A 16-year-old boy with intractable epilepsy

Slides:

Advertisements

Similar presentations

63 year-old woman with subacute parkinsonism Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Advertisements

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Neonatal Parechovirus Encephalitis: Typical MRI findings.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 68 year old woman with transient ptosis on awakening.

A 52-year old man with recently diagnosed HIV infection with irregular shaking of his hand Teaching NeuroImages Neurology Resident and Fellow Section ©

A 62-year-old man presented with mild left hemiparesis, headache and blurred vision of his right eye Teaching NeuroImages Neurology Resident and Fellow.

Neurological Disorders Lesson 4.6 What causes epilepsy?

84 year old woman with spells of right upper limb weakness and numbness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy.

A patient with red dot on the forehead A 32-year old woman presented with red dot on her forehead and eyelid ecchymosis Teaching NeuroImages Neurology.

Teaching NeuroImages An 83-year-old woman with phonatory breaks and left hand rest tremor Neurology Resident and Fellow Section © 2013 American Academy.

Neurology Resident and Fellow Section 40 year old woman with left arm pain, numbness, and weakness Teaching NeuroImages © 2013 American Academy of Neurology.

A 43-year-old man with decreased consciousness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 38-year-old patient with partial seizures Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology A 14-year-old boy with lip twitching.

47-year-old with progressive upper limb weakness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

The Nervous System Somatic Nervous System- The division of the peripheral nervous system that connects the central nervous system with sensory receptors,

A 30-year male with cognitive decline and unsteady gait Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology A 23 month old full term male with seizures.

68 year old man with aphasia and facial droop © 2014 American Academy of Neurology Teaching NeuroImages Neurology Resident and Fellow Section.

A 4 Year Old Boy With Proptosis of Left Eye Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology.

A 71 year old man with rapid onset of anterograde amnesia Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

“Now you see it...” A broadly-distributed ictal rhythm easily missed on bipolar montage. Teaching NeuroImages Neurology Resident and Fellow Section © 2014.

Date of download: 6/23/2016 Copyright © 2016 McGraw-Hill Education. All rights reserved. Supplementary Sensorimotor Area (SSMA) Seizure; Subdural vs Scalp.

57 year-old man with confusion Teaching NeuroImages Neurology Resident and Fellow Section © 2015 American Academy of Neurology.

Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology Two sisters with scapular winging.

Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology 57-year-old man with a painful tumoral mass in the leg.

A 58 year old woman with acute-onset paresthesias

Neurology Resident and Fellow Section

A 71-YEAR-OLD FEMALE WITH MULTIPLE CRANIAL NERVE PALSIES

Hemigeographic tongue following an acute ischemic stroke

Teaching NeuroImages Neurology Resident and Fellow Section

A 22 year old male with acute seizures and hemiparesis

A 55 year-old with lung cancer and leg numbness

A 58-year-old man with cerebellar ataxia

A 57-year-old woman with seizures and coma

A 41-year-old man with progressive quadriparesis

A 9-year old girl with multi-compartmental intracranial hemorrhage

Teaching NeuroImages Neurology Residents and Fellows Section

Figure 1 Initial brain imaging (A–C) patient 1; (D–F) patient 2; (G–I) patient 3; (J–L) patient 4; and (M) patient 2. Initial brain imaging (A–C) patient.

Neurology Resident and Fellow Section

A 10 month old boy with macrocephaly

Acquired hepatocerebral degeneration

Resident and Fellow Section

Rupture and spontaneous resolution of a P1 perforator pseudoaneurysm

Neurology Resident and Fellow Section

Tractography of Cortico-Ponto-Cerebellar Pathways

with headache and seizures

A 6 years old girl with progressive strabismus and vision loss

68-year-old patient with memory impairment

A 7 month old boy with Glutaric Aciduria and flexor spells

Anti-NMDA receptor encephalitis presenting with imaging findings and clinical features mimicking Rasmussen syndrome Hansel Greiner, James L. Leach, Ki-Hyeong.

