Fig. 4

a–e A 22-year-old male patient with non-lesional right temporal lobe FIAE. The visual-based analysis of the axial PASL-MRI colour-coded cerebral perfusion map (a) highlights the hypoperfusion of the epileptogenic right temporal lobe (white arrows) associated with focal hypoperfusion of the ipsilateral right frontal lobe, which represented the cerebral area of seizure spread (red arrows). The estimated rCBF for the right and left temporal lobes was 52.34 and 70.98 ml/100 g/min, respectively, with ASLAI% of 30.23%. Additionally, the estimated rCBF of the right and left frontal lobes was 68.92 and 75.88 ml/100 g/min, respectively, with ASLAI% of 9.61%. The MV 1H-MRS spectra of the right and left temporal lobes (b and c, respectively), demonstrated increased MI/NAA, Glx/NAA and Glx/Cr, as well as decreased NAA/(Cho + Cr) ratios in the zone of epileptogenic activity in the right temporal lobe (b) in comparison to the contra-lateral non-epileptogenic left temporal lobe (c). For the right and left temporal lobes (b and c, respectively), these ratios were [NAA/(Cho + Cr) = 0.54 and 0.74 with %AF of 31.25%, MI/NAA = 0.74 and 0.52 with %AF of 34.92%, Glx/NAA = 1.60 and1.45 with %AF of 9.84% and Glx/Cr = 1.53 and 1.40 with %AF of 8.87%]. On the other hand, the ipsilateral right frontal lobe (d), which represented the cerebral area of seizure spread, showed decreased MI/NAA and NAA/(Cho + Cr), as well as increased Glx/NAA and Glx/Cr ratios, when compared to the contra-lateral left frontal lobe (e), where these ratios, for right and left frontal lobes, respectively, were [NAA/(Cho + Cr) = 0.67and 0.88 with %AF of 27.09%, MI/NAA = 0.57 and 0.64 with %AF of 11.57%, Glx/NAA = 1.39 and 1.30 with %AF of 6.69% and Glx/Cr = 1.34 and 1.25, with %AF of 6.95%]