Podcast
Questions and Answers
A 25-year-old woman with no significant medical history presents with recurrent episodes of staring spells. Each spell lasts for 15–20 seconds, during which she is unresponsive to verbal stimuli. Witnesses describe her blinking repetitively during the events, followed by immediate recovery with no confusion. The spells occur multiple times a day, predominantly during periods of inactivity.
Neurological examination is normal.
MRI brain is normal.
Routine EEG shows frequent generalized 3 Hz spike-and-wave discharges, particularly during hyperventilation.
What is the most likely diagnosis and the best initial treatment?
A 25-year-old woman with no significant medical history presents with recurrent episodes of staring spells. Each spell lasts for 15–20 seconds, during which she is unresponsive to verbal stimuli. Witnesses describe her blinking repetitively during the events, followed by immediate recovery with no confusion. The spells occur multiple times a day, predominantly during periods of inactivity. Neurological examination is normal. MRI brain is normal. Routine EEG shows frequent generalized 3 Hz spike-and-wave discharges, particularly during hyperventilation. What is the most likely diagnosis and the best initial treatment?
A 60-year-old man presents with sudden-onset jerking of his right arm that lasts for 2–3 minutes, followed by weakness of the same arm for 30 minutes. He remains fully conscious during the events. He reports three such episodes in the past two weeks, all occurring while awake.
Neurological examination shows mild right arm weakness.
MRI brain reveals an area of gliosis in the left motor cortex.
EEG shows focal sharp waves in the left central region.
What is the most likely diagnosis and the next step in management?
A 60-year-old man presents with sudden-onset jerking of his right arm that lasts for 2–3 minutes, followed by weakness of the same arm for 30 minutes. He remains fully conscious during the events. He reports three such episodes in the past two weeks, all occurring while awake. Neurological examination shows mild right arm weakness. MRI brain reveals an area of gliosis in the left motor cortex. EEG shows focal sharp waves in the left central region. What is the most likely diagnosis and the next step in management?
A 45-year-old woman presents with a 3-week history of episodic confusion and unresponsiveness lasting several minutes. She has no recollection of the events but reports headache and mild fatigue afterward. Family members report lip-smacking and chewing movements during the episodes.
Neurological examination is normal.
MRI brain shows mild hippocampal atrophy on the left.
EEG reveals interictal sharp waves in the left temporal region.
What is the most likely diagnosis and the best next step?
A 45-year-old woman presents with a 3-week history of episodic confusion and unresponsiveness lasting several minutes. She has no recollection of the events but reports headache and mild fatigue afterward. Family members report lip-smacking and chewing movements during the episodes. Neurological examination is normal. MRI brain shows mild hippocampal atrophy on the left. EEG reveals interictal sharp waves in the left temporal region. What is the most likely diagnosis and the best next step?
A 34-year-old man presents with brief episodes of sudden head nodding and bilateral arm jerking. The events occur primarily in the morning within 1–2 hours of waking and are triggered by sleep deprivation. There is no loss of consciousness.
Neurological examination is normal.
MRI brain is normal.
EEG shows generalized polyspike-and-wave discharges, most prominent during photic stimulation.
What is the most likely diagnosis and initial management?
A 34-year-old man presents with brief episodes of sudden head nodding and bilateral arm jerking. The events occur primarily in the morning within 1–2 hours of waking and are triggered by sleep deprivation. There is no loss of consciousness. Neurological examination is normal. MRI brain is normal. EEG shows generalized polyspike-and-wave discharges, most prominent during photic stimulation. What is the most likely diagnosis and initial management?
Signup and view all the answers
A 50-year-old man presents with episodes of sudden, transient inability to move or speak, lasting 10-15 seconds. He remains aware during the events and describes a feeling of being "frozen in place." The episodes occur predominantly when he is lying in bed and are often preceded by auditory hallucinations.
Neurological examination and MRI brain are normal.
EEG shows rhythmic sharp waves over the right frontal region during sleep.
