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Clinical Reasoning: A 59-Year-Old Man With Acute-Onset Encephalopathy and Aphasia
Clea Gutierrez-Albizuri1, Markel Erburu-Iriarte1, Juan José Gómez Muga2
1Department of Neurology, Basurto University Hospital, Osakidetza Basque Health Service, Bilbao, Spain.
Neurology
|October 16, 2025
Summary
Acute encephalopathy with seizures poses diagnostic challenges. This case highlights how specific neuroimaging findings, alongside clinical data, are crucial for accurate diagnosis and effective management.
Area of Science:
- Neurology
- Neuroscience
- Radiology
Background:
- Acute encephalopathy presents diagnostic challenges due to diverse etiologies.
- Seizures complicate the assessment and management of acute encephalopathy.
- A systematic diagnostic approach is essential for identifying treatable causes.
Purpose of the Study:
- To present a case of acute encephalopathy with seizures.
- To illustrate the diagnostic process for complex encephalopathy cases.
- To emphasize the role of neuroimaging in reaching a final diagnosis.
Main Methods:
- Case report of a 59-year-old man with acute confusion, aphasia, and seizures.
- Electroencephalogram (EEG) to assess brain activity.
- Cerebrospinal fluid (CSF) analysis.
- Brain Magnetic Resonance Imaging (MRI) to evaluate structural abnormalities.
Main Results:
- Initial stroke workup was negative.
- Valproate therapy was initiated.
- EEG revealed slow background activity.
- CSF analysis was normal.
- Brain MRI demonstrated bilateral cortical T2 hyperintensities with diffusion restriction in the insula and cingulate gyrus.
Conclusions:
- Neuroimaging findings were key in narrowing the differential diagnosis.
- A systematic approach, integrating clinical and radiological data, is vital for diagnosing acute encephalopathy.
- Identifying specific etiologies allows for targeted and effective treatment strategies.
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