A 51-year-old previously healthy man noticed transient numbness and tingling in his left arm. A few days later, he experienced a 10-second episode of left arm flailing, along with a feeling of being “disconnected” lasting approximately 10-20 seconds. Immediately before this episode, the patient experienced lightheadedness, flushing and a feeling of dread.
Upon examination, the care team found that the patient had diminished sensation to temperature in his right leg. A Brain MRI revealed a 1.4-by-1.5-centimeter right superior frontal gyrus lesion. The lesion was hyperintense on fluid-attenuated inversion recovery (FLAIR) imaging (Figure 1), and it was not associated with any enhancement (Figure 2).
What’s the diagnosis?
Reproduced with permission from Ansali B, Tate M, Templer JW, Dixit K: Challenge Case Report: New Onset Seizures. Practical Neurology (US) 2021;20(9):58-62.
Matthew C. Tate, MD, PhD, is an associate professor of Neurological Surgery and Neurology at Northwestern Medicine.
Jessica W. Templer, MD, is an assistant professor of Neurology in the Division of Epilepsy/Clinical Neurophysiology at Northwestern Medicine.
Karan S. Dixit, MD, is an assistant professor of Neurology in the Divisions of Neuro-oncology and Hospital Neurology at Northwestern Medicine.
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