Lawson J, Triner W, Kluge B. Occipital Lobe Status Epilepticus, A Stroke Mimic with Novel Imaging Findings: A Case Report.
Clin Pract Cases Emerg Med 2022;
6:212-215. [PMID:
36049189 PMCID:
PMC9436493 DOI:
10.5811/cpcem.2022.1.55482]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/04/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction
Stroke mimics are a major diagnostic challenge during the initial evaluation of patients presenting with an acute focal neurological deficit. This case reviews a patient who presented to the emergency department (ED) with homonymous hemianopsia, a rare manifestation of focal status epilepticus of the occipital lobe. Her initial brain computed axial tomographic perfusion scan and magnetic resonance imaging revealed novel findings associated with this diagnosis.
Case Report
A 70-year-old female presented to our ED with left visual field hemianopsia, dyskinesia, dysmetria, and facial droop. Her initial diagnosis was left posterior fossa circulation cerebrovascular accident. However, her neuroimaging indicated hypervascularity of the left occipital lobe without evidence of infarct or structural lesion. A cerebral angiogram excluded arteriovenous malformation. Subsequently, an electroencephalogram showed left occipital lobe status epilepticus.
Conclusion
Hemianopsia is a rare presentation of focal status epilepticus mimicking stroke. Hypervascularity seen on advanced neuroimaging may have suggested this diagnosis on initial ED evaluation.
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