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NCSE with Underlying Tumour — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersNCSE with Underlying TumourSCE Neurology

A 55-year-old man is brought to the emergency department after being found confused. EEG shows continuous left temporal rhythmic delta activity with superimposed sharp waves. He is treated for NCSE with IV lorazepam and IV levetiracetam. Follow-up EEG shows resolution of the epileptiform pattern. However, he has a persistent receptive aphasia. MRI brain reveals a left temporal lobe mass lesion. What is the most likely explanation for the persistent aphasia?

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Correct answer: C — Structural damage from the underlying tumour causing the aphasia independently of the seizures

While the NCSE has resolved (confirmed by EEG), the persistent aphasia is most likely due to the underlying structural lesion (left temporal tumour) affecting Wernicke's area directly. The tumour was the cause of the NCSE and is independently causing aphasia through mass effect or infiltration. Further management should focus on the tumour diagnosis (biopsy/resection). A: EEG shows resolution of NCSE. B: Todd's aphasia typically resolves within hours. D: Levetiracetam does not typically cause isolated receptive aphasia. E: No nutritional deficiency history.

Reference: NICE NG99 Brain Tumours (2021); NICE NG217 (2025)