[A case of Wegener's granulomatosis presenting with tonic-clonic status epilepticus]

A 47-year-old man with a diagnosis of paranasal Wegener's granulomatosis was admitted to our hospital for generalized seizures. He had been treated with long-term predonine therapy after the initial onset of Wegener's granulomatosis. The ictal EEG showed generalized spike and wave complexes, mainly presenting in the bifrontal areas. The postictal EEG revealed periodic localized sharp discharges in the left frontal area. At the initial seizure onset, a midline multilobular mass lesion having a heterogeneous enhancement effect was detected in the lower frontal lobe on gadolinium-enhanced T1-weighted imaging (Gd T1-WI). The anterior skull base and bifrontal lobes were encroached by upward contiguous invasion of the midline mass lesion from the ethmoid sinus on Gd T1-WI. The high signal intensity lesions in the bifrontal lobes on T2- and Gd T1-WI resolved with palliative predonine therapy following methylpredonisolone pulse therapy. Recurrent generalized tonic-clonic status epilepticus was caused by the granulomatous lesion encroaching on the frontal lobe with contiguous invasion from the paranasal Wegener's granulomatosis.