1. How would you classify this patient's seizure disorder?
Simple partial seizures (SPS), manifested by RUE tonic posturing with head and eye deviation to the right. Followed by a secondarily generalized tonic seizure (GTS)
2. Is there anything in the description of the seizure that indicates a precise localization of the onset of the seizure? If so, which aspects help localize the lesion and where is the lesion located? Indicate the side of involvement.
Yes. RUE tonic posturing, especially as described here, is suggestive of left supplementary motor area (SMA) seizures. Head and eye deviation to the right is consistent with SMA seizures also.
3. Is the localization obtained through the seizure history consistent with that indicated by his original neurological presentation? Indicate the precise location of his original neurologic lesion, including the side of involvement. Indicate the specific structure(s) involved by the original lesion.
Yes. The patient’s symptoms began with RLE weakness, indicating left paracentral lobule involvement (which is just posterior to the left SMA). While a nonfluent aphasia is usually caused by a lesion to the posterior part of the left inferior frontal gyrus (areas 44, 45) (as in a Broca’s aphasia), left SMA lesions may also produce a nonfluent aphasia.
4. In general, what type of pathologic process is involved in this case? If vascular, what vessel is involved?
Vascular – left anterior cerebral artery (ACA) infarct
5. What diagnostic procedure(s) would you undertake at this point?
References:
1. Fontaine D, Capelle L, Duffau H. Neurosurgery 2002;50:297-305.
2. Alario F, Chainay H, Lehericy S, Cohen L. Brain Res 2006;1076:129-143.
3. Hillis AE. Neurology 2007;69:200-213.
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