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canp2019c02

Case 2

M Khara and JP Rossiter

Department of Pathology and Molecular Medicine, Queen’s University, Kingston, ON

 

This is the case of a 26 year old man who presented in late 2016 following two seizures characterized by focal onset, with right sided neck pain, head turning and gaze deviation to the right, and subsequent generalization to tonic clonic seizure activity. Review of systems revealed a healthy male with a recent history of intentional weight loss. There was no other significant medical history and general physical and neurological examination was unremarkable.

MR imaging demonstrated a ~13 mm lesion within the antero-medial left frontal lobe, characterized by low T1/T2/FLAIR signal, without diffusion restriction, abnormal enhancement, or mass effect. EEG indicated a possible frontal lobe epileptogenic focus.

The patient was followed clinically and with serial neuroimaging (stable), initially with satisfactory seizure control, but by late 2018 he had increasing seizure frequency despite being on multiple antiepileptic medications. He underwent neurosurgical resection of the lesion and subsequently has good seizure control with medications.

 

Materials submitted: One representative HPS stained section

Questions: Diagnosis? Any syndromic association?