What is the most likely diagnosis and next step in management?
A 50-year-old man presents with episodes of sudden, transient inability to move or speak, lasting 10-15 seconds. He remains aware during the events and describes a feeling of being "frozen in place." The episodes occur predominantly when he is lying in bed and are often preceded by auditory hallucinations. Neurological examination and MRI brain are normal. EEG shows rhythmic sharp waves over the right frontal region during sleep. What is the most likely diagnosis and next step in management?
Signup and view all the answers
A 29-year-old woman presents with episodes of prolonged staring, during which she exhibits automatisms like fumbling with her hands and lip-smacking. The events last 2–3 minutes and are followed by confusion for 15–20 minutes. She also describes a rising epigastric sensation before the episodes. These have been occurring for years but are increasing in frequency.
Neurological examination is normal.
MRI shows hippocampal sclerosis on the right.
EEG reveals interictal right temporal sharp waves and rhythmic 5 Hz activity over the right temporal region during events.
What is the most likely diagnosis and next step in management?
A 29-year-old woman presents with episodes of prolonged staring, during which she exhibits automatisms like fumbling with her hands and lip-smacking. The events last 2–3 minutes and are followed by confusion for 15–20 minutes. She also describes a rising epigastric sensation before the episodes. These have been occurring for years but are increasing in frequency. Neurological examination is normal. MRI shows hippocampal sclerosis on the right. EEG reveals interictal right temporal sharp waves and rhythmic 5 Hz activity over the right temporal region during events. What is the most likely diagnosis and next step in management?
Signup and view all the answers
A 38-year-old man presents with nocturnal events where he suddenly sits up in bed, screams, and thrashes his arms. These episodes last 30–60 seconds and occur 2–3 times per week. He denies daytime symptoms or memory of the episodes.
Neurological examination is normal.
MRI brain is normal.
EEG during wakefulness is unremarkable, but sleep EEG shows bursts of rhythmic fast activity over the frontal regions during events.
What is the most likely diagnosis and management approach?
A 38-year-old man presents with nocturnal events where he suddenly sits up in bed, screams, and thrashes his arms. These episodes last 30–60 seconds and occur 2–3 times per week. He denies daytime symptoms or memory of the episodes. Neurological examination is normal. MRI brain is normal. EEG during wakefulness is unremarkable, but sleep EEG shows bursts of rhythmic fast activity over the frontal regions during events. What is the most likely diagnosis and management approach?
Signup and view all the answers
A 42-year-old woman presents with recurrent episodes of a "sudden surge of energy," during which she vocalizes unintelligible sounds and exhibits rapid, forceful movements of her arms. The episodes last 10–20 seconds and occur unpredictably, often during the day.
Neurological examination is normal.
MRI brain is normal.
Video EEG monitoring captures an event with hyperkinetic movements and preserved awareness, accompanied by rhythmic fast activity in the left frontocentral region.
What is the most likely diagnosis?
A 42-year-old woman presents with recurrent episodes of a "sudden surge of energy," during which she vocalizes unintelligible sounds and exhibits rapid, forceful movements of her arms. The episodes last 10–20 seconds and occur unpredictably, often during the day. Neurological examination is normal. MRI brain is normal. Video EEG monitoring captures an event with hyperkinetic movements and preserved awareness, accompanied by rhythmic fast activity in the left frontocentral region. What is the most likely diagnosis?
Signup and view all the answers
A 55-year-old man with a history of hypertension presents with sudden right-sided weakness lasting 3–4 minutes, followed by complete resolution. He denies loss of consciousness, speech difficulty, or other symptoms.
Neurological examination and MRI brain are normal.
EEG shows periodic lateralized epileptiform discharges (PLEDs) over the left hemisphere.
What is the most likely diagnosis and best next step?
A 55-year-old man with a history of hypertension presents with sudden right-sided weakness lasting 3–4 minutes, followed by complete resolution. He denies loss of consciousness, speech difficulty, or other symptoms. Neurological examination and MRI brain are normal. EEG shows periodic lateralized epileptiform discharges (PLEDs) over the left hemisphere. What is the most likely diagnosis and best next step?
