A 24-year-old man has stereotyped episodes of rising epigastric sensation followed by unresponsive staring with automatisms lasting about 90 seconds, sometimes with postictal dysphasia. MRI brain shows a small, T2-hyperintense hippocampus with loss of internal architecture on the left. What is the underlying pathology?
- A Mesial temporal sclerosis (hippocampal sclerosis) ✓
- B Focal cortical dysplasia type II
- C Low-grade glioneuronal tumor
- D Cavernous malformation
Correct answer: A. Mesial temporal sclerosis (hippocampal sclerosis)
Explanation
The semiology of epigastric aura, automatisms, and postictal aphasia localizes to the dominant mesial temporal lobe, and hippocampal atrophy with increased T2 signal and lost internal architecture is the hallmark of mesial temporal sclerosis, the commonest cause of drug-resistant focal epilepsy in adults. Cortical dysplasia and tumors produce extra-hippocampal structural lesions rather than isolated hippocampal signal change.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.