Sîrbu Journal of Medical Case Reports 2011, 5:441 http://www.jmedicalcasereports.com/content/5/1/441 (Figure 1, panel A). Cerebral MRI performed four years later confirmed the diagnosis of brain tumor. Over this time, the pattern of the seizures changed, becoming par- tial, complex, sometimes evolving to secondarily gener- alized seizures, with premenstrual flare-ups in intensity and frequency. Surgery or brain biopsy were constantly refused by the patient’s mother. She was treated with carbamazepine, phenytoin, valproic acid and topiramate in diverse doses and combinations without effect on sei- zures, which continued once or several times a day. On admission to our clinic, 13 years after the disease onset, neurological examination revealed no positive findings other than neuropsychological abnormalities. Mnesic activity, general cognitive index (GCI), vocabu- lary and operational effectiveness of thinking had decreased by 35% (mean range) compared to the pre- vious examination at disease onset. Biological tests appeared to be normal. A chest X-ray and cardiology examination were normal. MRI revealed a 32.3 mm (anteroposterior)×43.1 mm (transverse)×28.3 mm (craniocaudal) multicystic cortico-subcortical parie- tal lesion, divided by septations, without edema or mass effect, and no enhancement (Figure 1, panels B, C, D). As our patient refused to have a cerebral biopsy, we decided to perform a complementary imaging explora- tion, which could offer us more details about the tumor. Page 2 of 5 Tomoscintigraphy (single-photon emission CT) with Tc99m MIBI indicated no tumor metabolic activity. Standard electroencephalogram (EEG) showed interictal abnormalities like spikes and polyspikes. One minute of hyperventilation activated a tonic-clonic generalized sei- zure, accompanied by specific EEG recording (Figure 2). The long history together with the clinical and imaging data led us to the diagnosis of DNP. One year later, our patient died during sleep. At that time she was on topir- amate 400 mg/day in two divided doses, without seizure control. Discussion To the best of our knowledge, this is the first reported case with probable sudden death in symptomatic epi- lepsy due to DNT. DNT is a newly-described, patholo- gically benign tumor, arising within the supratentorial cortex. Over 100 cases have been reported in the lit- erature since the first description by Daumas-Duport in 1988 [1]. The majority of cases are found in the temporal lobe where they can coexist with mesial tem- poral sclerosis, followed by the frontal, parietal and rarely the occipital lobe. From the epidemiologic point of view, incidence is between six and 35 years old, with an average of 21.5 years and an equal sex distribution. Figure 1 Imaging results. (A) First CT scan show a left temporoparietal diffuse hypodense area, quite inhomogeneous without mass effect. (B- D) MRI performed 13 years after seizure onset revealed a multicystic cortico-subcortical parietal lesion, without edema, mass effect, and enhancement.