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A 26 year old music composer presented with sudden onset of frontal headache followed by an episode of witnessed tonic-clonic convulsion which lasted 10 minutes. He had bitten his tongue and was confused for 20 minutes. There was no visual disturbances. He was previously in good health without a history of epilepsy or other illnesses. There was no family history of epilepsy. His alcohol intake had been 5–10 units per week for the past eight years.
The patient had a normal BM of 6.8 when checked by the ambulance crew. On arrival in the accident and emergency department, physical examination was unremarkable. The patient became more alert and his Glasgow coma scale score was 15/15. His vital signs were normal with a blood pressure of 150/84 mm Hg. There was no focal neurology or signs of meningism. Fundoscopy was normal and visual field was full on direct confrontation. Blood tests including blood glucose (5.0 mmol/l), electrolytes, liver function, and full blood count were all normal. A magnetic resonance imaging (MRI) scan of the skull was performed (fig1, left). He did not receive any treatment and a repeat MRI scan was performed seven months later (fig 1, right).
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