Signup and view all the answers
A 19-year-old college student reports episodes of sudden head drops and brief loss of postural tone lasting 1-2 seconds, occurring multiple times daily. These began at age 12 but were dismissed as clumsiness. He also has generalized tonic-clonic seizures occurring every few months.
MRI brain is normal.
EEG shows generalized polyspike-and-wave discharges, especially during sleep deprivation.
What is the most likely diagnosis and appropriate treatment?
A 19-year-old college student reports episodes of sudden head drops and brief loss of postural tone lasting 1-2 seconds, occurring multiple times daily. These began at age 12 but were dismissed as clumsiness. He also has generalized tonic-clonic seizures occurring every few months. MRI brain is normal. EEG shows generalized polyspike-and-wave discharges, especially during sleep deprivation. What is the most likely diagnosis and appropriate treatment?
Signup and view all the answers
A 65-year-old woman with diabetes presents with episodic confusion lasting several hours, during which she exhibits lip-smacking and repetitive swallowing movements. These episodes occur 1-2 times per month.
Neurological examination is normal.
MRI brain shows age-appropriate atrophy.
EEG reveals periodic lateralized epileptiform discharges (PLEDs) over the left temporal region.
What is the most likely diagnosis and next step?
A 65-year-old woman with diabetes presents with episodic confusion lasting several hours, during which she exhibits lip-smacking and repetitive swallowing movements. These episodes occur 1-2 times per month. Neurological examination is normal. MRI brain shows age-appropriate atrophy. EEG reveals periodic lateralized epileptiform discharges (PLEDs) over the left temporal region. What is the most likely diagnosis and next step?
Signup and view all the answers
A 47-year-old man presents with episodic jerking of his left hand that occasionally spreads to involve the arm and face. The episodes last 1–2 minutes, followed by a transient speech difficulty.
Neurological examination is normal between events.
MRI brain reveals a small lesion in the right precentral gyrus.
EEG shows frequent sharp waves over the right central region.
What is the most likely diagnosis and best next step?
A 47-year-old man presents with episodic jerking of his left hand that occasionally spreads to involve the arm and face. The episodes last 1–2 minutes, followed by a transient speech difficulty. Neurological examination is normal between events. MRI brain reveals a small lesion in the right precentral gyrus. EEG shows frequent sharp waves over the right central region. What is the most likely diagnosis and best next step?
Signup and view all the answers
A 26-year-old woman presents with recurrent episodes of involuntary pelvic thrusting, vocalizations, and complex limb movements lasting 5–10 minutes. These occur only in the presence of others and are preceded by a “warning” of vague discomfort.
Neurological examination and MRI brain are normal.
EEG during events shows no epileptiform activity or ictal changes.
What is the most likely diagnosis and management?
A 26-year-old woman presents with recurrent episodes of involuntary pelvic thrusting, vocalizations, and complex limb movements lasting 5–10 minutes. These occur only in the presence of others and are preceded by a “warning” of vague discomfort. Neurological examination and MRI brain are normal. EEG during events shows no epileptiform activity or ictal changes. What is the most likely diagnosis and management?
Signup and view all the answers
A 62-year-old woman with a history of hypertension presents with frequent episodes of brief right-sided face and arm twitching. She remains fully conscious during the events, which last 30–60 seconds.
MRI brain shows an old left middle cerebral artery infarct.
EEG reveals sharp waves over the left central region.
What is the most likely diagnosis and treatment?
A 62-year-old woman with a history of hypertension presents with frequent episodes of brief right-sided face and arm twitching. She remains fully conscious during the events, which last 30–60 seconds. MRI brain shows an old left middle cerebral artery infarct. EEG reveals sharp waves over the left central region. What is the most likely diagnosis and treatment?
