SHM Converge Scientific Abstract ePoster Gallery-A Single Lesion, Many Symptoms: Mesial Temporal Sclerosis Misdiagnosed as Delirium, Infection, and Syncope

Pdf Summary

This poster describes a 48-year-old woman with a 20-year history of recurrent episodes that were repeatedly misdiagnosed as delirium, infection, syncope, or psychiatric illness. Her symptoms included confusion, behavioral changes, olfactory and visceral auras, focal motor jerks, and postictal confusion. Only after a neurology consultation during a hospitalization was mesial temporal sclerosis (MTS) identified using MRI with an epilepsy protocol, which showed left hippocampal atrophy and T2 hyperintensity.  <br /><br />The poster emphasizes that MTS is the most common structural cause of drug-resistant temporal lobe epilepsy and is frequently underrecognized because its presentation can mimic psychiatric or medical emergencies. Standard brain MRI may miss the diagnosis, while dedicated epilepsy-protocol imaging, hippocampal volumetry, and advanced quantitative methods improve sensitivity.  <br /><br />The case highlights major system-level reasons for delayed diagnosis, including fragmented psychiatric and neurologic care, diagnostic anchoring on earlier psychiatric labels, limited access to specialized imaging, and poor awareness of atypical seizure presentations. Red flags for clinicians include stereotyped recurrent episodes, brief loss of consciousness, olfactory or visceral auras, memory impairment, and focal neurologic signs during “psychiatric” events.  <br /><br />After targeted antiepileptic treatment, the patient’s seizure frequency dropped from 7–8 episodes per month to 2–3 per month, with marked improvement in behavior and cognition. The poster concludes that early recognition of MTS can prevent years of ineffective treatment and that surgical management offers high rates of long-term seizure freedom in appropriately selected patients.

Asset Subtitle

Sourabh Singh

Meta Tag

Author List Amit Kumar, Jugraj Singh, Neychelle Rocca, Sourabh Singh

Category Clinical Vignettes

Concept Temporal Sclerosis

Concept Temporal Lobe Epilepsy

Concept Drug-Resistant Epilepsy

Concept Epilepsy-Protocol MRI

Concept Seizure

Distinguished Non-Finalist

Presenter Organization Midwestern University

Presenting Author Sourabh Singh

Track Adult

Keywords

mesial temporal sclerosis

temporal lobe epilepsy

epilepsy protocol MRI

hippocampal atrophy

drug-resistant epilepsy

misdiagnosis

psychiatric mimic

olfactory aura

visceral aura

antiepileptic treatment

Temporal Sclerosis

Temporal Lobe Epilepsy

Drug-Resistant Epilepsy

Epilepsy-Protocol MRI

Seizure