Case report

A 70-year-old woman presented in 2007 with episodes of left- or right-sided paraesthesiae, which would gradually spread over the affected side, sometimes associated with difficulty in walking, or episodes of expressive dysphasia with sensory disturbance in the mouth or tongue. The attacks typically evolved over several minutes and lasted up to 30 min. They occurred up to three times a week over an 18-month period. She had no significant medical history, nor any relevant family history. Her general practitioner had started aspirin after the first episode in August 2007; dipyridamole had subsequently been added at the local transient ischaemic attack (TIA) clinic. However, the events became more frequent and severe.

She scored 95/100 on the Addenbrookes Cognitive Examination-Revised (ACE-R). Carotid Doppler ultrasound studies found no significant extracranial precerebral arterial stenoses. Interictal EEGs demonstrated bitemporal epileptiform changes, with frequent irregular slow wave activity with sharp components in the middle to anterior temporal region bilaterally.

In early 2009, an MR brain scan showed a small (1.3 cm) intraparenchymal haemorrhage in the right parietal lobe. Further MRI with gradient …