Case report
A 47-year-old female presented to the emergency department of our center
with a history of 1 episode of jerky movement of the left upper limb
following lip smacking lasting for about 15–30 seconds, followed by
loss of consciousness and post-ictal confusion. However, there is no
history of uprolling of the eyes, tongue biting, frothing of the mouth,
generalized tonic-clonic movement, and bowel or bladder incontinence.
Also, there was no history of fever, trauma, or previous seizure
disorder. She also complained of 6-7 episodes of headache mimicking
migraine from 1 year on and off, relieved by over-the-counter
medications. She had been diagnosed with hypothyroidism for 6 years and
is under levothyroxine. On examination, there were no signs of meningeal
irritation with normal systemic examination. Her vital signs were within
normal limits.
Neurological assessment was normal, along with unremarkable laboratory
findings. The EEG was done and showed no epileptiform discharge. The CT
head also shows no abnormality.
Thus, she was admitted for neurological monitoring and further
evaluation. An MRI of the brain was planned, which revealed a small
lobulated popcorn appearance lesion of size 10*9.5*8.5 mm with a central
high and peripheral low intensity rim in the right frontal lobe and
white matter showing tiny enhancing areas within, blooming in SWIs with
mixed bright and dark phase images (Figure 1: MRI of brain on right )and
altered low T2 signal intensity (Figure 1: MRI of brain on left ) around
them, suggestive of frontal lobe cavernoma.
Figure 1