Repetitive Attacks Research Articles

Multiplex attacks in sigmoid volvulus.

Sigmoid volvulus (SV) recurs in about one quarter of the patients, whereas multiplex (≥3) attacks are quite rare and attacks with five or more times are extremely rare. The aim of this study was to evaluate multiplex SV attacks in our series and worldwide data. In Ataturk University Faculty of Medicine Department of General Surgery, among 1,071-case SV series, data were evaluated retrospectively in 612 patients, while prospectively in 459 with respect to age, gender, previous volvulus attacks, and prognosis. Worldwide data were obtained from Web of Science database and they were compared with our results. Mean SV attack count, multiple- (≥2) and multiplex- (≥3) attack rates were 1.4, 26.1%, and 4.2%, respectively, in our series, while they were 1.7, 26.7%, and 3.2%, respectively, in worldwide data (p>0.05, in all). In our series, recurrence rates were 26.1%, 19.3%, and 51.2%, respectively, (p<0.001, in all), while mortality rates were 7.3%, 13.7%, and 19.5%, respectively, (p<0.001, in all) in single-, double-, and multiplex- (≥3) attack patients. Although multiplex (≥3) attacks are uncommon in SV, when it goes up, elective surgery must be considered in selected cases to avoid repetitive attacks and related high mortality.

Stress and Heart in Remodeling Process: Multiple Stressors at the Same Time Kill.

Myocardial remodeling is developed by increased stress in acute or chronic pathophysiologies. Stressed heart morphology (SHM) is a new description representing basal septal hypertrophy (BSH) caused by emotional stress and chronic stress due to increased afterload in hypertension. Acute stress cardiomyopathy (ASC) and hypertension could be together in clinical practice. Therefore, there are some geometric and functional aspects regarding this specific location, septal base under acute and chronic stress stimuli. The findings by our and the other research groups support that hypertension-mediated myocardial involvement could be pre-existed in ASC cases. Beyond a frequently seen predominant base, hyperkinetic tissue response is detected in both hypertension and ASC. Furthermore, hypertension is the responsible factor in recurrent ASC. The most supportive prospective finding is BSH in which a hypercontractile base takes a longer time to exist morphologically than an acutely developed syndrome under both physiologic exercise and pressure overload by transaortic binding in small animals using microimaging. However, cardiac decompensation with apical ballooning could mask the possible underlying hypertensive disease. In fact, enough time for the assessment of previous hypertension history or segmental analysis could not be provided in an emergency unit, since ASC is accepted as an acute coronary syndrome during an acute episode. Additional supportive findings for SHM are increased stress scores in hypertensive BSH and the existence of similar tissue aspects in excessive sympathetic overdrive like pheochromocytoma which could result in both hypertensive disease and ASC. Exercise hypertension as the typical form of blood pressure variability is the sum of physiologic exercise and pathologic increased blood pressure and results in increased mortality. Hypertension is not rare in patients with a high stress score and leads to repetitive attacks in ASC supporting the important role of an emotional component as well as the potential danger due to multiple stressors at the same time. In the current review, the impact of multiple stressors on segmental or global myocardial remodeling and the hazardous potential of multiple stressors at the same time are discussed. As a result, incidentally determined segmental remodeling could be recalled in patients with multiple stressors and contribute to the early and combined management of both hypertension and chronic stress in the prevention of global remodeling and heart failure.

Laparoscopic sigmoid colectomy for diverticulitis – stricture: A case report with review of literature

Diverticulosis is a common condition in the western world. It is often asymptomatic. However, its inflammation and the occurrence of its complications precipitate symptoms. Uncomplicated diverticulitis can be managed conservatively, most of the times. Complicated diverticulitis may need an endoscopic, interventional radiological, or surgical intervention. Herein, we report the case of a 53-year-old patient with complicated sigmoid diverticulitis, i.e., stricture caused by repetitive attacks of acute diverticulitis, who underwent a laparoscopic sigmoid colectomy followed by primary anastomosis.

Acute intermittent porphyria and spinal muscular atrophy: two rare diseases seen in one patient

Porphyrias are a cluster of inherited metabolic diseases. Acute intermittent porphyria (AIP) is inherited autosomal dominantly that presents with multi-systemic symptoms and acute repetitive attacks in any age of lifespan. Spinal muscular atrophy (SMA) is a motor neuron disease that is autosomal recessively inherited and seen with a relatively higher incidence in Turkey. In this case report, we discuss a 27-year-old male with gait problems and fatigue. Here, we report a familial heterozygous mutation in hydroxymethylbilane synthase (HMBS) gene together with homozygous deletion in the survival motor neuron 1 (SMN1) gene in a Turkish patient.

