Current-source Analysis of Interictal Spikes in a Patient With Ictal Crying

Ictal crying has been associated with ictal activities in the medial frontal or medial temporal area of the nondominant hemisphere. We applied current-source analysis to the interictal spikes of a patient with episodes of ictal crying without sad feelings, but fear sensation. The current sources were in the medial frontal area of both cerebral hemispheres, the temporal area and the posterior cingulate gyrus of the right hemisphere.

Current Source Distribution of Periodic Lateralized Epileptiform Discharge: Comparison With Diffusion-Wighted MR Imaging in Viral Encephalitis

BACKGROUND: Periodic lateralized epileptiform discharges (PLEDs) are the main electroencephalograph (EEG) findings that imply the existence of acute or subacute structural lesions. The purpose of this study was to investigate the electrophysiologic characteristics of PLEDs by identifying the relationship between the current-source distribution (CSD) of PLEDs and the high signal intensity of diffusion-weighted magnetic resonance imaging (MRI; HSI-DWI) in viral encephalitis. METHODS: Six patients were enrolled. Twenty typical EEG, 1-s epochs, including the negative peak of the PLEDs, were averaged into an averaged-PLED (a-PLED). The CSD at the negative peak point of the a-PLED was located on the Talairach human brain map in each patient. The CSDs of the patients were compared with the anatomic locations of encephalitic lesions observed on diffusion-weighted MRI. RESULTS: In all patients, the locations with HSI-DWI were observed in the cortical areas. In two out of the six patients the locations of CSD and those of HSI-DWI were matched. In the other patients, they were partly matched. The matched areas were observed in the frontal, temporal, and parietal areas. The additional areas of CSD were in both insular areas, and those of HSI-DWI were in the frontal, temporal, parietal, and occipital areas. CONCLUSIONS: This study showed that the CSDs of PLEDs in viral encephalitis were mostly matched with the HSI-DWI in the cortical area of the frontal, temporal, and parietal areas. The cortical lesion itself in viral encephalitis may be part of the neural generator of PLEDs.

Restricted Spinothalamic Sensory Loss Below Thoracic Dermatomal Level Caused by Pontine Infarction

Cerebral lesions can cause dermatomal sensory deficit. The most commonly reported site is the medulla oblongata due to its well-separated sensory systems. Dermatomal sensory deficit that has developed after pontine infarctions have been reported in several cases, the majority of which involved the medial lemniscus. However, restricted spinothalamic sensory loss has rarely been reported in pontine infarctions. We report herein a patient who presented with dermatomal spinothalamic sensory deficits below the tenth thoracic level after pontine infarction.