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We report an 84-year-old female who showed a rare manifestation of epilepsy, ictal paresis, a type of simple partial seizure presenting with focal motor dysfunction. While the patient exhibited severe left hemiplegia which lasted for a week, cranial diffusion-weighted MRI demonstrated slightly high intensity in the right posterior quadrant, and electroencephalography (EEG) showed continuous epileptiform discharges located mainly in the right parieto-occipital area, strongly suggesting that the patient was in an ictal state. 99mTc-hexamethylpropylene amine oxime-single photon emission computed tomography (HMPAO-SPECT) showed markedly high blood perfusion in the right parieto-temporo-occipital areas. Considering the distribution of EEG epileptiform activities and HMPAO-SPECT hyperperfusion, it is most likely that the ictal paresis of our patient was associated with epileptic activities at the sensorimotor area which caused either direct or indirect activation of an inhibitory system. Careful clinical consideration of the possibility of ictal paresis is needed in elderly patients, especially in those with preexisting dementia, because paresis can be as severe as complete flaccid hemiplegia and can last as long as for a week.

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We could cure two cases of arteriovenous fistula (AVF) of the scalp by the pressure cooker technique (PCT). Case Presentations: Case 1 showed scalp AVF with a direct arteriovenous (AV) shunt between the left posterior auricular artery (PAA) and the left superficial temporal vein (STV), which was also fed by a branch of the left occipital artery (OA). Case 2 showed scalp AVF with a direct AV shunt between the left occipital vein (OV) connected to the left STV and the left OA and left PAA as the collateral feeders. The shunts could be completely occluded by forming a plug using coils and lowconcentration n-butyl-2-cyanoacrylat (NBCA) and injecting Onyx with pressure through a non-detachable microcatheter (MC) by the PCT via the left PAA in Case 1 and via the left OA in Case 2. The MC could be removed in both patients. Conclusion: This technique may be useful if it is applied only to the external carotid artery system, in which adhesion of the MC is manageable, and Onyx injection finishes within a several minutes. Keywords▶ scalp arteriovenous fistula, pressure cooker technique Onyx, n-butyl-2-cyanoacrylat