Scn1a gene reactivation after symptom onset rescues pathological phenotypes in a mouse model of Dravet syndrome

Dravet syndrome is a severe epileptic encephalopathy caused primarily by haploinsufficiency of the SCN1A gene. Repetitive seizures can lead to endurable and untreatable neurological deficits. Whether this severe pathology is reversible after symptom onset remains unknown. To address this question, we generated a Scn1a conditional knock-in mouse model (Scn1a Stop/+) in which Scn1a expression can be re-activated on-demand during the mouse lifetime. Scn1a gene disruption leads to the development of seizures, often associated with sudden unexpected death in epilepsy (SUDEP) and behavioral alterations including hyperactivity, social interaction deficits and cognitive impairment starting from the second/third week of age. However, we showed that Scn1a gene re-activation when symptoms were already manifested (P30) led to a complete rescue of both spontaneous and thermic inducible seizures, marked amelioration of behavioral abnormalities and normalization of hippocampal fast-spiking interneuron firing. We also identified dramatic gene expression alterations, including those associated with astrogliosis in Dravet syndrome mice, that, accordingly, were rescued by Scn1a gene expression normalization at P30. Interestingly, regaining of Nav1.1 physiological level rescued seizures also in adult Dravet syndrome mice (P90) after months of repetitive attacks. Overall, these findings represent a solid proof-of-concept highlighting that disease phenotype reversibility can be achieved when Scn1a gene activity is efficiently reconstituted in brain cells.

Effect of low dose methotrexate as an add-on therapy in patients with palindromic rheumatism unresponsive to hydroxychloroquine: An observational study.

Palindromic rheumatism (PR) is characterized by repetitive attacks of arthritis and/or periarthritis. There is inadequate data regarding the role of low dose methotrexate in patients with PR. The aim of this study was to determine the efficacy of low dose methotrexate add-on therapy in patients withPR with inadequate response to hydroxychloroquine (HCQ) monotherapy. In this observational study, between August 2016 and July 2019, 15 patients with seropositive PR with inadequate response to HCQ (≥ 2attacks per month even after 6 months of therapy) were included. All patients were treated with oral low dose methotrexate in addition to HCQ. The responses to therapy were monitored 3 and 6 months after adding methotrexate. In our study, of the 15 patients with PR, two-third were female, with a mean age of 45.73±9.18 years. All were seropositive (Rheumatoid factor positive in eight patients; anti-cyclic citrullinated peptide [CCP] positive in 11 patients; both Rheumatoid factor and anti-CCP positive in four patients). The average number of attacks at baseline was 5.6±2.8, and the median duration of attacks was 2 years. All patients had significant response to add-on methotrexate therapy at follow-up after 3 and 6 months; none developed Rheumatoid arthritis (RA) after 2 years of follow-up. Low dose methotrexate is an effective add-on therapy in patients with PR having inadequate response to HCQ.

Critical Role of 3D ultrasound in the diagnosis and management of Robert's uterus: a single-centre case series and a review.

A septate uterus with a non-communicating hemicavity was first described by Robert in 1969/70 as a specific malformation of the uterus. The condition is commonly associated with a blind uterine hemicavity, unilateral haematometra, a contralateral unicornuate uterine cavity and a normal external uterine fundus. The main symptoms are repetitive attacks of pain at four-weekly intervals around menarche, repeated dysmenorrhea, recurrent pregnancy loss and infertility.In this report, we review the disease, its diagnosis and treatment, and describe five cases of Robert's uterus. Three dimensional (3D) ultrasound (US) imaging was performed by the transvaginal route in four cases. In the fifth case of a 13-year-old girl, we avoided the vaginal route and magnetic resonance imaging (MRI) and 3D transrectal US yielded the correct diagnosis.The following treatment procedures were undertaken: laparoscopic endometrectomy, hysteroscopic septum resection, laparoscopic uterine hemicavity resection and total laparoscopic hysterectomy (TLH). The diagnosis and optimum treatment of Robert's uterus remains difficult for clinicians because of its rarity. A detailed and careful assessment by 3D US should be performed, followed by hysteroscopy in combination with laparoscopy, to confirm the diagnosis.

