247961.002.jpg
fig2
The brain MRI with and without contrast showed diffusion-weighted imaging (DWI) restriction over bilateral occipital cortex (more so over the left side) in a gyriform pattern (Figure 2) with concordant area of apparent diffusion coefficient (ADC) hypointensity (Figure 3).
Periictal brain MRI ADC mapping showing bilateral occipital hypointense signal alteration (left>right). Abbreviations: ADC, apparent diffusion coefficient; MRI, magnetic resonance imaging.
CRINM2019-5247961.003.jpg
PMC6475548_01_CRINM2019-5247961.003.jpg
fig3
The brain MRI with and without contrast showed diffusion-weighted imaging (DWI) restriction over bilateral occipital cortex (more so over the left side) in a gyriform pattern (Figure 2) with concordant area of apparent diffusion coefficient (ADC) hypointensity (Figure 3).
Periictal brain MRI with contrast showing no corresponding area of enhancement. Abbreviation: MRI, magnetic resonance imaging.
CRINM2019-5247961.004.jpg
PMC6475548_01_CRINM2019-5247961.004.jpg
fig4
T1-weighted imaging with contrast showed no contrast uptake (Figure 4), and we saw no oedema or mass effect.
Periictal brain MRI SWAN image: showing gyriform hyperintense signal abnormality over bilateral occipital cortex. Abbreviations: MRI, magnetic resonance imaging; SWAN, susceptibility weighted angiography.
CRINM2019-5247961.005.jpg
PMC6475548_01_CRINM2019-5247961.005.jpg
fig5
Susceptibility weighted magnetic resonance sequences (susceptibility weighted imaging [SWI], susceptibility weighted angiography [SWAN]) demonstrated hyperintensity corresponding to the area of DWI restriction (Figure 5).
Postictal plain CT of the brain showing no interval abnormality compared to the CT of the brain upon presentation. Abbreviation: CT, computed tomography.
CRINM2019-5247961.006.jpg
PMC6475548_01_CRINM2019-5247961.006.jpg
fig6
A second brain CT after 1 month (Figure 6) showed no interval change compared to the initial CT and no evidence of residual changes observed in MRI (DWI, ADC, and SWI).