Fig. 1
a–n A 42-year-old male with right temporal lobe FIAE. The structural MR images, including coronal T2WI (a), axial FLAIR image (b) and axial T2*-GRE image (c), as well as axial DWI and ADC at b value 0 s/mm2 (d and e, respectively), all are unremarkable and negative. The visual-based analysis of the axial cerebral PASL-MRI colour-coded cerebral perfusion maps (f and g) reveals no abnormal perfusion pattern. The MV 1H-MRS picture maps are demonstrated in (h) (I–VI). The MRS spectra of the right (i) and left (j) temporal lobes reflect the increase in MI/NAA, Glx/NAA and Glx/Cr, as well as the decrease in NAA/(Cho + Cr) ratios in the zone of epileptogenic activity in the right temporal lobe (i) in comparison to the contra-lateral non-epileptic left temporal lobe (j), where these ratios for right and left temporal lobes, respectively, are [NAA/(Cho + Cr) = 0.44 and 0.81 with %AF = 29.6%, MI/NAA = 0.50 and 0.38 with %AF = 27.27%, Glx/NAA = 1.61 and 1.35 with %AF = 16.95%, as well as Glx/Cr = 1.59 and 1.33 with %AF = 17.81%], while the MRS spectra of the right (k) and left (l) thalami demonstrate a decrease in MI/NAA and NAA/(Cho + Cr), as well as increase in Glx/NAA and Glx/Cr peak concentration ratios in the ipsilateral right thalamus (k) compared to the contra-lateral left thalamus (l) with these ratios for right and left thalami, respectively, were [NAA/(Cho + Cr) = 0.45 and 0.56 with %AF = 21.78%, MI/NAA = 0.20 and 0.25 with %AF = 20%, Glx/NAA = 1.35 and 1.27 with %AF = 6.11% and Glx/Cr = 1.30 and 1.25, with %AF = 3.92%]. On the other hand, the MRS spectra of the right (m) and left (n) cerebellum, reveal trivial %AF in all concentration ratios [NAA/(Cho + Cr) = 0.76 and 0.74 with %AF = 2.66%, MI/NAA = 0.47 and 0.45 with %AF = 1.36%, Glx/NAA = 1.29 and 1.28 with %AF = 0.77% and Glx/Cr = 1.25 and 1.24 with %AF = 0.80%]. The clinical examinations and EEG studies confirmed our results