AB1040 COEXISTENCE OF DEMYELINATION DISEASE AND FAMILIAL MEDITERRANEAN FEVER

Background:In the course of familial Mediterranean fever (FMF), the frequency of other inflammatory diseases increases compared to the general population. Multiple sclerosis (MS) or demyelinating diseases (DD) of central nervous system (CNS) are also more common in FMF patients than in the general population.Objectives:In this study, we would like to report 5 cases with MS/DD accompanied by FMF or MEFV mutations in two families.Methods:4 patients with FMF and 1 patient with MEFV mutation were included in this study. The patients with FMF were diagnosed according to Tell-Hashomer clinical criteria for FMF. The diagnosis of MS was made according to McDonald criteria.Results:The clinical features of the patients were shown in Table 1.Conclusion:FMF and MS/DD are characterized by repetitive attacks. Familial association can be seen in 12% of patients with MS (1). This is related to both HLA and non-HLA-related genetic tendency. The probability of developing MS increased 4 times in FMF patients (2). This seems to be related to the presence of MEFV gene creating a pro-inflammatory background. In such family samples, combining HLA and non-HLA gene related studies with MEFV gene analysis will be useful in common genetic factors investigation.

A Typical Presentation of Trigeminal Neuralgia Induced by Intracranial Hypertension Mimicking Sinusitis

Trigeminal neuralgia is a chronic pain syndrome that affects the trigeminal nerve. Trigeminal neuralgia is broadly classified into two major subtypes as typical and atypical trigeminal neuralgia. The former is described as repetitive attacks of sharp, severe, excruciating pain with pain-free intervals while the latter is characterized by dull burning facial pain. Facial pain is the main feature of the trigeminal neuralgia but it could be the symptoms of multiple sinogenic and non-sinogenic disorders, it is difficult to distinguish sinogenic pain caused due to sinusitis from non-sinogenic facial pain caused by other etiologies such as trigeminal neuralgia, migraine and idiopathic intracranial hypertension to avoid imprecise treatment at early stages and for a better prognosis. Here, we present the case of a 56-years-old woman, who presented with trigeminal neuralgia mimicking chronic sinusitis. Delayed diagnosis can result in a poor quality of life, unnecessary intervention, and financial burden.

Scale Inside-Out: Rapid Mitigation of Cloud DDoS Attacks

The distributed denial of service (DDoS) attacks in cloud computing requires quick absorption of attack data. DDoS attack mitigation is usually achieved by dynamically scaling the cloud resources so as to quickly identify the onslaught features to combat the attack. The resource scaling comes with an additional cost which may prove to be a huge disruptive cost in the cases of longer, sophisticated, and repetitive attacks. In this work, we address an important problem, whether the resource scaling during attack, always result in rapid DDoS mitigation? For this purpose, we conduct real-time DDoS attack experiments to study the attack absorption and attack mitigation for various target services in the presence of dynamic cloud resource scaling. We found that the activities such as attack absorption which provide timely attack data input to attack analytics, are adversely compromised by the heavy resource usage generated by the attack. We show that the operating system level local resource contention, if reduced during attacks, can expedite the overall attack mitigation. The attack mitigation would otherwise not be completed by the dynamic scaling of resources alone. We conceived a novel relation which terms “Resource Utilization Factor” for each incoming request as the major component in forming the resource contention. To overcome these issues, we propose a new “Scale Inside-out” approach which during attacks, reduces the “Resource Utilization Factor” to a minimal value for quick absorption of the attack. The proposed approach sacrifices victim service resources and provides those resources to mitigation service in addition to other co-located services to ensure resource availability during the attack. Experimental evaluation shows up to 95 percent reduction in total attack downtime of the victim service in addition to considerable improvement in attack detection time, service reporting time, and downtime of co-located services.

