Case Study

A 64 year old right-handed black male was seen for evaluation of spells. His past medical history included treatment for hypertension, diabetes mellitus, and hypercholesterolemia. Four generalized nocturnal seizures occurrred after a "TIA" though he was seizure free on phenytoin 300 mg nightly. However, he complained of feeling "sleepy and drunk". New daytime spells in the preceding 5 weeks were manifest as abrupt onset of slurred speech and "confusion" with left hand weakness for 1-2 minutes. During this time he would lie down during this time for fear of a convulsion. MRI demonstrated a small right parietal hyperintensity on DWI. EEG demonstrated right temporal delta. Carotid dopplers revealed a right ICA stenosis of >90% and an occlusion of the left ICA Intraoperative EEG was performed during carotid right endarterectomy.

Figure: Intraoperative EEG monitoring demonstrating segments of EEG immediately before clamping (a) and 20 seconds following clamping of the right internal carotid artery (b). A longitudinal bipolar montage with a sensitivity 10 uv and filter settings of 1-70 Hz.

What caused these spells? Click here for answers and discussion.