A case of mistaken mesial temporal identity

doi:10.1136/bmj.b2258

Published 23 June 2009, doi:10.1136/bmj.b2258
Cite this as: BMJ 2009;338:b2258

Practice

Lesson of the Week

A case of mistaken mesial temporal identity

A Neligan, clinical research fellow¹, D R Holdright, consultant cardiologist², F J Rugg-Gunn, consultant neurologist¹, J W Sander, professor of neurology¹

¹ UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, ² UCLH Heart Hospital, London W1G 8PF

Correspondence to: J W Sander lsander@ion.ucl.ac.uk

Re-examine a diagnosis of epilepsy when there is worsening controland investigations are normal

The first 150 words of the full text of this article appear below.

The accurate diagnosis and treatment of paroxysmal events canbe difficult. It requires a detailed eye witness account anda clear description of the circumstances of the event, includinglocation, development, tempo, and duration. Even with this information,a definitive diagnosis may not be attainable.

A 45 year old left handed man presented with a four year historyof paroxysmal events. He was referred by his neurologist forconsideration of epilepsy surgery. Previous medical historywas unremarkable. The first episode of loss of consciousnessoccurred while the patient was with friends. It was precededby a brief period of severe chest pain with profuse sweating,which lasted less than a minute. A 12-lead electrocardiogramwas normal. The second episode occurred two years ago and wasalso preceded by chest pain. During this episode, the patientfelt weak, lay on the ground, and lost consciousness. Durationwas uncertain, but on regaining . . . [Full text of this article]