PMC6974623_01
Patient #x. Axial T1-weighted MRI obtained at age 5 years, demonstrating a left middle cerebral artery distribution infarct and a disproportionately small left cerebral hemisphere.
fneur-10-01397-g0001.jpg
PMC6974623_01_fneur-10-01397-g0001.jpg
F1
At 1 month of age, he was noted to have right sided weakness and imaging ultimately revealed a left middle cerebral artery distribution perinatal stroke (Figure 1).
Pre-operative EEG showing an ESES pattern occupying 90% of the sleep recording. The interictal discharges localize to the left frontal, and left occipital regions independently. Volume conduction to the right frontal and right occipital regions is also seen, but the maximum clearly lateralizes to the left hemisphere. Display setup: bipolar double banana montage, 10 s page, low frequency filter 1 Hz, high frequency filter 70 Hz, gain 100 microvolts per cm.
fneur-10-01397-g0002.jpg
PMC6974623_01_fneur-10-01397-g0002.jpg
F2
Scalp EEG at the time demonstrated independent left frontal and occipital interictal discharges with a spike wave index (SWI) of 90-100% meeting criteria for ESES on the left (Figure 2).
Post-operative EEG obtained 14 months after left hemispherotomy. There is complete resolution of ESES with no interictal discharges. Only expected non-epileptiform changes of continuous slow and asymmetry of sleep structures in the left hemisphere are seen. Display setup: bipolar double banana montage, 10 s page, low frequency filter 1 Hz, high frequency filter 70 Hz, gain 100 microvolts per cm.
fneur-10-01397-g0003.jpg
PMC6974623_01_fneur-10-01397-g0003.jpg
F3
Post-operative EEG showed complete resolution of ESES (Figure 3).