August 31, 2023

The symptoms manifested by the subject on August 30th I observed were sudden cessation of speech, freezing, gripping the podium and looking of the left, slightly up and away for a few minutes. This is often attributed to and underlying irritative lesion in this case the posterior inferior frontal gyrus. Broadman Areas 45 and 44 just anterior to the face area of the motor cortex in the Precentral gyrus and just above the Sylvian fissure. 

A.

This is the least likely to explain the sx of subject being assessed or ought be assessed fully. But this possibility  is extremely dangerous  

https://www.mayoclinic.org/diseases-conditions/intracranial-hematoma/symptoms-causes/syc-20356145. Post fall injury could have started a small bleed which can over time forma cyst like lesion and increase in size

• Headache that gets worse

• Vomiting

• Drowsiness and progressive loss of consciousness

• Dizziness

• Confusion

• Unequal pupil size

• Slurred speech

• Loss of movement (paralysis) on the opposite side of the body from the head injury

As more blood fills your brain or the narrow space between your brain and skull, other signs and symptoms may appear, such as:

• Lethargy

• Seizures

• Unconsciousness

B.

Transient ischemic attack (TIA) - Symptoms and causes - Mayo Clinic

Overview

A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke. A TIA usually lasts only a few minutes and doesn't cause permanent damage.

Often called a ministroke, a TIA may be a warning. About 1 in 3 people who has a TIA will eventually have a stroke, with about half occurring within a year after the TIA.

A TIA can serve as both a warning of a future stroke and an opportunity to prevent it.

Symptoms

Transient ischemic attacks usually last a few minutes. Most signs and symptoms disappear within an hour, though rarely symptoms may last up to 24 hours. The signs and symptoms of a TIA resemble those found early in a stroke and may include sudden onset of:

• Weakness, numbness or paralysis in the face, arm or leg, typically on one side of the body

• Slurred or garbled speech or difficulty understanding others

• Blindness in one or both eyes or double vision

• Vertigo or loss of balance or coordination

You may have more than one TIA, and the recurrent signs and symptoms may be similar or different depending on which area of the brain is involved.

C.

 Petit Mal : These non-convulsive seizures look like staring spells

1.. https://www.mayoclinic.org/diseases-conditions/petit-mal-seizure/symptoms-causes/syc-20359683 

2. Johns Hopkins Medical. Absence Seizures.

 

 3 a. Absence Seizures: Symptoms, Causes, Diagnosis, Treatment (verywellhealth.com) Illustrations provided.

What Are Absence Seizures?

These non-convulsive seizures look like staring spells

By Reza Shouri, MD, Updated on February 05, 2023,  Medically reviewed by Diana Apetauerova, MD

An absence seizure, often referred to as petit mal seizure, is a non-convulsive seizure that is often not recognized as a seizure at all. Absence seizures usually occur in children who have Epilepsy, but adults can have them as well. While absence seizures are not as disruptive or obvious as convulsive seizures, they cause impairment of consciousness and interfere with learning, driving, and other aspects of life.

Absence seizures can go unnoticed. They can occur several times a day and rarely cause disruption, noise, or clearly obvious manifestations. Sometimes, a person may experience them for months before others begin to take notice.

The person experiencing the seizure is usually not aware that it's happening. Consciousness is impaired, which means they're not aware of their surroundings or movements. Unlike other seizures, absence seizures do not cause jerking movements or physical convulsions, however.1

After the seizure, they will quickly resume awareness and continue what they were doing before it came on.

3. b. Illustrations for delineating Petit Mal Absence Seizures  Google Image Result

3. c.

Differential Diagnosis for Absence Seizures: Epilepsy Foundation. Temporal Lobe Epilepsy (TLE). Complex Partial Seizures: It has been renamed: Focal Impaired Awareness: 

• During this type of seizure, a person may have a fixed stare, be unaware or confused about what is going on around them, have fumbling with their fingers, or lip-smacking movements. The seizures last 30 seconds to a couple of minutes.

