CASE 1: A 19-year-old woman with diagnosed psychogenic non epileptic spells, presented for evaluation of acute onset gait imbalance and abrupt movements. Observation of the movements revealed jerky movements of her right hemi-body, occurring with variable intensity and frequency. Her gait was consistent with astasia-abasia, and neurological examination was otherwise unremarkable. CSF studies were negative for any autoimmune or infectious etiologies. EEG was normal. Gadolinium enhanced magnetic resonance imaging (MRI) of the brain revealed a non-enhancing white matter lesion in the posterior parietal lobe on the right subcortical and temporoparietal region.
A 51-year-old man with prior suicide attempt, major depressive disorder, and no prior history of seizures, presented after a motor vehicle accident. On examination, he was appropriately responsive and oriented; with on-going distractible, generalized nonrhythmic shaking which alternated sides with his eyes closed. History was notable for a prior traumatic head injury. Routine EEG was normal, and MRI brain revealed encephalomalacia and laminar necrosis of the right temporal lobe, involving the right temporoparietal junction.