A 58-year-old man with a prior history of coronary artery disease, hypertension, and radical prostatectomy for adenocarcinoma 6 years earlier presented with a 1-week history of headache and nausea, followed by a witnessed generalized tonic-clonic seizure. The history was positive for a 100 pack-year smoking history and an absence of intravenous drug use or sexual promiscuity. The physical examination, after resolution of the postictal state, was remarkable only for a tongue bite. Routine laboratory studies and toxicology screening were normal. An initial noncontrast computed tomography (CT) scan of the brain showed a questionable tiny arachnoid cyst adjacent to the right tentorium and ethmoid sinusitis (Fig 1). A magnetic resonance imaging (MRI) scan with contrast revealed a hypodense area with loss of gray-white differentiation on T1 imaging. Postgadolinium scan showed an enhanced 1.6 ϫ 1.3 cm mass in the left anteromedial temporal lobe (Figs 2A to 2C, arrows). There was also increased signal on T2 and flair images in the surrounding white matter suggestive of edema/mass effect (Figs 2D and 2E, arrows). There was a 0.65-cm area of increased signal on T2 and hypointense flair without enhancement on the postgadolinium measures in the right temporal region, likely representing a subarachnoid cyst. The differential included metastases, primary lymphoma, meningioma, and toxoplasmosis. A CSF
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