Author: Manasi Jyothish, Shalini Chintamaneni, Graham Johnson / Editor: Steve Corry-Bass / Reviewer: Graham Johnson / Codes: NeuC12, NeuP4, NeuP5, NeuP8, SLO1 / Published: 07/04/2022

A 61-year-old gentleman with a history of absence seizures since childhood developed an aura of left cheek burning with left arm numbness and weakness one evening. Similar episodes have heralded imminent seizures in the past. This time; no seizure was witnessed.

By the next morning, the weakness had progressed, from the left arm to include the left leg. He also developed slurred speech. Examination revealed grossly reduced power in left upper and lower limbs, left sided facial droop, slow speech and vision that was restricted to seeing only hand movements. The patient stated that this was the worst weakness he had ever had.

A CT brain showed bilateral dense cortical calcification, parenchymal atrophy and a crescentic area suspicious for a very small subdural collection. No appreciable mass effect was found. 

The patient’s power improved, and he became more alert over the next few days. However, more sensitive imaging was needed to confirm diagnosis and he subsequently had an MRI.

This showed extensive changes of cortical volume loss with signal abnormality on the diffusion weighted imaging, with no evidence of ischaemic stroke. 

The patient was discharged from hospital 3 days following initial attendance. 

Module Content