Drug-resistant epilepsy, early-onset hypertension and white matter lesions: a hidden paraganglioma.
Katri SilvennoinenAlison J WaghornSimona BalestriniSanjay M SisodiyaPublished in: BMJ case reports (2019)
We describe the case of a 35-year-old man with focal epilepsy since age 16. Due to a refractory course, several treatments were tried over the years, including insertion of a deep brain stimulator. At the time of his first assessment at our unit, he had recently been diagnosed with hypertension. An MR scan of brain revealed multiple T2 hyperintense white matter lesions, and evidence of previous haemorrhage in the left basal ganglia and pons. On follow-up imaging, the changes were considered to be in keeping with hypertensive arteriopathy. He was referred for further assessment of his hypertension and was found to have a para-aortic paraganglioma. This was excised 16 months after his initial presentation to us. The surgery was associated with an improvement in his seizure control. This case serves as a reminder of the need to be vigilant about the possibility of coexisting conditions in people with epilepsy.
Keyphrases
- white matter
- blood pressure
- drug resistant
- early onset
- multiple sclerosis
- multidrug resistant
- late onset
- acinetobacter baumannii
- temporal lobe epilepsy
- minimally invasive
- high resolution
- resting state
- computed tomography
- coronary artery bypass
- case report
- aortic valve
- magnetic resonance imaging
- pseudomonas aeruginosa
- acute coronary syndrome
- cystic fibrosis
- brain injury
- arterial hypertension
- contrast enhanced
- aortic dissection
- coronary artery disease
- fluorescence imaging