Abstract
A patient was transferred to our hospital after being in a twilight state for 4 months as a result of rapid progression of cognitive disturbance following tonic-clonic status epilepticus. On EEG, various types of epileptic discharge, including frequent paroxysmal activities on P3, O1, T5, PLEDs on the left posterior quadrant and ictal discharges originated from F3, C3 were recorded. During this time, partial seizures occurred repeatedly, and non-convulsive status epilepticus was diagnosed. On MRI, high signal intensity extending over a wide area in the left posterior hemisphere was observed on FLAIR images. On SPECT, hyperperfusion was depicted in the left temporo-parieto-occipital region. The sites of abnormal MRI and SPECT were almost consistent with the site of continuous periodic lateralized epileptiform discharges (PLEDs) on EEG. Adjustment of antiepileptic drugs succeeded to control the non-convulsive status epilepticus. Improvement in EEG, MRI and SPECT findings was also observed. In this case, the reversible high signal intensity observed on MR FLAIR image was probably due to edema of the cortex adjacent to the focus, caused by prolonged epileptic seizures. This case indicates that MR FLAIR sequence and SPECT are useful for the diagnosis and follow-up observation of non-convulsive status epilepticus.
