84 year old woman with spells of right upper limb weakness and numbness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy.

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Presentation transcript:

84 year old woman with spells of right upper limb weakness and numbness Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology

Vignette History of: – Prior strokes to left parietal and right occipital lobes. – Metastatic breast cancer with skull involvement. O’Gorman et al © 2014 American Academy of Neurology

Imaging O’Gorman et al © 2014 American Academy of Neurology

Imaging O’Gorman et al © 2014 American Academy of Neurology

EEG pattern associated with a skull osteolytic lesion in breast cancer Breach effect or breach rhythm – a focal increase in amplitude of alpha, beta and mu rhythms detected at or near the site of a bony skull defect.[1] – Usually associated with surgical skull defects. – Also seen in osteolytic lesions of the skull.[2] – No association with epilepsy. – EEG alteration may be confused with focal epileptiform discharges. Final diagnosis: focal seizure O’Gorman et al © 2014 American Academy of Neurology