Case Study

A 78 year old RHWM had hypertension, hypercholesterolemia, and was otherwise in good health. He complained of recent memory difficulties over the preceding 6 months prior to presentation diagnosed with cerebral amyloid angiopathy. Focal seizures were evidenced as a warning of a strange feeling, colored lights moving from left to right, brief inconsolable "reaction" of turning to the right side and curling up in a ball. Seizures typically lasted 2 minutes but could be serial and also prolonged > 5 minutes. A brain MRI brain revealed an area of cortical encephalomalacia in the left posterior temporal region involving the posterior quadrant. An EEG demonstrated left mid- and posterior temporal sharp waves. He was resistant to multiple AEDs on PHT, PB, and LEV with monthly ED visits for breakthrough serial seizures that would require hospitalization due to a prolonged "post-ictal" state.

Figure: EEG in (A) demonstrates left posterior temporal PLEDs Plus with repetitive sharp waves followed by a rhythmic ictal discharge and (B) with focal left hemispheric non-convulsive status epilepticus with rhythmic slowing. Parameters: bipolar montage, sensitivity 7 uv, and filters of 1-70 Hz.

What was wrong with the patient? Click here for answers and discussion.

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