A 75-year-old patient wit...

A 75-year-old patient was admitted to the emergency department with acute onset of aphasia and decreased strength in the right arm and leg. The patient previously had urothelial cancer with no relapse, chronic renal insufficiency, type 2 diabetes, and peripheral and coronary artery disease with quadruple aortocoronary bypass. Clinical examination revealed right-sided hemiparesis and hemihypesthesia, neglect to the right, and global aphasia. The tendon reflexes were brisk, and orientation was impaired. Ischemic stroke with a possible epileptic component due to myoclonia in the upper extremities of the patient was suspected. CT angiography of the brain and neck was performed (Fig 1), and the patient was transferred to the ICU. An EEG showed alpha activity on the right, epileptic focus with rhythmic delta activity, and several suspected epileptic discharges frontotemporal and frontocentral on the left (Fig 2). There was no evidence of status epilepticus. An anti-epileptic therapy with levetiracetam was started, and subsequently sensory and motor deficits and aphasia disappeared. Later, MRI was carried out, and a suspected nidus was found in the patient's left visual cortex, accompanied by perifocal gliosis, a chronic steal phenomenon, and an eventual pseudoaneurysm in the left-sided basal ganglia (Fig 3). No tumors were detected.