PMC6522399_01
Chronological changes in brain MRI. (A) At the initial attack, brain magnetic resonance imaging (MRI) on fluid-attenuated inversion recovery (FLAIR) showed enlargement of bilateral medial temporal lobes with high-intensity signals. (B) At the second attack, MRI showed hyperintense lesions in the bilateral medial temporal lobe with slight atrophy. (C) Seven months after the onset, MRI showed bilateral hippocampal atrophy with high-intensity signals. (D) Twelve months after the onset, MRI showed no remarkable interval changes from (C).
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Brain magnetic resonance imaging (MRI) showed bilateral high-intensity lesions in the hippocampus and amygdala on fluid-attenuated inversion recovery (FLAIR) imaging (Fig. 1A). Brain MRI showed bilateral hippocampal high-intensity lesions (Fig. 1B), but an EEG showed no epileptiform discharges. FLAIR imaging showed bilateral hippocampal high intensity lesions and atrophy (Fig. 1C). FDG-PET showed hypermetabolism in the left posterior hippocampus (Fig. 2A). Brain MRI showed no remarkable change in the interval from the previous examination (Fig. 1D), and FDG-PET revealed that the improvement in the hypermetabolism in the left posterior hippocampus had been maintained as well (Fig. 2C).
Sequential changes on fluorodeoxyglucose-positron emission tomography (FDG-PET). Fluorodeoxyglucose-positron emission tomography (FDG-PET) showing hypermetabolism in a left posterior hippocampal lesion [standardized uptake value (SUV): mean 6.26, max 7.29] (A), which improved after steroid treatment (SUV: mean 4.38, max 4.96) (B). Image showing that, five months after the initiation of steroid therapy, the improvement in the hypermetabolism had been maintained (SUV: mean 4.38, max 5.04) (C). The SUV values were measured in the region of interest (ROI) including the highest SUV value.
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FLAIR imaging showed bilateral hippocampal high intensity lesions and atrophy (Fig. 1C). FDG-PET showed hypermetabolism in the left posterior hippocampus (Fig. 2A). FDG-PET after additional IVMP treatment showed remarkable improvement of hypermetabolism of the left hippocampus (Fig. 2B).
Subclinical seizures on an overnight video-electroencephalogram (vEEG). An overnight vEEG performed 1 year after the clinical onset showing subclinical seizure patterns both in the left temporal area (6 times in 24 hours) and right temporal area (2 times in 24 hours). A representative subclinical seizure pattern arising from the left temporal area is presented (red dotted lines). LFF: low-frequency filter, HFF: high-frequency filter
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An overnight long-term vEEG revealed two subclinical seizures arising from the right mid-posterior temporal area and six from the left temporal area (Fig. 3).