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Focal epilepsy due to cavernoma — SCE Neurology MCQ

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ModerateEpilepsyFocal epilepsy due to cavernomaSCE Neurology

A 71-year-old woman presented with stereotyped right facial twitching followed by expressive aphasia. On examination, there was mild right facial weakness between attacks. Initial investigations showed: MRI showed a left inferior frontal mixed-signal lesion with haemosiderin rim. What is the most likely diagnosis?

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Correct answer: E — Focal epilepsy due to cavernoma

Focal epilepsy due to cavernoma is the best answer because the vignette describes Focal epilepsy due to cavernoma: a cavernoma with matching focal seizures is the most likely epileptogenic lesion. Nocturnal frontal lobe epilepsy is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Autoimmune limbic encephalitis with seizures and Post-traumatic epilepsy are less appropriate because they would require different localisation, timing or test findings; Psychogenic non-epileptic seizure would fit a different syndrome. Clinical pearl: low-grade glioma is a differential but the haemosiderin popcorn appearance favours cavernoma.

Reference: NICE NG217; BNF; DVLA Assessing fitness to drive