A case of somatosensory, paralytic seizure and sensory Jacksonian march followed by supplementary motor seizure, caused by cerebral venous angioma

Abstract

We report a case of unusual epileptic seizures caused by cerebral venous angioma. A 25-year-old woman had suffered from pharmacoresistant seizures for 19 years. Her attacks began with a tingling sensation in the some of the left foot and continued with muscular weakness of the left foot for several hours. This sensation suddenly marched from the sole to the thigh of the left leg, and was followed by tonic-clonic movements in the four extremities. Consciousness was preserved during the seizures. Neurological examination revealed no abnormality except for weakness of the left gastrocnemius muscular strength. After intravenous administration of gadolinium, brain MRI showed strong enhancement of the tubular structures, which extended from the right parietal lobe to the ventricular wall. Contrast angiography revealed a venous angioma in the right parietal lobe. IMP-SPECT disclosed decreased cerebral blood flow in the area adjacent to the venous angioma. An EEG recording demonstrated sharp waves at Cz and Pz at interictal periods, and diffuse spike rhythms followed by a 7-Hz diffuse spike and wave complexes during the tonic-clonic seizures. This series of seizures began with localized somatosensory and paralytic seizures caused by the venous angioma, often leading to sensory Jacksonian march and finally to what appeared to be generalized tonic-clonic convulsion. We considered that the seizure discharges spread through the Rolandic sensory strip and to the supplementary motor seizure which involves all of the four extremities with preserved consciousness.