LAUSR

Dear Editor, New onset refractory status epilepticus (NORSE) is a clinical presentation in a patient without active epilepsy or other pre-existing relevant neurological disorders, with new onset of refractory status epilepticus without a clear acute or active structural, toxic or metabolic cause [1]. Febrile infection-related epilepsy syndrome (FIRES) is a subcategory of NORSE, applicable to all ages, that requires a febrile infection starting between 2 weeks and 24 h prior to the onset of refractory status epilepticus [1]. Regarding the etiology, a viral infection has been hypothesized due to the evidence of lymphocytic pleocytosis in the cerebrospinal fluid (CSF). Another possible hypothesis is an autoimmune etiology supported by the good response to immunomodulatory therapies (steroids, immunoglobulins, plasma exchange). Brain MRI is usually unrevealing or it can show nonspecific alterations related to the continuous epileptic activity. Here, we report a peculiar neuroradiological picture associated with FIRES in an adult patient.