Case report

A 47-year-old female presented to the emergency department of our center with a history of 1 episode of jerky movement of the left upper limb following lip smacking lasting for about 15–30 seconds, followed by loss of consciousness and post-ictal confusion. However, there is no history of uprolling of the eyes, tongue biting, frothing of the mouth, generalized tonic-clonic movement, and bowel or bladder incontinence. Also, there was no history of fever, trauma, or previous seizure disorder. She also complained of 6-7 episodes of headache mimicking migraine from 1 year on and off, relieved by over-the-counter medications. She had been diagnosed with hypothyroidism for 6 years and is under levothyroxine. On examination, there were no signs of meningeal irritation with normal systemic examination. Her vital signs were within normal limits.
Neurological assessment was normal, along with unremarkable laboratory findings. The EEG was done and showed no epileptiform discharge. The CT head also shows no abnormality.
Thus, she was admitted for neurological monitoring and further evaluation. An MRI of the brain was planned, which revealed a small lobulated popcorn appearance lesion of size 10*9.5*8.5 mm with a central high and peripheral low intensity rim in the right frontal lobe and white matter showing tiny enhancing areas within, blooming in SWIs with mixed bright and dark phase images (Figure 1: MRI of brain on right )and altered low T2 signal intensity (Figure 1: MRI of brain on left ) around them, suggestive of frontal lobe cavernoma.
Figure 1