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Lateralized hyperkinetic motor behavior.

Balaji Krishnaiah1, Jayant Acharya1, Aiesha Ahmed1

  • 1Department of Neurology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.

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|March 6, 2018
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Summary

This case report details a 68-year-old woman experiencing post-seizure motor behavior. Reversible MRI findings aided diagnosis, differentiating it from status epilepticus.

Keywords:
Electroencephalogramepilepsypost-ictal stateseizures

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Area of Science:

  • Neurology
  • Neuroscience
  • Clinical Neurophysiology

Background:

  • Seizures are typically followed by a post-ictal phase characterized by generalized slowing of brain activity.
  • Distinguishing post-ictal phenomena from other neurological events is crucial for appropriate patient management.

Observation:

  • A 68-year-old woman exhibited unilateral, semi-purposeful motor behavior two days after a generalized seizure.
  • Initial electroencephalogram (EEG) revealed beta activity without epileptiform discharges.
  • Computed tomography (CT) showed left parieto-occipital hypodensity.

Findings:

  • Magnetic resonance imaging (MRI) demonstrated restricted diffusion and FLAIR hyperintensities in the left precentral and post-central gyri.
  • These MRI findings were reversible.
  • The observed motor behavior was ultimately attributed to the post-ictal state.

Implications:

  • Unilateral compulsive motor behavior in the post-ictal state requires careful consideration.
  • Misdiagnosis as partial status epilepticus can lead to unnecessary treatments.
  • Reversible MRI abnormalities can be valuable in diagnosing and guiding treatment for post-ictal events.