PMC5377060_01
(A) Electroencephalogram (EEG) (bipolar display) showing epileptic activity with discharges of generalized sharp waves, alternating with phases of lower amplitude, moderately slowed activity without epileptiform signals. (B) Follow-up EEG under antiepileptic medication, showing broader transients in now more triphasic configuration with more phase lag, alternating with suppressed phases of a now lower amplitude.
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F1
Multiple electroencephalograms (EEGs) showed generalized slow-wave activity (Figure 1A). EEGs showed further slowing of background activity, with the appearance of triphasic signals (Figure 1B). Electroneuromyography demonstrated the absence of motor responses, even upon maximal electrical nerve stimulation, but the presence of somatosensory evoked potentials.
Cerebral magnetic resonance imaging (MRI): (A,B) T2-weighted axial scans. (C) T1-weighted coronal scan after intravenous application of gadolinium contrast medium. (D) Coronal scan with fluid attenuated inversion recovery imaging (FLAIR). (A) MRI on day 3. (B-D) MRI on day 16, showing an asymmetry with a minimal increase of signal intensity in the left thalamus (B,D) and in the cerebellum, with slight swelling and compression of the cerebellar sulci (D). No pathological contrast enhancement was seen (C).
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F2
The initial cranial magnetic resonance imaging (MRI) scan demonstrated no abnormal findings (Figure 2A) nor did the subsequent cranial CT scan on days 7 and 10. The cranial MRI scan on day 16 showed slight hyperintensity in the region of the left lateral thalamus (Figures 2B-D).
Histopathological analyses of brain biopsy. (A) Images show a mild hypercellularity. (B) Diffuse infiltration by T cells (CD3-positive). (C) Marked microglial activation (HLA-DR-positive). Magnification 200x. Scale bar corresponds to 100 microm.
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F3
An open brain biopsy on day 15 showed scant infiltration of the cerebral cortex by CD3-positive T-lymphocytes and microglial activation (Figure 3).