case_images: PMC10720357_01
case_images: Examinations in the first admission. (A) Interictal EEG. (B) SPECT reveals markedly hypointense areas. (C-E) Dipoles are concentrated in the left operculum on magnetoencephalography (C: T1 axial, D: T1 coronal, E: T1 sagittal). (F) Ictal EEG.
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case_images: PMC10720357_01_fneur-14-1261104-g001.jpg
case_images: fig1
case_images: Electroencephalography (EEG) after admission showed a spike rhythm in the left frontal and left central areas during the interictal period (Figure 1A). The ictal EEG showed rhythmic discharges in the left central area (Figure 1F). On single-photon emission computed tomography (SPECT) interictally, regional blood perfusion was decreased in the left frontal, parietal, temporal, and occipital cortex compared with the corresponding regions on the contralateral side, and poor regional blood perfusion was observed in the bilateral anterior temporal lobes (Figure 1B). Notably, the dipoles were densely distributed in the left inferior frontal lobe and left insula in the magnetoencephalogram performed for surgical evaluation (Figures 1C-E).
case_images: Imaging and pathology. (A,B) Computed radiography demonstrates the location where the cortical electroencephalogram was recorded. (C) Re-examination after resection of the epileptic focus. (D) Pathological findings after surgery led to a diagnosis of meningoencephalitis (Hematoxylin and eosin (H&E) stained images).
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case_images: PMC10720357_01_fneur-14-1261104-g002.jpg
case_images: fig2
case_images: According to the clinical symptoms, EEG, MRI, magnetoencephalography (MEG), and SPECT, we inferred that the left inferior frontal gyrus played an important role in this patient's epileptic seizures, and an electrocorticography (ECoG) electrode was surgically implanted under the dura mater to cover the superior temporal gyrus, middle frontal gyrus, inferior frontal gyrus, lateral fissure, central area, and parietal lobe (Figures 2A,B). We determined the locations of the epileptic foci in relation to eloquent areas by cortical electrical stimulation, and we decided that the next surgical plan should be resection of the epileptic foci in the left middle and posterior frontal and left parietal lobes (Figure 2C). The pathological conclusion was that the lesion was frontal, and the patient was diagnosed with meningoencephalitis (Figure 2D).
case_images: Preoperative MRI and postoperative pathology results from last surgery. (A-C) MRI results (A: T2 axial, B: T1 axial, C: T1 sagittal) showed marked atrophy of the patient's brain tissue (including head of left caudate in T2 axial). (D) Results of reexamination after cerebral hemispherectomy. (E,F) Postoperative pathological findings from the second resection surgery met the diagnostic criteria for Rasmussen encephalitis (H&E stained images).
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case_images: PMC10720357_01_fneur-14-1261104-g003.jpg
case_images: fig3
case_images: MRI data showed atrophic findings in the left frontotemporoparietal region and left caudate head (Figures 3A-C). Considering the persistent focal epilepsy symptoms and cortical atrophy of one cerebral hemisphere, the patient was ultimately diagnosed with Rasmussen encephalitis according to the European consensus diagnostic criteria and was subsequently transferred to the neurosurgery department for hemispherectomy (Figure 3D). Within 7 years after surgery, the patient was totally seizure-free (ILAE 1) (Figures 3E,3F).