Case report

A 19-year-old right-handed woman reported three episodes of loss of consciousness since the age of 13 years, each preceded by light-headedness and burning in the throat and with amnesia and confusion after the event. She had also experienced occasional vacant episodes suggestive of complex partial seizures and mild self-limiting headaches. The frequency of the vacant episodes had increased to once monthly with temporary episodes of dysphasia lasting a few minutes.

Neurological examination was normal. She was started on levetiracetam.

MRI scan of the brain showed a small spherical enhancing mass within the cortex along the depths of the superior temporal sulcus, involving the upper bank of the middle temporal gyrus on the left (figure 1). The perfusion imaging showed a regional cerebral blood volume of 1.1 ml/100 g. Spectroscopy demonstrated low N-acetyl aspartate and an inverted peak at 1.33 ppm suggesting lactate. Diffusion-weighted …