Title: Partial epileptic seizures: a diagnosis clue for brain tumors

Author(s):
Chirila I M.D., Baciu M M.D., Rosu O M.D., Blesneag AV M.D. PhD, Muresan
DF M.D. PhD.
Department of Clinical Neurosciences, Iuliu Hatieganu University of
Medicine and Pharmacy, Cluj-Napoca, Romania

Country Emergency Hospital, Cluj- Napoca, Romania

Introduction: Astrocytomas are central nervous system neoplasms with

the ability to infiltratetissues. MRI is the first choice in brain tumor
evaluation. A small part of cortex tumors can determine seizures in early
stages, even though they might not be visible on MRI.

Case presentation: A 59 years old male patient was admitted to the

Neurology Department of the County Emergency Hospital from Cluj
complaining of involuntary movements of the right upper limb and right
hemiface that started 2 days before admission. The patient is known to
have sinus tachycardia and mild hypertension. Neurological evaluation did
not reveal any pathological changes at that moment. A native CT scan
revealed just an arahnoidian cyst in the posterior fossa. Because the
symptoms persisted, an MRI was performed. It revealed a lesion in the left
precentral gyrus without enhancement after contrast administration.
SPECT/MRI and CT with intravenous contrast were also performed,
highlighting the same lesion, hyperintense on T2-weighted images but
without vasogenic edema nor mass effect. The pacient received treatment
with carbamazepine and nebivolol with no change in seizure frequency.
Later he underwent surgery. The histopathologycal exam revealed the
tumor type as being anaplastic astrocytoma grade OMS III. He received
adjuvant radio and chemotheraphy. Favorable clinical evolution, without
seizures after surgery.

Conclusion: Brain tumors might be difficult to diagnose and can be

missed in early phases. Cerebral MRI spectroscopy is very useful in order
to guide you toward the right diagnosis but the histopathological
examination remains the gold standard in the diagnosis of tumors. Early
diagnosis is fundamental, since proper treatment may increase life
expectancy.

Particularities: Even though the evaluation was very complex, it was

difficult to establish a precise diagnosis. The presence of superficial brain
pathology was revealed by the patient's clinical manifestation.