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Endgames Case Review

A man having a convulsion

BMJ 2019; 364 doi: (Published 07 February 2019) Cite this as: BMJ 2019;364:k5365
  1. Shing Fung Lee, resident specialist,
  2. Frank Chi Sing Wong, chief of service
  1. Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
  1. Correspondence to SF Lee leesfm{at}

A 40 year old right handed man was admitted to the emergency department after experiencing a convulsion at home. During the episode, he lost consciousness and experienced twitching of the left limbs. He regained consciousness after a few minutes, with no post-ictal drowsiness. He had no further seizures and reported no recent head injury, medication use, or recreational drug use. He had no fever, weight loss, or malaise. Physical examination, including neurological examination, was normal.

Urgent non-contrast computed tomography of the brain showed cortical thickening in the right parietal lobe with adjacent ill defined white matter hypodense changes; there was no hyperdensity.

Blood tests, including full blood counts, a liver function test, electrolytes, urea, and c-reactive protein levels, were normal.

Further investigation with magnetic resonance imaging (MRI) of the brain was arranged (fig 1, 2).

Fig 1

Magnetic resonance imaging (MRI) of the brain with fluid attenuation inversion recovery (FLAIR)

Fig 2

Axial diffusion weighted MRI brain


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