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A 19-year-old right-handed man was admitted because of prolonged somnolence after an epileptic seizure. He had no relevant medical or family history and no history of substance abuse. However, his early childhood development had been delayed, with him finding difficulty keeping up with other children during physical activity. On examination, he was sleepy but with no other neurological signs. MR scan of the brain showed multiple bihemispheric cortical FLAIR (fluid-attenuated inversion recovery) hyperintensities that were not confined to one single vascular territory (figure 1A). Electroencephalogram (EEG) showed reduced amplitude of the left occipital waveforms and left temporal slowing. His serum creatine kinase was elevated at 471 U/L (normal <190), and lactate was elevated in both plasma (2.8 mmol/L; normal 0.5–2.2) and cerebrospinal …
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