The Disconnected Dry Cleaner
A 34 year old dry cleaner is referred to you because of complaints of feeling occasionally disconnected from his environment. This feeling comes ons usdeenly without warning, lasts for about two minutes, and then slowly disappears. At times, he feels cold or dizzy and this feeling is not necessarily associated with the feeling of disconnection. On review of symptoms, he admits to a vague right sided headache for three months, which goes away with acetaminophen. The rest of his review of symptoms and family history is entrely within normal limits. His physical examination is normal. He only abnormality on the neurological examination is a subtle left hemonymous hemianopsia with macular sparring. A routine MRI was unremarkable. He was admitted for monitoring. An EEG during an episode of disconecction is shown below is shown below:
This 16 channel EEG shows a run of paroxysmal activity which starts with a phase reversal in the right temporal leads. The paroxysmal activity starts on the right side and then spreads to both hemispheres.
- The EEG shows a "phase reversal" over the right temporal lobe. This suggest which of the following:
a) absence seizures
b) partial epilepsy
c) brain tumor
- Indicate the age of first seizure in patients with each of these diagnoses:
a) ideopathic epilepsy
b) vascular epilepsy
c) brain tumor
d) cerebral microgyria
- What further tests would you order?
- The patient is started of dilantin but develops an exfoliative dermatitis 4 days letter. You tell him to stop the dilantin and to begin which anti-convulsant? What is the prognosis for "curing" the patient's problem with anti-convulsants?