Case Report Open Access Al-Tewerki et al., J Neurol Disord 2019, 7:3 Volume 7 • Issue 3 • 1000409 J Neurol Disord, an open access journal ISSN: 2329-6895 Journal of Neurological Disorders J o u r n a l o f Ne u r o lo g i c al D is o r d e r s ISSN: 2329-6895 Dysembryoplastic Neuroepithelial Tumor (DNET) in Parietal Lobe: Is It Different? Malak Marzouk Al-Tewerki 1 , Mashael Omar Al-Khateeb 1 *, Reem Saleh Al-Rasheed 2 and Faisal Aboud Al-Otaibi 1 1 Department of Neuroscience, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia 2 Alfaisal University, Riyadh, Saudi Arabia Abstract Dysembryoplastic neuroepithelial tumor (DNET), a benign, mixed neuroglial tumor that most commonly occupies the temporal lobe of the cortex. The spectrum of clinical presentation varies from simple partial seizure to generalized seizure in some cases. This is a case of a 20-year-old man who presented with a drug resistant epilepsy and was found to have a DNET located in the partial lobe. Therefore, based on radiological fnding the diagnosis of DNET was made. Surgical resection of the tumour was done, and the patient recovered uneventfully. The patient was discharged with antiepileptic medications, and showed a complete seizure-free for one year follow up. To the best of our knowledge, this case report brings attention to a rare location of DNET in parietal lobe, also, discusses the clinical presentation, pathological fndings, different diagnostic modalities, and surgical approach to such tumour. *Corresponding author: Alkhateeb MO, Department of Neuroscience, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, Tel: +966 14647272; E-mail: kmashael@kfshrc.edu.sa Received August 08, 2019; Accepted September 12, 2019; Published September 19, 2019 Citation: Al-Tewerki MM, Al-Khateeb MO, Al-Rasheed RS, Al-Otaibi FA (2019) Dysembryoplastic Neuroepithelial Tumor (DNET) in Parietal Lobe: Is It Different?. J Neurol Disord 7: 409. Copyright: © 2019 Al-Tewerki MM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Dysembryoplastic Neuroepithelial Tumor (DNET); Seizure; Pharmacoresistant epilepsy; Parietal lobe Introduction Dysembryoplastic neuroepithelial tumor (DNET) is a benign uncommon mixed glial–neuronal tumour. Initially described by Daumas-Duport et al. in 1988 [1]. Commonly appears in the temporal lobe of the cortex and associated with medically intractable epilepsy [2]. Several diagnostic modalities have been used to diagnose DNET, such as electroencephalogram (EEG), brain Magnetic Resonance Imaging (MRI), brain Computed Tomography (CT) and histopathological fndings. Te management, of DNET is mainly surgical that reveals good outcomes and low rates of recurrence. Case Report A 20-year-old man known to have a drug resistant epilepsy for the last 3 years, which started with dizziness, behavioral arrest and tonic of the upper extremities mainly the right followed generalized tonic-clonic seizure. He was on Levetiracetam (1500 mg) twice daily and Topiramate (100 mg) twice daily, he was previously on Valproate and Carbamazepine. His seizure is intractable not controlled by medications. Te seizure frequency is around once per week mostly nocturnal and no proceeded aura. Neurological examination was unremarkable. Visual feld examination showed loss of visual feld over the nasal and anterior part of the right and it was normal visual feld over the lef side. An EEG 24- hour study recording showed two seizure semiology in the form of complex partial seizures and atonic seizure accordingly without proceeded aura. On brain MRI fair axial showed cortically based well-defned lef parasagittal frontal lobe lesion with no restricted difusion or enhancement (Figure 1). A positron emission tomography-Computed Tomography (PET-CT) revealed symmetrical global physiological metabolic activity noted throughout the study. Radiological diagnosis of DNET was made. Extensive evaluations in Epilepsy Monitoring Unit with scalp recording and subdural invasive recording of bilateral strips covering mesial frontal and lef parasagittal regions, that showed lesion in the lef parietal lobe drug-resistant epilepsy which is corresponding and congruent to brain MRI fndings with congruent data that warrants epilepsy surgery intervention. Te tumour was attached to the cortex mesially invaginating the white matter deep to the ventricle. Gross total resection of the tumor along with the thickness of the cortex mesially were taken. Te tumor was grayish and sof in the center of and light grayish at the peripheral with thickness. Tere was transient seizure activity during intraoperative stimulation stimulation. Te hand area was localized. Cavitron Ultrasonic Surgical Aspirator (CUSA) was performed from the lef mesial frontal tumour. It consists of multiple fragments of sof tan tissue measuring in aggregate 2.5 × 2 × 0.3 cm (Figure 2). Figure 1: Brain MRI showed left parasagittal isointense lesion surrounded by hyperintense rim with a hypointense center.