A 21 year old woman with frequent vomiting

Neurology Resident and Fellow Section

A 56 YEAR OLD MAN WITH TRANSIENT VISUAL LOSS

39 years-old man with abnormal body movements during sleep

Infant with absence seizure- like episodes

Case 19: 14-month-old boy with bilateral frontal and sylvian polymicrogyria. Case 19: 14-month-old boy with bilateral frontal and sylvian polymicrogyria.

Figure 3 EEG demonstrating ictal seizure discharges in a patient with faciobrachial dystonic seizures The EEG of a 56-year-old woman with faciobrachial.

A–C, Surgical planning, case 9 (Table 1): 18-year-old boy with life-long medically intractable seizure disorder due to a perinatal hemorrhage (A). A–C,

Figure MRI brain 6 weeks post admission (A–C) Symmetrical high signal changes on fluid-attenuated inversion recovery sequences predominantly affecting.

Neurology Resident and Fellow Section

Figure 2 Brain MRI at 1 year of age

Figure Neurologic, gastrointestinal, and dermatologic findings

Figure Spinal cord imaging (A, B) Sagittal and axial T2-weighted cervical spine MRI demonstrating hyperintensities in the central gray matter of patient.

A 2 year old girl with progressive neurological deficits

A 3-year-old boy with increased head circumference

A treatable case of subacute encephalopathy

Bilateral opercular polymicrogyria.

Curvilinear reformations show relative position of subdural electrode contacts to a cortical dysplasia located deep in the left frontal lobe. Curvilinear.

Congenital cortical malformation.

Presentation transcript:

A 16-year-old boy with intractable epilepsy Teaching NeuroImages Neurology Resident and Fellow Section © 2016 American Academy of Neurology

Vignette A 16-year-old male with intractable focal epilepsy with preserved awareness and Attention Deficit Hyperactivity Disorder underwent evaluation for epilepsy surgery Epilepsy onset occurred at age 5 years; seizures arise from sleep and are characterized by right arm extension with preserved consciousness. Ictal EEG has no clear localization or lateralization High resolution 3T MRI, fMRI and depth electrodes placement were performed Bartolini L et al. © 2016 American Academy of Neurology

Imaging Bartolini L et al. Figure 1. 3T brain MRI and fMRI of a 16-year-old child with intractable focal epilepsy due to schizencephaly and polymicrogyria Axial T1-weighted (left) and axial and coronal T2-weighted (right) images demonstrate polymicrogyria extending from the cerebral convexity to the ventricular margin. Focal cleft where abnormal gray matter meets the ependymal surface is consistent with closed-lip schizencephaly (A). Activation with repetitive bilateral foot (B), bilateral finger (C) and tongue tapping (D) reveals homotopic distribution of motor cortex with hand deep into the cleft centrally, foot mesially, and mouth laterally at the edge of the area of schizencephaly. The threshold for the study was set at top 5% of voxels. Bartolini L et al. © 2016 American Academy of Neurology

Imaging Bartolini L et al. Figure 2. Skull radiograph from the same patient showing depth electrode placement. Motor mapping is shown as red dots next to the electrodes. Right lateral (RL): stimulation of electrodes 1-2 resulted in motion of the left hand; Right medial (RM): stimulation of 1-2 resulted in left arm and face motion, 3-4 jaw motion, 5-6 left side of mouth motion, 7-8 left knee twitch; Left lateral (LL): stimulation of electrodes 1-2 resulted in right hand then right arm then right leg twitch, 3-4 right leg extension, 5 right foot twitch. Bartolini L et al. © 2016 American Academy of Neurology

Homotopic motor distribution on fMRI in closed-lip schizencephaly MRI brain demonstrates bifrontal closed-lip schizencephaly. Functional MRI (fMRI) shows homotopic distribution of tongue/finger/foot motor function at the edge of and along the depth of the schizencephalic cleft. fMRI is a reliable tool to identify the eloquent cortex in the planning for epilepsy surgery. References: 1. Martinez-Rios C, McAndrews MP, Logan W, Krings T, Lee D, Widjaja E. MRI in the evaluation of localization-related epilepsy. J Magn Reson Imaging. 2016;44(1):12-22. 2. Gaillard WD, Berl MM. Functional magnetic resonance imaging: functional mapping. Handb Clin Neurol. 2012;107:387-98. Bartolini L et al. © 2016 American Academy of Neurology