Frontal encephalocele in a middle-aged woman with first seizure: smells like a seizure to me.

A 48-year-old woman with a history only of chronic sinus symptoms presented with her first seizure. Coworkers witnessed a staring spell and speech interruption for approximately 30 seconds followed by a generalized convulsion lasting 2 minutes. After brief postictal confusion, her neurologic examination was normal. Laboratory studies showed no abnormalities. There were no identifiable provoking factors such as infection or sleep deprivation.Noncontrast headCT (figure, A) revealed soft-tissue density in the right nasal cavity and sphenoid, ethmoid, and maxillary sinuses, thought to represent a skull base tumor. An MRI study (figure, B–D) demonstrated a large frontal encephalocele and dysplasia in both inferior frontal lobes. EEG showed intermittent bifrontal rhythmic delta activity. Developmental abnormalities such as encephalocele can present in adulthood as epilepsy that often may be corrected by surgical intervention.1,2 James F. Morley, MD, PhD, Dennis L. Kolson, MD, PhD, Philadelphia, PA.