case_images: PMC11743308_01
case_images: PMC11743308_02
case_images: Diagnostic results of the proband. a) The Magnetic Resonance Imaging (MRI) of the proband revealed signs of cerebral hemisphere sub-atrophy. Bilateral subdural hygromas were present, with the right side being more pronounced (18 mm) compared to the left (5 mm). A similar encysted liquid formation, in the shape of a biconvex lens, was observed in the parietal-occipital region on the left and measured 1.2 x 2.6 cm in size with clear, even contours. Additionally, a small retro cerebellar cyst was present, causing the retro cerebellar space to expand to 22 x 9 mm in the sagittal projection. b)The proband's EEG revealed disrupted bioelectrical activity in the wakefulness-sleep cycle. During wakefulness, diffuse beta-wave activity was observed throughout the recording, with no clear determination of the basic rhythm. Epileptiform activity was recorded in the form of acute-slow wave complexes in the left central leads that spread to the parietal and temporal leads, and sometimes showed asynchronous bilateral spread. During sleep, diffuse theta/alpha-like waves were observed, with a maximum in the fronto-central leads and accompanied by diffuse beta-wave activity, resulting in a fragmented sleep structure. Low-index sleep spindles were recorded and in dreams, sharp-slow wave complexes were detected in the central and parietal leads. Additionally, flashes of diffuse delta waves with maximum amplitude in the central and temporal leads were recorded during sleep with a high index. The EEG trace was also found to have artifacts related to motor activity.
case_images: gr1.jpg
case_images: PMC11743308_02_gr1.jpg
case_images: fig1
case_images: Evaluation using magnetic resonance imaging (MRI) indicated severe perinatal lesions of the CNS of hypoxic-ischemic origin, also signs of sub-atrophy of the cerebral hemispheres (Fig. 1a). Electroencephalography (EEG) showed disrupted bioelectrical activity with diffuse beta waves, left central epileptiform discharges, and fragmented sleep with reduced spindles and sharp-slow wave complexes, supporting severe epileptic encephalopathy (Fig. 1b).