Signup and view all the answers
A 30-year-old man presents with recurrent episodes of sudden head turning to the left, accompanied by grunting sounds. Each episode lasts 15–30 seconds and occurs multiple times per week. He remains aware during the events.
Neurological examination is normal.
MRI brain is normal.
EEG shows ictal rhythmic theta activity over the right frontal region during events.
What is the most likely diagnosis and treatment?
A 30-year-old man presents with recurrent episodes of sudden head turning to the left, accompanied by grunting sounds. Each episode lasts 15–30 seconds and occurs multiple times per week. He remains aware during the events. Neurological examination is normal. MRI brain is normal. EEG shows ictal rhythmic theta activity over the right frontal region during events. What is the most likely diagnosis and treatment?
Signup and view all the answers
Study Notes
Question 1
- Patient: 25-year-old woman with recurrent staring spells.
- Spell Duration: 15-20 seconds.
- Symptoms: Unresponsive to verbal stimuli, repetitive blinking, immediate recovery.
- Frequency: Multiple times a day, predominantly during inactivity
- Normal neurological exam: Neurological examination came back normal.
- Normal MRI: MRI of the brain was normal.
- EEG: Frequent generalized 3 Hz spike-and-wave discharges, particularly during hyperventilation.
- Most likely diagnosis: Absence seizures
- Initial treatment: Trial of ethosuximide.
Question 2
- Patient: 60-year-old man with jerking episodes.
- Symptom Duration: 2-3 minutes, followed by arm weakness for 30 minutes.
- Episode Frequency: Three episodes in the past two weeks
- Patient Consciousness: Fully conscious during the episodes, awake.
- Neurological Exam: Mild right arm weakness.
- MRI Brain: Area of gliosis in the left motor cortex.
- EEG: Focal sharp waves in the left central region.
- Most likely diagnosis: Focal seizures with postictal paresis.
- Next Step: Trial of levetiracetam.
Question 3
- Patient: 45-year-old woman with episodic confusion.
- Symptoms: Episodic confusion, headache, fatigue, lip-smacking, chewing.
- Neurological Exam: Normal.
- MRI Brain: Mild hippocampal atrophy on the left.
- EEG: Interictal sharp waves in the left temporal region.
- Most likely diagnosis: Temporal lobe epilepsy.
- Next Step: Start anti-seizure medication.
Question 4
- Patient: 34-year-old man with brief episodes of head nodding and arm jerking.
- Episode Trigger: Sleep deprivation
- Symptoms: Head nodding, bilateral arm jerking.
- Consciousness Loss: No loss of consciousness.
- Neurological Exam: Normal.
- MRI Brain: Normal.
- EEG: Generalized polyspike-and-wave discharges, most prominent during photic stimulation.
- Most likely diagnosis: Juvenile myoclonic epilepsy.
- Initial management: Start valproate.
Question 5
- Patient: 50-year-old man with episodes of sudden inability to move or speak.
- Duration: 10-15 seconds
- Awareness during episodes: Aware during events.
- Feeling: Frozen in place.
- Episodes occur: Predominantly when lying in bed, preceded by auditory hallucinations.
- Neurological Exam: Normal.
- MRI Brain: Normal.
- EEG: Rhythmic sharp waves over the right frontal region during sleep.
- Most likely diagnosis: Frontal lobe epilepsy.
- Next step: Initiate anti-seizure therapy.
Question 6
- Patient: 29-year-old woman with prolonged staring episodes.
- Symptoms: Prolonged staring, automatisms (fumbling with hands, lip-smacking), confusion following the episodes(15-20 minutes), rising epigastric sensation beforehand.
- Duration: 2-3 minutes.
- Frequency: Increasing frequency.
- Neurological Exam: Normal.
- MRI: Hippocampal sclerosis on the right.
- EEG: Ictal right temporal sharp waves and rhythmic 5 Hz activity over the right temporal region during events.
- Most likely diagnosis: Temporal lobe epilepsy.
- Next step: Consider anti-seizure medication and/or epilepsy surgery evaluation.
