A previously healthy 32-year-old male presented to the emergency room after experiencing bilateral tonic-clonic seizures with tongue biting and loss of consciousness. This was followed by a 40-minute period of postictal confusion and non-fluent aphasia.

Four days prior to this, the patient had exhibited brief hyperkinetic dystonic movements in the right cervical and facial region. Family members also reported notable behavioral changes, including irrelevant responses during conversations, prolonged latency in answering questions, and transient difficulty in communication. These behavioral symptoms lasted for approximately two weeks and then resolved spontaneously.

Neurological examination demonstrated non-fluent aphasia and motor deficits. MRI findings revealed precentral and postcentral leptomeningeal enhancement, along with FLAIR-hyperintense lesions, in line with a diagnosis of FLAMES. Cerebrospinal fluid analysis showed pleocytosis at 41 leukocytes/µL (reference rage <5/µ). The patient was treated with high-dose corticosteroids and remained seizure-free at the 6-month follow-up. Subsequent testing for anti-MOG antibodies returned positive, confirming the diagnosis of MOGAD, with FLAMES as the primary clinical and radiological presentation.