JLE

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Subtotal hemispherotomy for late-onset spasms after anti-myelin oligodendrocyte glycoprotein antibody-positive acute haemorrhagic leukoencephalitis Volume 23, numéro 6, December 2021

Figure 1

FLAIR images at the onset of AHLE (A), after left subtotal hemispherotomy (B). At the onset of AHLE, extensive high-signal intensity regions can be observed in the left basal ganglia, and frontal and temporal lobes. A similar hyperintense region can also found in the white matter of the right frontal lobe. (C, D) Scalp EEG performed 14 months after the onset of AHLE using the international 10–20 electrode system and reformatted to the longitudinal bipolar montage. The electromyography electrodes were attached to the deltoid muscles bilaterally. Interictal EEG (C) showing diffuse, left-hemisphere dominant, high-amplitude spike-and-wave complexes. Ictal EEG (D) recorded during an epileptic spasm revealed that general attenuation or spikes preceded the left temporal lesion, and diffuse slow waves periodically appeared predominantly in the left hemisphere on video-EEG. Electromyography (EMG) revealed a crescendo-decrescendo sequence with a diamond-shaped configuration associated with diffuse triphasic slow waves. (E) Intraoperative electrocorticography (ECoG); performed with a bandpass filter of 0.016–300 Hz and a sampling rate of 2000 Hz, before (left) and after subtotal hemispherotomy (right). Intraoperative electrocorticography (ECoG) revealed repetitive spikes mainly over the frontal and parietal lobes before subtotal hemispherotomy. Although the spikes over the frontal lobe disappeared after subtotal hemispherotomy, those over the parietal lobe remained.

AHLE: acute haemorrhagic leukoencephalitis; FLAIR: fluid-attenuated inversion recovery: R: right; L: left; LOS: late-onset spasms; LDEL: left deltoid muscle; RDEL: right deltoid muscle.