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What are the pitfalls in the diagnosis of epilepsy in the elderly?
Case StudyA 66 year old male with hypertension, diabetes, hypercholesterolemia, and TIA is admitted after an episode of acute confusion and left hemiparesis. He was found down at home by his wife stuporous without recall of the event with a deficit that resolved within 1 hour. Retrospectively the patient had brief monthly episodes of "confusion" for 4 years since his TIA that would make him sleepy though he did not recall them. MRI brain, laboratory, and cardiac evaluations were unrevealing. Carotid ultrasound showed left carotid stenosis < 50% and right carotid stenosis (50-69%). This was validated by CT angiography with a right carotid cross-sectional stenosis of 60-70%. He was diagnosed with crescendo TIAs and underwent right carotid surgery with intraoperative EEG.
Figure: Intraoperative EEG demonstrating diffuse suppression on initial carotid clamping. What are the pitfalls in the diagnosis of epilepsy in the elderly? Click here for answers and discussion.
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