The Obvious Cause of Seizures May Not Be the Underlying Cause

Publisher Summary This chapter presents the case of a man diagnosed with Seizures related to alcohol abuse and past history of head trauma. The patient had a previous history of alcohol and drug abuse. He presented to the emergency department following a generalized tonic–clonic seizure. He responded to lorazepam 2 mg intravenously. He was then given phenytoin 1 g intravenously without further seizures, but he had a prolonged postictal state that required careful observation. He aspirated and was treated for pneumonia. Repeat cranial CT with and without contrast was unremarkable. He attended Alcoholics Anonymous and remained free of further seizure activity. EEG was repeated, showing focal slowing in the left frontal region. Cranial MRI showed a neoplasm in the left frontal lobe. Craniotomy revealed high-grade malignancy consistent with glioblastoma multiforme. The patient had an all-too-familiar seizure presentation associated with alcohol. When the seizure pattern changed to multiple complex partial seizures, further imaging was done with MRI scanning. The fact that he had continued seizures long after he was alcohol-free should have altered the doctor's thinking away from the patient's alcohol as a precipitating factor of his seizure to other etiologies.