Summary:A 66-year-old right-handed man developed seizures characterized by an electric sensation and convulsive movements involving the left arm, which sometimes secondarily generalized. The patient, however, reported that the seizures occurred in his right arm. Neurological examination showed many features of left hemineglect, including allesthesia, secondary to acute infarction of the right parietal lobe.Although allesthetic response was not documented during the seizure, it is likely that sensory symptoms of the seizures were localized inappropriately or that he had false memory for lateralization of seizures. In this case, the neglect syndrome caused by infarction of the right parietal lobe extended to symptoms of the seizure itself. Key Words: AllesthesiaNeglect-Seizure-Cerebral infarction-Right parietal lobe.Unilateral ictal somatosensory, motor, and visual phenomena are generally reliable indicators of the hemisphere of seizure onset, whereas other types of phenomena provide less reliable lateralizing information (1). As an exception, we report a patient with a right hemispheric infarction who incorrectly indicated that his seizures began in the ipsilateral arm and hand. CASE REPORTA 66-year-old right-handed man was admitted to the hospital because of partial seizures. His son had noticed that his father's left shoulder drooped and that he had begun dragging his left foot several hours before the first seizure. On the day of admission, he developed five partial seizures, three of which secondarily generalized. There was recovery of consciousness between seizures. He recalled that his seizures began abruptly with an electric sensation in his right hand and that his right hand became twisted. However, his family and attending physicians observed dystonic postures and clonic movements of his left hand and arm at the beginning of the seizures and postictal left hemiparesis.The patient drank alcohol socially and smoked one pack of cigarettes a day. General medical examination was unremarkable. The day after admission, he was alert and oriented but indifferent to his neurological deficits. He had Accepted September 13, 1996. Address correspondence and reprint requests to Dr. K. Heo at Department of Neurology, Pusan-Paik Hospital, 633-165 Kaikum-Dong, Pusanjin-Ku, Pusan 614-735, Korea. mild dysarthria, a left homonymous hemianopsia, mild left hemiparesis, and slight bradykinesia on the left. He recognized that his left-sided arm and leg belonged to him. There was no aphasia, acalculia, or left-right disorientation. He could not draw a cube or cross well, and when he performed a crossing-out task he failed to strike out 17 of the 36 marks, all of which were on the left side. He also bisected a line far to the right. When tested for extinction, with use of unilateral right-hand tactile and right-sided auditory stimuli, his performance was flawless. However, when given unilateral left-hand tactile and left-sided auditory stimuli, he detected all stimuli but displaced the stimuli to the right hand and ear in most tr...
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