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Updated: Jul 19, 2025

Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Clinical Reasoning: A Young Adult With New Seizures and Chapeau de Gendarme
Alexandria Valdrighi1, Anne G Douglas2, Robert C Knowlton2
1From the Department of Child Neurology (A.V.), University of California, San Francisco; Department of Neurology (A.G.D.), University of Pennsylvania, Philadelphia; and Department of Neurology (R.C.K., M.S., J.K.K.), University of California, San Francisco. alexandria.valdrighi@ucsf.edu.
Abstract:
The evaluation of new seizures is a common clinical query for neurologists. It can be challenging to delineate between the numerous etiologies of new focal or generalized seizures and, if focal, to localize their onset. In this case report, we present a 26-year-old patient with a new onset of stereotyped events concerning for seizures featuring facial grimacing, dystonic left-hand posturing, and convulsions with immediate return to baseline. Throughout the case, we highlight a stepwise diagnostic approach to the evaluation of new-onset seizures, discuss clues that seizure semiology can provide for localization of ictal onset, and review a novel and atypical presentation of a disease entity frequently encountered by neurologists.
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