Non-paraneoplastic limbic encephalitis characterized by mesio-temporal seizures and extratemporal lesions: A case report

EEG at admission to neurology department; (a) interictal EEG. Note spike-waves over the right temporal lobe; (b)–(d) ictal EEG. Note disappearance of the alpha activity and presence of rhythmic theta waves on leads P4, T4 and T6. Epigastric aura occurred six sec after onset (b). Spikes and spiking activity on leads T6, P4, F8 and T4 and diffuse fast (13–16Hz) rhythms were associated with fear, flushing, diaphoresis and déjà-vu (c) and (d); (e) end of the seizure (40s after (d)). There was no loss of consciousness during the seizure.

MRI (FLAIR-sequences). At entry (a)–(c): note two small intracortical lesions localized in the parietal cortex of the right hemisphere (10mm: (a) and (b)) and in the fronto-basal cortex of the left hemisphere (6mm: (c)). No abnormalities were observed in the temporal lobes. Twenty days after admission (d)–(f): persistence of the extratemporal cortical lesions (d) and (e) with bilateral hyperintensity and swelling of the mesial temporal lobes (more evident on the right side: (e) and (f). Seven days after immunotherapy (g)–(i) persistence of hyperintensity of the mesial temporal lobe on the right side and disappearance of the other lesions.