Case history
Case history #1
A 16-year-old boy presents to the emergency department with a first-time seizure event after attending an all-night party and consuming alcohol. Witnesses described the seizure as beginning abruptly with bilateral limb stiffening, followed by jerking movements in all limbs; the patient has no memory of warning symptoms prior to the seizure. The event seemed to last about 1 minute, and the patient was quite somnolent afterward. Further review of the history reveals that the patient has been experiencing "jerks" in the morning after awakening, usually involving the arms and shoulders and occasionally causing him to drop things. These "jerks" do not seem to present a problem during the rest of the day.
Case history #2
A 55-year-old woman recently diagnosed with a brain tumor in the left hemisphere has a witnessed seizure event. The seizure is initially recognized when the patient begins staring and is unresponsive to those around her. She seems to be picking at her clothes with her left hand, but the right arm and leg are not moving. After 20 seconds, she displays rapid head-turning and eye deviation to the right, with tonic extension of the right arm and flexion of the left arm. This is quickly followed by tonic extension of the left arm, then clonic jerking occurring in both arms synchronously. This jerking gradually slows and stops after about 30 seconds. The patient then becomes quite somnolent, and she appears to be using her arm and leg less on the right than the left.
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