• There can be unusual posturing (movement or positioning) in an arm. This can help identify where seizures start in the brain.

• Some people also speak gibberish or lose their ability to speak in a sensible manner. Language problems are more common if the seizures are coming from the dominant temporal lobe.

• The focal seizure can go into generalized tonic-clonic jerking. The person may be weak after the seizure has stopped.

• Some people can also have prolonged seizures. Rarely, repeated or long seizures called status epilepticus may develop.

• Seizures in neocortical or lateral temporal lobe epilepsy often start with an auditory aura, such as buzzing or hearing a specific sound.

Patients often talk about experiencing a strange feeling that cannot be described. Major Risk factors include Brain injury including head trauma with loss of consciousness. Our subject has history of fall and concussion.

3. d 

Often, brain magnetic resonance imaging (MRI) is needed to identify whether there is a lesion in the brain that could be causing the episodes. A temporal lobe lesion, for example, can cause temporal lobe seizures, which may also manifest with repetitive movements and be mistaken for absence seizures.

3. e.

An electroencephalogram (EEG) will show a symmetrical 3 Hz spike and wave pattern. This is described as generalized seizure activity because it involves both sides of the brain, in contrast to focal seizure activity, which involves only one region. 24-hour sleep deprived EEG can be helpful for establishing more complete diagnosis of the basis  [Seizure disorders I have provided a link for overnight EEG record.

Often, the abnormalities on EEG can be elicited by hyperventilation, so your child may be asked to breathe rapidly during the EEG so that the pattern can emerge

3.e.i.

How a Sleep-Deprived EEG May Diagnose Seizures (verywellhealth.com)

What Is a Sleep-Deprived EEG for Seizures? Especially useful for clarifying Differential Diagnosis and getting to treatable underlying disorders that affect speech abruptly without loss of consciousness and loss By Brandon Peters, MD, Updated on October 21, 2022,  Medically reviewed by Diana Apetauerova, MD

A Sleep-deprived EEG is a type of EEG that's done to detect subtle seizures, like absence seizures or focal seizures. Like standard EEGs, this non-invasive test records the electrical activity of the brain and can pick up on abnormal brain waves through electrodes attached to the scalp. When you fall asleep or doze during the test, the machine will continue to record activity in your brain.

4. 

Transient ischemic attack (TIA) - Symptoms and causes - Mayo Clinic

Overview :

A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke. A TIA usually lasts only a few minutes and doesn't cause permanent damage.

Often called a ministroke, a TIA may be a warning. About 1 in 3 people who has a TIA will eventually have a stroke, with about half occurring within a year after the TIA. A TIA can serve as both a warning of a future stroke and an opportunity to prevent it.

Symptoms. There could be symptoms of aphasia and freezing abruptly if the TIA is induced by pathology of the superior branch of the Middle Cerebral Artery. But The common sx are listed were not observed during the past several months when he developed these “Absence” type events.

Transient ischemic attacks usually last a few minutes. Most signs and symptoms disappear within an hour, though rarely symptoms may last up to 24 hours. The signs and symptoms of a TIA resemble those found early in a stroke and may include sudden onset of:

• Weakness, numbness or paralysis in the face, arm or leg, typically on one side of the body

• Slurred or garbled speech or difficulty understanding others

• Blindness in one or both eyes or double vision

• Vertigo or loss of balance or coordination

You may have more than one TIA, and the recurrent signs and symptoms may be similar or different depending on which area of the brain is involved. The striking  behavioral change observed can be evoked by pathology affected the Superior branch of the Middle Cerebral Artery perfusing the Broca’s  area.

I welcome comments and discussion to get fuller understanding of the observed phenomena

Velandy Manohar, MD.,

Website: velandymanoharmd.com

Linked In: (29) Velandy Manohar | LinkedIn