A 60 year old woman is reviewed in a neurology clinic after experiencing three 'funny turns' in the last month. She describes a rising feeling in her stomach, after which she goes 'blank' for around one minute. She does not fall to the floor, and has had no incontinence or tongue biting (her daughter reports vigorous lip movements during the episodes.)  The patient does not recall what has happened and remains  confused for a few minutes. 

She is usually fit and well, takes no regular medications, and does not smoke or drink alcohol. She is right-handed.


Neurological examination is normal, and all observations are within normal limits.


Which of the following brain regions is most likely implicated in this patient's presentation?

Options:
explanation: This vignette describes a focal seizure involving the left temporal lobe. Common signs of a frontal lobe seizure include contralateral motor symptoms, post-ictal weakness and Jacksonian march (clonic movements travelling proximally). By contrast, lip-smacking, language deficits and unusual epigastric sensations are more suggestive of a temporal lobe seizure.
name: Left frontal lobe
label: b
answer: no
explanation: This vignette describes a focal seizure involving the left temporal lobe. As this woman is right-handed, the most likely localisation would be in the left hemisphere of the brain. In right-handed individuals, language and speech centres are typically located in the left hemisphere. The lip-smacking, language deficits and unusual epigastric sensation are consistent with a temporal lobe seizure localisation. The temporal lobe is often associated with processing visceral and emotional experiences, and orofacial automatisms. By contrast, symptoms of occipital lobe seizures include visual hallucinations, uncontrolled eye movements and flashes, as the primary visual cortex is located in the occipital lobe.
name: Right occipital lobe
label: e
answer: no
explanation: This vignette describes a focal seizure involving the left temporal lobe. As the primary visual cortex is located in the occipital lobe, symptoms of occipital lobe seizures include visual hallucinations, uncontrolled eye movements and flashes. By contrast, lip-smacking, language deficits and unusual epigastric sensations are more suggestive of a temporal lobe seizure.
name: Left occipital lobe
label: c
answer: no
explanation: This is the correct answer. This vignette describes a focal seizure involving the left temporal lobe. In right-handed individuals, language and speech centres are typically located in the left hemisphere. This suggests a left-sided seizure location in this patient. The lip-smacking, language deficits and unusual epigastric sensation are consistent with a temporal lobe seizure localisation: this region is associated with processing visceral and emotional experiences, as well as orofacial automatisms.
name: Left temporal lobe
label: a
answer: yes
explanation: This vignette describes a focal seizure involving the left temporal lobe. Common signs of a frontal lobe seizure include contralateral motor symptoms, post-ictal weakness and Jacksonian march (clonic movements travelling proximally). By contrast, lip-smacking, language deficits and unusual epigastric sensations are more suggestive of a temporal lobe seizure.
name: Right temporal lobe
label: d
answer: no

Correct answer: a

Left temporal lobe