Sargun Walia1, Papul Chalia1, Guntash Kaur2, Bhavan Shah1
1Penn State Milton S. Hershey Medical Center, 2Government Medical College Patiala
Objective:
The objective of this case report is to illustrate a unique presentation of glioblastoma, emphasizing the importance of recognizing atypical seizure manifestations for timely diagnosis and intervention.
Background:
Ictal piloerection, often referred to as "goose bumps," represents a rare form of autonomic seizures, frequently under recognized as a manifestation of ictal epilepsy. The prevalence of pilomotor seizures is rare and estimated as 1.2% in temporal lobe.
Results:
52-year-old male with history of hypertension, arthritis, asthma presented initially to the hospital with generalized tonic clonic seizures. Patient initial semiology was described as presence of full body piloerection, erythema, and dizziness, at times would cluster and further cause a generalized tonic clonic seizure. Patient had initially presented to a community hospital, where a MRI brain revealed left temporal lobe edema suspected from a seizure. CSF studies obtained were non contributory for any signs of infection, no cytology was performed and the patient was discharged home on Levetiracetam. He later presented to an academic center with a generalized tonic clonic seizure. Patient was then placed on continuous EEG, while he continued to have multiple episodes of full body piloerection, metallic taste in the mouth, with preserved awareness. These events were ictal and lateralized over the left temporal region. Repeat MRI brain demonstrated a non-enhancing, non-hemorrhagic left mesial temporal lobe and insular mass. Biopsy confirmed diagnosis of glioblastoma multiforme methylated MGMT, amplified EGFR, positive EGFRvIII .
Conclusions:
This case illustrates the intricate relationship between autonomic dysfunction and epilepsy, particularly focusing on pilomotor events in the presence of focal MRI abnormalities. The rarity of pilomotor seizures as a sole presenting feature complicates diagnosis, emphasizing the need for a comprehensive approach to unconventional seizures. Through rigorous assessment, continuous EEG monitoring, and imaging, we identified a non-enhancing left temporal lobe mass, confirmed as glioblastoma.