Question 7
- Patient: 38-year-old man with nocturnal events of sitting up, screaming, and thrashing his arms.
- Episode Duration: 30-60 seconds.
- Frequency: 2-3 times per week.
- Awareness during episodes: Does not remember the events.
- Neurological Exam: Normal
- MRI Brain: Normal
- EEG: Bursts of rhythmic fast activity over the frontal regions during events.
- Most likely diagnosis: Nocturnal frontal lobe epilepsy.
- Management Approach: Trial of anti-seizure medication.
Question 8
- Patient: 42-year-old woman describing "sudden surge of energy."
- Symptoms: Rapid, forceful movements of her arms, vocalizing unintelligible sounds.
- Duration: 10-20 seconds.
- Neurological Exam: Normal
- MRI Brain: Normal
- Video EEG: Hyperkinetic movements, preserved awareness, rhythmic fast activity in the left frontocentral region.
- Most likely diagnosis: Frontal lobe epilepsy
Question 9
- Patient: 55-year-old man with right-sided weakness.
- Symptom Duration: 3-4 minutes.
- Neurological Exam: Normal
- MRI Brain: Normal
- EEG: Periodic lateralized epileptiform discharges (PLEDS) over the left hemisphere.
- Most likely diagnosis: Focal seizures with motor symptoms.
- Next Step: Start anti-seizure medication.
Question 10
- Patient: 19-year-old college student with head drops lasting 1-2 seconds.
- Symptoms: Head drops, brief loss of postural tone.
- Frequency: Multiple times daily.
- History: Generalized tonic-clonic seizures every few months (at age 12 or more; previously wrongly diagnosed as clumsiness).
- MRI Brain: Normal
- EEG: Generalized polyspike-and-wave discharges, especially during sleep deprivation.
- Most Likely Diagnosis: Juvenile myoclonic epilepsy.
- Treatment: Initiate valproate.
Question 11
-
Patient: 65-year-old woman with episodic confusion, lip-smacking, and repetitive swallowing.
-
Episodes frequency: 1-2 times per month.
-
Neurological Exam: Normal
-
MRI brain: Age-appropriate atrophy
-
EEG: Periodic lateralized epileptiform discharges (PLEDs) over the left temporal region
-
Most probable diagnosis: Focal seizures
-
Next treatment: Start anti-seizure medication
Question 12
-
Patient: 47-year-old man with episodic jerking of left hand, face, and speech difficulty.
-
Episode duration: 1-2 minutes.
-
MRI brain: Small lesion in the right precentral gyrus
-
EEG: Frequent sharp waves on the right central region.
-
Most probable diagnosis: Focal epilepsy
-
Next treatment: Initiate anti seizure medication
Question 13
- Patient: 26-year-old woman with involuntary pelvic thrusting , vocalizations, complex limb movements,
- Duration: 5-10 minutes.
- Neurological Exam: Normal
- MRI brain: Normal.
- EEG: No epileptiform activity during events.
- Most probable diagnosis: Psychogenic non-epileptic events.
- Management: Referral to psychotherapy.
Question 14
- Patient: 62-year-old woman with right-sided face and arm twitching.
- Episode duration: 30-60 seconds
- MRI brain: Old left middle cerebral artery infarct
- EEG: Sharp waves over the left central region.
- Most probable diagnosis: Focal seizures
- Treatment: Start anti-seizure medication
Question 15
- Patient: 30-year-old man with sudden head turning to the left, grunting sounds
- Episode duration: 15-30 seconds
- Neurological Exam: Normal
- MRI Brain: Normal
- EEG: Ictal rhythmic theta activity on right frontal region during events
- Most likely diagnosis: Frontal lobe epilepsy
- Treatment: Start anti-seizure medication
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge on seizure disorders with this quiz focusing on cases involving absence seizures and other neurological symptoms. Analyze patient presentations and their corresponding diagnoses, treatments, and EEG findings. Ideal for medical students and healthcare professionals.
