2025 American Academy of Neurology Abstract Website

Objective:

To highlight a case of epilepsia partialis continua in a patient with meningeal extension of an extracranial mass which was diagnosed as “meningioma” by primary care without biopsy.

Background:

This is a 69yo right-handed female with acute onset left facial twitching and decreased movement in the left upper extremity upon waking up in the morning approximately 2 hours before arrival to the hospital. This twitching was noticed with additional leftward gaze by husband shortly after. She was able to follow commands, nod yes-no, and had some appropriate verbal answers during the continuous twitching. She had recently been diagnosed with a meningioma in the last month after she had rapidly increasing extracranial “fullness” over her right temple. Lorazepam was administered with delayed but good effect and patient was started on levetiracetam.

Design/Methods:

N/a

Results:

CT during the seizure, showed a large mass in subgaleal space with extension through the osseous structures into the meningeal spaces, and perfusion imaging showed hyperperfusion in the area of the mass as well as the surrounding brain consistent with seizure-activity. MRI showed large marrow-replacing tumor extending extracranially into the subgaleal space and, temporalis muscle, and intracranially into the epidural and subdural. Pathology was consistent with Follicular B-cell Lymphoma.

Conclusions:

This was a patient who had a visible swelling of her scalp who was told it was a meningioma and needed a nonurgent appointment for evaluation, who came into the hospital with 2 hours of continuous seizure activity as a result of the rapidly increasing growth of this mass, which on imaging was not consistent with a typical meningioma. She was started on antiseizure medication and started on intrathecal methotrexate with good results. However, timely imaging or biopsy of the scalp swelling might have lead to earlier detection and treatment, and spared this patient from status epilepticus and seizure medication.