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Epileptic aphasic seizure — SCE Neurology MCQ

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HardEpilepsyEpileptic aphasic seizureSCE Neurology

A 22-year-old man presented with brief recurrent episodes of inability to speak with preserved awareness. On examination, comprehension was intact between events and there was no headache. Initial investigations showed: EEG showed left temporal ictal discharges during an episode. What is the most likely diagnosis?

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Correct answer: E — Dominant-temporal focal aphasic seizure with preserved awareness

The best answer is “Dominant-temporal focal aphasic seizure with preserved awareness”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Migraine aura with gradual positive visual and sensory symptoms”, “Transient ischaemic attack without stereotyped recurrent ictal activity”, “Functional speech arrest with no electroclinical correlate”, “Absence seizure with generalised three-hertz spike-wave activity” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/