a 41-year-old woman with seizure

the patient was a 41 year old woman that was brought to the emergency department (ed) by her husband following seizure. according to the relatives accompanying her, the seizure was of tonic-clonic type, had occurred one hour before presentation to ed, and had lasted 3 minutes. the patient had been drowsy for about 15 minutes after the end of the seizure. she had no history of head trauma and did not mention headache, nausea and vomiting, fever, vision problems or others. on presentation, amnesia regarding the things that happened was evident. in her history, she had a generalized tonic-clonic seizure 4 years back, regarding which she had not done proper follow up for taking necessary diagnostic measures and had not been treated with anti-epileptic medication. she had a history of surgery for removing cold thyroid nodule 20 years ago and was under calcium treatment for 15 years but she had decided to stop taking her medications since 5 year ago. she did not have a history of alcohol or drug abuse. the patient was conscious and awake on presentation and did not have any specific clinical complaints. her vital signs on presentation were as follows: blood pressure = 120/70mmhg, pulse rate = 68/minute, respiratory rate = 16/minute, o2saturation= 98% at air room, oral temperature= 37°c, and bedside blood sugar in the normal range. in head and neck examination, the surgery scar was seen in the thyroid region. examination of the thyroid also showed a nodular surface in palpation. examination of the heart, lungs, abdomen and extremities did not have pathologic findings. neurologic examinations including evaluation of cranial nerves, sense and power of the muscles, cerebellar examination and deep tendon reflexes were normal. based on the opinion of the in-charge physician, anti-epileptic drugs were not prescribed at this stage. laboratory tests including complete blood cell count, liver function tests (lft), and level of blood sugar (bs), sodium, potassium, calcium, phosphorus, magnesium, urea and creatinine electrolytes were ordered. considering the full consciousness of the patient and stability of vital signs and clinical examinations, by taking safety measures and accompanied by a nurse, the patient was referred to the radiology unit to undergo a brain computed tomography (ct) scan, the results of which are shown in figure 1.