Unique ictal signature: Delta brush as part of an ictal morphology in a patient with hypoglycemic neuronal injury

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Our patient is a 2-year-old male with previously undiagnosed long chain 3-hydroxyacylCoA dehydrogenase deficiency (LCHAD). He presented with neuronal injury secondary to hypoglycemia. Upon arrival to our medical center, he was unresponsive, sedated and intubated. Continuous EEG monitoring was begun to evaluate for presence of seizures and the patient was treated with levetiracetam for seizure prophylaxis and midazolam for sedation. He was not treated with a paralytic agent. Approximately 24 hours following injury, EEG recording showed a subclinical seizure with left occipital delta brush morphology (see Fig.