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A patient with medically intractable status epilepticus of temporal lobe origin is presented. A computed tomogram showed a low density area adjacent to the midbrain, possibly related to atrophy of the medial temporal lobe. Cerebral angiography revealed early filling veins and an anterior temporal blush. Magnetic resonance (MR) scanning (T2 weighted images) showed increased signal intensity in the region of the amygdala and anterolateral left temporal lobe. Ictal activity was recorded from scalp electrodes over the left temporal area, and many paroxysms were recorded from cortical surface electrodes. An anterior temporal lobectomy revealed only gliosis. The cerebral blood flow changes accompanying status epilepticus of focal origin are reviewed, and a possible relation of electroencephalographic, angiographic, and MR findings is discussed.

Pediatric neurologists agree that the determination of brain death in children, and especially retarded children, is difficult and that the criteria used in adult brain death may not be sufficient in pediatric cases. An unusual case of sustained electrocerebral silence on electroencephalogram (EEG) in a three-year-old retarded comatosed child with preserved intracerebral perfusion documented by a series of cerebral radionuclide angiograms (CRAG) is presented. The EEG showing electrocerebral silence represents loss of cerebrum (cortex) function (Barlow 1976). This absence of cortical function is demonstrated even though intracranial circulation is shown to be intact. We believe that the correlative studies presented accurately document a discordance between apparent loss of cortical function in a child as indicated by electrocerebral silence in the face of preserved cerebral blood flow. It is suggested that when evaluating brain death in retarded children with known cerebral atrophy, special emphasis should be placed on the CRAG and that the EEG should be read with caution.