Radiological and EEG findings identified a stroke-like episode. A: T2-weighted axial magnetic resonance image (MRI) at 2 days after onset of stroke-like episode demonstrating high intensity areas in both occipital lobes (arrow a) (consistent with acute cortical infarcts on the corresponding diffusion imaging and apparent diffusion coefficient map, not shown), cortical edema in the right parietal and temporal lobes (arrow b) and atrophic change in the left occipital lobe (arrow c). B, ′H-magnetic resonance spectroscopy (MRS) from the right occipital lobe demonstrating a prominent inverted lactate couplet at 1.3 parts per million and a decrease in N-acetylaspartate-Creatine ratio (0.94). C: EEG demonstrating a diffusely slow background consistent with encephalopathy and a right occipital seizure (sensitivity: 10 microvolts/mm).