Neuro-otology: at the borders of ear and brain

Vertigo and dizziness are frequent chief complaints in clinical practice. Symptoms may originate from otological, neurological, medical and psychiatric etiologies, which poses an interdisciplinary challenge. Systematic analysis of case history and clinical examination generally allow classification into peripheral-, central- or non-vestibular disorders. The most important criteria for differentiation are the timeline, quality of symptoms, modulating factors and accompanying symptoms. As concerns the clinical examination, the following tests are relevant: head impulse test, test for spontaneous nystagmus, positional nystagmus, central ocular motor signs and the Romberg test. However, neuro-otological disorders with combined peripheral and central vestibular pathology do exist. Occlusion of the anterior inferior cerebellar artery results in ischemia of the labyrinth and cerebellum and therefore causes acute vestibular syndrome and unilateral hearing loss. Repetitive attacks of vertigo or dizziness which are accompanied by ear symptoms and headaches may be due to an overlap syndrome of Menière's disease and vestibular migraine. In this case patients often have to be treated with adual prophylactic medication to control symptoms. In case of chronic dizziness and instability of gait asubsample of patients may suffer from CANVAS, which is acombination of bilateral vestibulopathy, acerebellar syndrome and polyneuropathy. Chronic dizziness with signs of peripheral and central vestibular dysfunction can also originate from tumors of the cerebellopontine angle with compression of central structures. In conclusion, the diagnostic algorithm in the workup of patients with vertigo and dizziness should always include tests for peripheral and central vestibular and ocular motor function.

How to Deter North Korea's Military Provocations

This study identifies reasons why North Korea initiates conflicts against South Korea and its allies, and also provides suggestions to deter North Korea’s future provocations. Logistic models with robust standard errors indicate North Korea is likely to adopt hostile foreign policies when it is prior to and following leadership succession and when the United States is involved in a war. Moreover, while the effects of economic factors on North Korea’s or North Korean conflict behavior vary, they become more significant when interacting with both North Korea’s leadership succession and US preoccupation with other world affairs. The findings suggest the following: First, that South Korea should pay extra attention to North Korea when it pursues leadership succession. Second, in addition to solidifying the existing Korea-US military alliance, South Korea should build self-sufficient defense forces for a scenario in which the United States would be unable to provide a security umbrella. To deter North Korea’s repetitive attacks in this context, South Korea primarily needs to change its military doctrine from the ‘deterrence by denial’ to a ‘proactive deterrence strategy.’ Moreover, stealth and C4ISRPGM capabilities are necessary to execute this strategy. Third, South Korea and international societies should help North Korea change its economic infrastructure instead of providing direct humanitarian aid.

Intelligent network security assessment with modeling and analysis of attack patterns

ABSTRACTThis paper presents a new concept for information security assessments while promoting several areas of its application. Threat generation, attack pattern analysis, quantitative risk computation, and network security monitoring locally or remotely are the major application areas of this concept. Instead of testing assets one by one, by applying separate repetitive attacks and assessments, the presented system generates and executes attacks once on a sample group, composes assessment data, and uses the data for the assessment of an entire network. This unique approach can be used as a model to guide the development of tool‐based assessment systems, intelligent network security analysis, monitoring systems, and also as a complementary function in information security test and evaluation laboratories. Copyright © 2012 John Wiley &amp; Sons, Ltd.

The first report of self-directed aggression in a stray dog in Turkey

We present the first report of a stray dog that recovered from canine compulsive disorder (CD)/obsessive compulsive disorder (OCD) leading to self-mutilation in Turkey. The dog was brought to a private veterinary clinic in Ankara with severe injuries on his rear paws and tail. During the routine clinical examination, it was noticed that he was displaying repetitive attacks to his hind end. A presumptive diagnosis of CD/OCD was made on the basis of the clinical examination and outdoor observation. After 6 months of treatment involving behavioral modification and medication, a large decrease in intensity and frequency of the CD was observed.

A Case of Concealed WPW Syndrome, Accompanied with Coronary Sinus Orifice Atresia and Persistent Left Superior Vena Cava

A 58-year old man was transferred because of repetitive attacks of tachyarrhythmia and crescendo angina pectoris. Electrocardiogram during attack showed paroxysmal supraventricular tachycardia with down slope ST depression. After emergent PCI, catheter ablation was performed. We could not insert the electrode catheter to coronary sinus, and delayed phase of CAG showed sinus orifice atresia and coronary venous flow to innominate vein via left superior vena cava. We successfully blocked left-sided concealed accessory pathway with trans-septal approach. Asynptomatic venous anomaly sometimes results in complication of cardiac surgery, device implantation and catheter ablation. The hemodynamic circuits should be precisely recognized before and during these procedures.

