PMC5697387_01
Bipolar EEG montage showing left occipital sharp waves (P3, O1) evolving into brief electrographic focal clinical seizures.
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Continuous video EEG during the patient's most recent episodes showed left occipital sharp waves evolving into brief, frequent electrographic and clinical seizures, lasting 60-70 seconds (Figure 1).
Axial brain MRI images of the patient showing transient left occipital enhancement following episode of clustered seizures in 2013 (a, b, c, d) and in 2017 (e, f, g, h). In 2013, (a) peri-ictal brain MRI-DWI shows diffusion restriction in left occipital cortex one day after her first reported seizure. (b) Follow-up MRI-DWI five weeks later shows complete resolution of abnormality in left occipital cortex. (c) Peri-ictal brain MRI T2/FLAIR shows hyperintense signal in left occipital cortex one day after her first reported seizure. (d) Follow-up MRI T2/FLAIR five weeks after seizure activity shows complete resolution of abnormality in left occipital cortex. In 2017, (e) peri-ictal brain MRI-DWI shows diffusion restriction in left occipital cortex one day after her first reported seizure. (f) Peri-ictal ADC map shows hypointensity in the left occipital cortex. (g) Peri-ictal brain MRI T2/FLAIR shows hyperintense signal in left occipital cortex. (h) Follow-up MRI T2/FLAIR six weeks following seizure activity shows complete resolution of abnormality in left occipital cortex.
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MRI with DWI, ADC, and T2/FLAIR showed diffusion restriction and hyperintense signal throughout the left occipital cortex (Figures 2(e), 2(f), and 2(g)). Follow-up MRI performed six weeks later showed that the lesions involving the left occipital lobe completely resolved without any residual encephalomalacia (Figure 2(h)). MRI scans that were obtained four years ago showed increase in diffuse cortical and FLAIR signal abnormality involving the left occipital lobe with more focal diffusion restriction and hyperintense T2 signal medially (Figures 2(a) and 2(c)). Follow-up MRI five weeks later showed complete resolution (Figures 2(b), and 2(d)).