Culpable brain lesion causing complex partial status in Wilson’s disease: Deduction by arterial spin labeled perfusion MRI

A 16-year-old girl presented with a history of new onset seizures. Her semiology favored complex partial seizures of right frontal origin characterized by facial deviation and head aversion to the left followed by tonic posturing of the left upper limb. Seizure duration was approximately one minute with no post ictal confusion and recurred every ten minutes throughout the night. She presented to us 12 hours after her first seizure. Her clinical history was positive for Wilson’s disease diagnosed five years ago when she had presented with dystonia and tremors of her right hand, followed by dystonia of the trunk and left upper limb. She had low serum Ceruloplasmin levels and a positive KayserFleischer (KF) ring at that time and had been on d-Pencillamine treatment for the past five years. On current admission she was on d-Pencillamine 500 mg/day, trihexyphenydyl and pyridoxine and