Abstract
A 68-year-old woman was admitted to our hospital because of convulsive seizures followed by dysarthria and motor aphasia. At 3 days before admission, she presented with acute onset of right arm weakness. Neurological examinations on admission revealed consciousness disturbance, global aphasia, and right hemiparesis. Cranial routine diffusion-weighted magnetic resonance imaging (MRI) on admission and at 3 days after admission demonstrated cortical-ribbon of the left frontal cerebral hemisphere, although T2 weighted MRI showed no abnormality on admission and serial MRI examination. The patient was diagnosed as having cerebral infarction with early seizures and was treated with anti-platelet therapy, since her clinical course had progressively deteriorated before admission. Moreover, anticonvulsant was added due to generalized tonic seizures that were recurrent after admission. Her aphasia and motor weakness had almost improved within 12 hours, and all symptoms disappeared within 3 days after treatment. At 4 days after admission, EEG revealed irregular alpha wave BGAs and occasional theta waves in the left frontal lobe. However, neither periodic lateralized epileptiform discharges nor spike waves were demonstrated. The abnormalities in the left frontal cerebral hemisphere detected on admission vanished completely 2 months later. We conclude that focal inhibitory seizures should be taken into consideration in the differential diagnosis of other conditions such as ischemic stroke.
