Abstract
BackgroundGall bladder cancer (GBC) is associated with abdominal pain, lump, nausea, vomiting, and jaundice due to either gall bladder mass or the involved adjacent peritoneal structures. Gall bladder cancer presenting as refractory epilepsy is rare. Here we report a young female GBC patient who presented with an atypical and refractory frontal lobe seizures as the first manifestation of gall bladder cancer.Case presentationA 46 years young female presented first time to the hospital with uncontrolled seizures and headache in 5 months duration. Seizures were very atypical in semiology with ptosis and mydriasis to either side along with ipsilateral ocular deviation. The episodes were bilateral but right eyelid ptosis, mydriasis and right horizontal conjugate deviation were frequent. MRI brain showed encephalomalacia in the left frontal region on axial T2 and coronal T1 weighted images without any enhancement on gadolinium contrast. CECT abdomen revealed a heterogeneously enhancing gall bladder mass with the evidence of lung metastasis from chest CT scan. CSF for malignant cytology was negative. Seizures were refractory to the treatment.ConclusionThough CNS involvement is uncommon but it can be the only presentation in gall bladder cancer.
Highlights
Gall bladder cancer (GBC) is associated with abdominal pain, lump, nausea, vomiting, and jaundice due to either gall bladder mass or the involved adjacent peritoneal structures
We report a patient with post infarction encephalomalacia in the left frontal area near frontal eye field leading to very atypical frontal lobe seizures and diagnosed later with gall bladder cancer
Gallbladder cancer (GBC) is a very aggressive. Another possibility for this seizure semiology could be the spread of the seizure from frontal to the insular region resulting in ptosis and mydriasis as a part of autonomic manifestations of seizure
Summary
The neurological manifestation in cancer appears because of the spread of the tumor to brain parenchyma or leptomeninges. We report a patient with post infarction encephalomalacia in the left frontal area near frontal eye field leading to very atypical frontal lobe seizures and diagnosed later with gall bladder cancer. The patient was suffering from headache every day without diurnal fluctuations. She was on daily analgesics for relieving the pain. There was no history of fever, rashes and myoclonic jerks except significant loss of weight in the last 3 months At admission, she was conscious, alert, higher mental functions were normal. Serum electrolytes and thyroid profile were normal Her Serum ANA and ENA screen were negative. CT abdomen of the patient showed heterogeneously enhancing gall bladder mass and CT chest suggested multiple metastatic lesions in the lungs Fig. 1. Chemotherapy was planned but caregivers denied further treatment and took the patient home
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