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Authentic bilateral motor seizures with preservation of consciousness are rare and often misdiagnosed as pseudoseizures. Few cases of bilateral tonic-clonic seizures (TCS) with retained consciousness have been reported and they were invariably associated with suprasylvian epileptogenic foci. We report a patient with left-sided TCS and contralateral spread but preserved ability to follow commands and retain memory, in the setting of post-traumatic right temporal encephalomalacia.
Case report.
A 19-year-old right-handed man presented with new onset of left-sided focal seizures 1 year after sustaining severe head injury that resulted in a 1-month coma. His seizures often began with an aura of “kaleidoscopic” vision, and progressed to left hand clonic activity that spread to the arm and occasionally the entire left side in a jacksonian pattern. They usually lasted only a few minutes and were never associated with any impairment of consciousness.
The seizures proved to be refractory to several medications, including carbamazepine, valproic acid, phenytoin, and gabapentin, and, after a 5-year period, he was hospitalized for video-EEG monitoring and surgical evaluation. His neurologic examination was remarkable for mild short-term memory and attention deficits, a left inferior quadrantanopsia, mild left hemifacial weakness, and slight left hyperreflexia.
Brain MRI revealed moderate volume loss in …
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