case_images: PMC11830410_01
case_images: PMC11830410_02
case_images: Section of scalp EEG with rhythmic high amplitude delta with superimposed spikes in left hemisphere (RHADS pattern) that is typical for AHS. RHADS = rhythmic high-amplitude delta activity with superimposed spikes; AHS = Alpers-Huttenlocher syndrome.
case_images: cureus-0017-00000077592-i01.jpg
case_images: PMC11830410_02_cureus-0017-00000077592-i01.jpg
case_images: FIG1
case_images: During the reduction of general anesthesia, the EEG revealed left-sided rhythmic high-amplitude delta waves superimposed with epileptiform discharges (Figure 1).
case_images: Brain MRI showed T2/FLAIR hyperintensity in left thalamus. a. FLAIR, b. T2, c. DWI, d. ADC.. FLAIR = fluid-attenuated inversion recovery; T2 = T2 weighted image MRI; DWI = diffusion-weighted imaging; ADC = apparent diffusion coefficient.
case_images: cureus-0017-00000077592-i02.jpg
case_images: PMC11830410_02_cureus-0017-00000077592-i02.jpg
case_images: FIG2
case_images: A subsequent brain MRI showed remarkable hyperintensity in the left thalamus on T2-weighted-fluid-attenuated inversion recovery (T2/FLAIR) sequences, along with diffusion restriction (DWI), but without any changes in apparent diffusion coefficient (ADC) or abnormal enhancement (Figure 2). 
case_images: MRI brain (left occipital gray matter and left precentral gyrus). MRI brain showed multiple T2/FLAIR hyperintensities in the left occipital gray matter (a. FLAIR, b. DWI) and in the left precentral gyrus (c. FLAIR, d. DWI) that are typical for AHS.. FLAIR = fluid-attenuated inversion recovery; T2 = T2 weighted image MRI; DWI = diffusion-weighted imaging; AHS = Alpers-Huttenlocher syndrome.
case_images: cureus-0017-00000077592-i03.jpg
case_images: PMC11830410_02_cureus-0017-00000077592-i03.jpg
case_images: FIG3
case_images: MRI revealed new multiple T2/FLAIR hyperintensities in the left occipital gray matter, bilateral basal ganglia, left precentral gyrus, and a stationary lesion in the left thalamus, along with an increase in the subarachnoidal spaces of the bilateral hemispheres (Figure 3).
case_images: Section of scalp EEG with typical RHADS pattern in right hemisphere. . EEG = electroencephalogram; RHADS = rhythmic high-amplitude delta activity with superimposed spikes.
case_images: cureus-0017-00000077592-i04.jpg
case_images: PMC11830410_02_cureus-0017-00000077592-i04.jpg
case_images: FIG4
case_images: The EEG displayed continuous right-sided rhythmic delta activity with superimposed fast and sharp components (Figure 4).