SHM Converge Scientific Abstract ePoster Gallery-An Uncommon Case of Focal Seizures Manifesting as Episodic Aphasia

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This case describes a 75-year-old man with progressive altered mental status, generalized weakness, and intermittent expressive aphasia. Because his speech difficulty triggered a code stroke, he underwent urgent evaluation. CT head, MRI brain, CT angiography, and lumbar puncture were all unremarkable, and there was no evidence of acute stroke, hemorrhage, infection, or structural brain disease. Laboratory testing showed severe hyperglycemia and diabetic ketoacidosis (glucose 676 mg/dL, low bicarbonate, elevated anion gap, and hyponatremia), so he was initially treated for metabolic encephalopathy with IV fluids and insulin.<br /><br />Despite improvement in metabolic abnormalities, he continued to have brief episodes of aphasia while remaining awake and alert, with no focal motor or sensory deficits. EEG later demonstrated focal neuronal slowing in the left temporal lobe, correlating with speech arrest and consistent with a focal seizure focus. After loading with levetiracetam (Keppra) and starting maintenance therapy, his aphasic episodes became less frequent and shorter, and the EEG findings resolved. At 2-month follow-up, he had no recurrence of aphasia.<br /><br />The report emphasizes that episodic aphasia is usually linked to stroke, migraine, infection, or metabolic causes, but focal seizures are an important and uncommon cause. In this patient, diabetic ketoacidosis may have lowered the seizure threshold. The key lesson is to maintain a broad differential diagnosis for aphasia, especially when routine stroke and infectious workup is negative, because early recognition and treatment of focal seizures can prevent progression and long-term neurologic harm.

Asset Subtitle

Maya N. McKee

Meta Tag

Author List Arti Tewari, Maya N. McKee

Category Clinical Vignettes

Concept Speech Abnormality

Concept Focal Seizure

Concept Episodic Aphasia

Concept Stroke

Concept Seizure

Distinguished Non-Finalist

Presenter Organization University of Chicago Pritzker School of Medicine

Presenting Author Maya N. McKee

Track Adult

Keywords

aphasia

focal seizure

diabetic ketoacidosis

metabolic encephalopathy

expressive aphasia

EEG

left temporal lobe

stroke mimic

levetiracetam

hyperglycemia

Speech Abnormality

Focal Seizure

Episodic Aphasia

Stroke

Seizure