An autopsy case presenting repetitive hypoglycemia and unique cortical dysplasia

In epileptic patients, focal cortical dysplasia (FCD) is pathologically characterized by irregular cortical lamination, blurring of the grey and white matter border and the occurrence of dysplastic cells in the cerebral cortex. Here, we report the case of a 42-year-old male showing developmental delay, transient repetition of hypoglycemic attack and cortical dysplasia, partly mimicking FCD. He had no family history of neurological disorders. He had never been able to stand independently and had always been unable to speak. He developed generalized convulsion in infancy, and then, in the absence of predisposing factors, suffered from repetitive hypoglycemic attacks between the ages of 27 and 38. Various endocrine tests, abdominal CT and brain MRI failed to demonstrate abnormalities. He died of peritonitis. At autopsy, no changes were observed in the pancreas, liver, kidneys, endocrine organs or hypothalamus. In the insular and frontal cortices, many large bizarre cells in the deep layer were observed and perivascular oligodendrocyte satellitosis was present in the adjacent white matter. Unlike FCD, the cortical lamination and the grey-white matter interface were preserved. A well-demarcated pilocytic astrocytoma was present in the brainstem. The cortical dysplasia, consisting of the diffuse occurrence of bizarre cells and the preservation of cortical lamination, is unique and has not been previously reported. Repetition of hypoglycemic attacks within a certain period is also noteworthy, although the relationship of this with the cortical dysplasia is unknown.

Cerebral ischemia due to compression of the brain by ossified and hypertrophied muscle used for encephalomyosynangiosis in childhood moyamoya disease

Background Encephalomyosynangiosis is one of the indirect method in which ischemic brain surface is covered by temporal muscle for the treatment of moyamoya disease. Case Descriptions A 14-year-old girl who had been treated with bilateral STA-MCA anastomosis and EMS in 1999 was admitted on January 5, 2005. She showed transient incomplete palsy on the left side of the face and the ipsilateral upper extremity. On the day of admission, MRIs/MRA and 3-dimensional regional CBF measurement using stable xenon and CT scanning were conducted after performance of plain CT scanning. The MRI and CT studies showed that ossified and hypertrophied temporal muscle used for EMS to the right MCA territory compressed the brain just under the muscle. MRA demonstrated well-developed collaterals to the territories of the bilateral MCAs via the previously performed anastomosis. The CBF studies disclosed a low CBF value just under ossified and hypertrophied muscle used for EMS on the right side. She showed same transient ischemic attacks repetitively after January 5, 2005. Conclusions The repetitive attacks with the transient motor palsy on her left side was thought to be caused by direct compression of the brain by the ossified and hypertrophied muscle used for EMS and decrease in CBF just under it, and its removal was thought to be the treatment of choices. However, the patient and her parents refused the surgical procedure, and she is treated conservatively at present.

Characterization of offensive responses during the maturation of play‐fighting into aggression in male golden hamsters

In hamsters, the maturation of aggression during puberty is associated with a gradual reduction of offensive responses. The purpose of this study was to analyze the changes during this decrease to provide an enhanced description of the behavior. During early puberty, play-fighting is characterized by long and continuous contact duration throughout the encounter and repetitive attacks within bouts of agonistic interaction. By mid-puberty, adult patterns of offensive behavior emerge. Contact time becomes shorter in duration and shifts to the beginning of the test, while attacks become less repetitive per bout. In late puberty, animals show an enhanced efficiency of behavior, as indicated by an increased percentage of attacks followed by bites. This study provides a better understanding of the development of aggression by characterizing the differences between juvenile play-fighting and adult aggression and the process of the maturation of aggression.

Racial Politics in An Era of Transnational Citizenship: The 1996 "Asian Donorgate" Controversy in Perspective (review)

