Complex partial seizures as sole presentation of acute stroke - Rare learning case

Abstract

68 years old gentleman presented to ER with three days history of sudden onset of frequent spells of confusion and memory disturbance. These last for thirty to forty seconds at a time leaving him feeling very tired. His wife noted that he becomes unresponsive and stares in vague without jerks. He also described feeling as if he goes in a short dream repeatedly. He is diabetic, hypertensive and had CABG previously. Also suffered with long standing depression using SSRI’s on and off. No past history of similar symptoms, TIA or stroke. He admitted to have low mood. Clinically was fully alert, orientated but was unable to read or write nor to perform simple calculation without other focal signs. HisECG and basic blood tests were within normal limits. An MRI scan of the brain revealed a subacute infarction in the left medial temporal lobe with spots of minor bleeds. An EEG showed active seizure discharges from the same area. He was managed as inpatient with Aspirin and clopidogrel, atorvastatin and levetiracetam. He did well and all his symptoms resolved. He remained stable on follow up in the out patient three weeks later. Although it is well known, but very rare for a stroke to present with complex partial seizures without classical focal neurological signs, presenting with only seizures is even rarer. The back ground of depressive illness and vagueness of symptoms delayed his reporting to emergency department. Acute onset of neurological symptoms in a patient of such age with vascular risks should lead to imaging early.