Autonomic Seizure as a Presenting Symptom of Glioblastoma (P5-1.015).

in Neurology by Sargun Walia, Papul Chalia, Guntash Kaur, Bhavan Shah

TLDR

  • A 52-year-old male presented with rare pilomotor seizures, which were not recognized as ictal epilepsy at initial presentation, ultimately leading to the diagnosis of glioblastoma multiforme.
  • Continuous EEG monitoring and repeat MRI brain imaging were crucial in confirming the diagnosis and identifying the location of the lesion.

Abstract

The objective of this case report is to illustrate a unique presentation of glioblastoma, emphasizing the importance of recognizing atypical seizure manifestations for timely diagnosis and intervention. Ictal piloerection, often referred to as "goose bumps," represents a rare form of autonomic seizures, frequently under recognized as a manifestation of ictal epilepsy. The prevalence of pilomotor seizures is rare and estimated as 1.2% in temporal lobe. N/A. 52-year-old male with history of hypertension, arthritis, asthma presented initially to the hospital with generalized tonic clonic seizures. Patient initial semiology was described as presence of full body piloerection, erythema, and dizziness, at times would cluster and further cause a generalized tonic clonic seizure. Patient had initially presented to a community hospital, where a MRI brain revealed left temporal lobe edema suspected from a seizure. CSF studies obtained were non contributory for any signs of infection, no cytology was performed and the patient was discharged home on Levetiracetam. He later presented to an academic center with a generalized tonic clonic seizure. Patient was then placed on continuous EEG, while he continued to have multiple episodes of full body piloerection, metallic taste in the mouth, with preserved awareness. These events were ictal and lateralized over the left temporal region. Repeat MRI brain demonstrated a non-enhancing, non-hemorrhagic left mesial temporal lobe and insular mass. Biopsy confirmed diagnosis of glioblastoma multiforme methylated MGMT, amplified EGFR, positive EGFRvIII . This case illustrates the intricate relationship between autonomic dysfunction and epilepsy, particularly focusing on pilomotor events in the presence of focal MRI abnormalities. The rarity of pilomotor seizures as a sole presenting feature complicates diagnosis, emphasizing the need for a comprehensive approach to unconventional seizures. Through rigorous assessment, continuous EEG monitoring, and imaging, we identified a non-enhancing left temporal lobe mass, confirmed as glioblastoma.Dr. Walia has nothing to disclose. Dr. Chalia has nothing to disclose. Mrs. Kaur has nothing to disclose. Dr. Shah has nothing to disclose.

Overview

  • The case report describes a unique presentation of glioblastoma, focusing on the importance of recognizing atypical seizure manifestations for timely diagnosis and intervention.
  • The patient presented with ictal piloerection, a rare form of autonomic seizure, and focal MRI abnormalities.
  • The study highlights the importance of a comprehensive approach to unconventional seizures and the need for rigorous assessment, continuous EEG monitoring, and imaging.

Comparative Analysis & Findings

  • The patient presented with rare pilomotor seizures, which were not recognized as a manifestation of ictal epilepsy at initial presentation.
  • Continuous EEG monitoring and repeat MRI brain demonstrated a non-enhancing, non-hemorrhagic left mesial temporal lobe and insular mass, confirming the diagnosis of glioblastoma multiforme.
  • The patient's ictal events were lateralized over the left temporal region, indicating a focal onset of the seizures.

Implications and Future Directions

  • The study emphasizes the need for a comprehensive approach to unconventional seizures, including rigorous assessment, continuous EEG monitoring, and imaging.
  • Future studies should investigate the relationship between autonomic dysfunction and epilepsy, particularly in the presence of focal MRI abnormalities.
  • The diagnosis of glioblastoma should be considered in patients with unusual seizure presentations, even in the absence of typical seizure semiology.
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