Reviewed by: Racial Politics in An Era of Transnational Citizenship: The 1996 “Asian Donorgate” Controversy in Perspective Pei-te Lien Racial Politics in An Era of Transnational Citizenship: The 1996 “Asian Donorgate” Controversy in Perspective. Michael Chang . ( Lanham, MD: Lexington Books, 2004.) Aptly titled, this book has a singular purpose to help readers understand the conditions, facts, and meanings surrounding the 1996 campaign finance scandal to Asian (and other) Americans. Through a critical reading of the various discourses and the associated political practices related to the "Asian Donorgate," Chang produces a solid and inspiring contribution to the growing literature on the contemporary political experiences of Asian Americans. The book offers not only a rare treat to the politically concerned about the paradoxical and situational racial status of Asians in American politics, but a candid discussion of the dilemmas for community political organizing and empowerment given the opportunities and pitfalls that arise from globalization and the availability of transnational capital. Specifically, the author deconstructs events and discourses in the four-year period that begins with allegations of illegal campaign money raised by John Huang and several other naturalized Chinese Americans for the Democratic National Committee (DNC) during President Clinton's reelection campaign in 1996. His research ends with the release of Dr. Wen Ho Lee, a naturalized Taiwan-born nuclear scientist who was laid off and jailed for 9 months because of unfounded espionage charges. The choice of the two time-points was to reveal the pattern of shifting discourses and the consequences the former had on the development of the latter. By analyzing the ways that Asian American citizens were racialized as perpetual foreigners during this time period, the author shows "how citizenship and race in globalization play a critical role in locating Asian Americans as simultaneously marginal and central to mainstream American ideologies of nationhood" (3). The discreetness of the author in his approach to the sensitive subject matter is evinced by the opening pages, when he scrupulously defines the increasingly popular but much abused and often misunderstood terms of globalization, flexibility, transnationalism, flexible citizenship, diaspora, and hybridity. The same kind of prudence is seen in the organization of the book, which has a section on [End Page 111] research design and another on conceptual framework, and a "map" within subsequent chapters to prevent readers from getting lost in the jungle of complex ideas. Built upon themes of "shifting discourses," "neo-orientalism," "transnational citizenship," and "political agency and the public sphere," the book clearly articulates the flexible meanings of citizenship and challenges to community incorporation and empowerment regarding a highly transnationally-affiliated population. Besides the main methodology of discursive analysis, the author adopts sociological and anthropological approaches to data collection which involve elite interviews and archival research of governmental reports and news media coverage. The book's primary theoretical framework is critical transnationalism, which specifically opposes celebratory discourses of transnationalism that wishfully foresee the end of world divisions and inequality in the era of globalization. Rather, as informed by prior conceptions of transnational citizenship, racial formation, and dual-domination and extraterritoriality, the author views as inevitable the emergence of new forms of power hierarchies that may transcend national borders but still maintain the structures of inequalities within each nation-state and other social and political boundaries. In addition to critiquing the traditional Eurocentric "foreignizing" discourses adopted by mainstream American media and politicians in the "Asian Donorgate" events that deny the possibility of dual citizenship and loyalties to the majority-immigrant community, the book expresses serious concern about the deepening class and political divisions as a result of unequal access to transnational capital and transborder mobility in the post-1965 Asian American community and the challenges that this reality imposes on community-organizing and strategies for sovereignty and empowerment. Herein lies the value of the theory of a progressive sense of citizenship, which exposes the problems of distinguishing "aliens" from "citizens" in the assimilationist notion of normative citizenship in the age of globalization and proposes an alternative model of citizenship that appreciates the multicultural diversity brought in by individuals who maintain transnational affiliations. Whereas the author delivers powerful and repetitive attacks against the utility of the assimilation paradigm and the...

Pontine activation during focal status epilepticus secondary to hamartoma of the floor of the fourth ventricle

Epileptic seizures associated with hamartoma of the floor of the fourth ventricle (HFFV) are generally resistant to antiepileptic medication, may evolve into status epilepticus, and can respond favorably to surgical therapy. HFFV are rare, and during the neonatal or infantile period may be associated with repetitive and stereotyped attacks of hemifacial spasm, eye blinking, facial movements, head deviation and dysautonomic manifestations. Similarly, to gelastic seizures provoked by hypothalamic hamartomas, it has been suggested that these spells arise from within the HFFV, thus constituting a type of non-cortical seizure. We report an infant female patient that developed continuous left hemifacial attacks since she was 2-month-old, and that underwent presurgical investigation when she was 18-month-old. MRI disclosed a left sided HFFV, Video-EEG showed non-localizing and non-lateralizing findings, and SPECT aligned with MRI showed marked hyperperfusion within the hamartoma, spreading to ipsilateral cerebellar parenchyma and brainstem nuclei. Patient underwent lesionectomy and became seizure-free. We found two evidences on literature supporting the hypothesis of non-cortical seizures related to HFFV. The first, intra-cerebellar recordings surrounding hamartoma showed electrical activity related to seizures. The second, subtracted SPECT co-registered MRI showed hyperemia within hamartoma. The present report provides the third additional evidence. We found the involvement not only of the hamartoma, and pars of cerebellar hemisphere, but also an intense hyperemia involving brainstem nuclei during seizures. We believe that all these findings suggest a short subcortical network responsible for generating seizures in HFFV patients.