RESUMEN
Insular seizure is a rare entity. Insular spikes spread to the temporal, parietal, and frontal lobes and clinically manifest with seizure semiology specific to these areas. We report the case of a 19-year-old male patient who presented with complaints of left-sided hemimotor tonic-clonic focal seizures of the limbs occurring three times per day. Neuroimaging showed cortical-subcortical right posterior insular cortex hyperintensities on fluid-attenuated inversion recovery (FLAIR) sequence and T2-weighted MRI with no significant diffusion restriction on apparent diffusion coefficient (ADC) and no post-contrast enhancement, suggesting focal cortical dysplasia of right posterior insular cortex. Electroencephalogram (EEG) showed right frontal epileptiform activity with secondary bilateral synchrony. The patient's atypical hemimotor tonic-clonic focal seizure, the conventional video EEG showing right frontal spikes synchronizing with bilateral temporal ictal spikes, and insular cortical dysplasia on MRI led us to a diagnosis of insular epilepsy.
RESUMEN
Metronidazole is an antibiotic often used to treat bacterial infections in the vagina, skin, liver, stomach, joints, brain and spinal cord, heart, lungs, or bloodstream. It is an essential drug for treating anaerobic bacterial infections, microaerophilic bacterial infections, and protozoal infections. It is cytotoxic to many facultative anaerobic microorganisms. Metronidazole can be taken by most children and adults but might not be suitable for some people. It may produce different neurologic side effects like cerebellar dysfunction, peripheral neuropathy, vestibulotoxicity, visual impairment, encephalopathy, ataxic gait, seizures, dysarthria, and cochleotoxicity. We report a case of a gentleman in his early 60s with a liver abscess and a history of three weeks of use of metronidazole therapy presenting with altered sensorium, abnormal gait, and slurring of speech. MRI brain showed bilateral symmetrical hyperintensities involving the dentate nuclei of the cerebellum and dorsal brain stem without evidence of any diffusion restriction suggestive of metronidazole-induced encephalopathy (MIE).
