A 20-year-old man comes to the office for evaluation of abnormal behavior. Over the past 4 months, the patient has had several episodes of unresponsiveness, during which he would stare blankly while smacking his lips. He spontaneously becomes responsive after about 2 minutes and has no recollection of the event. The patient says these episodes are often preceded by an uneasy sensation in his upper abdomen and the pungent smell of something burning. He has had no falls or jerky movements of the extremities. The patient has no history of recent fever, headaches, head trauma, nausea, vomiting, or focal neurologic deficit. He had seizures in early childhood precipitated by high fevers but has had none since then and reports no other medical conditions. Cranial nerve examination reveals no abnormalities. Motor strength, sensation, and deep tendon reflexes are normal throughout. Neuroimaging is most likely to reveal an abnormality in which of the following locations in the brain?

Question

A 20-year-old man comes to the office for evaluation of abnormal behavior.  Over the past 4 months, the patient has had several episodes of unresponsiveness, during which he would stare blankly while smacking his lips.  He spontaneously becomes responsive after about 2 minutes and has no recollection of the event.  The patient says these episodes are often preceded by an uneasy sensation in his upper abdomen and the pungent smell of something burning.  He has had no falls or jerky movements of the extremities.  The patient has no history of recent fever, headaches, head trauma, nausea, vomiting, or focal neurologic deficit.  He had seizures in early childhood precipitated by high fevers but has had none since then and reports no other medical conditions.  Cranial nerve examination reveals no abnormalities.  Motor strength, sensation, and deep tendon reflexes are normal throughout.  Neuroimaging is most likely to reveal an abnormality in which of the following locations in the brain?

Quizplus · Accepted Answer

Eductional Objective: Recurrent focal impaired awareness seizures that are preceded by a distinctive aura (eg, uneasy epigastric sensation, olfactory hallucinations) are characteristic of mesial temporal lobe epilepsy.  The most common etiology is hippocampal sclerosis (mesial temporal sclerosis), which is associated with childhood febrile seizures.

A 20-Year-Old Man Comes to the Office for Evaluation of Abnormal