Rare Presentation of Basal Ganglia Stroke

Abstract

We present a case of 69 year old male patient who was brought to the emergency room of our hospital with

complaints of fever for 3 days and seizure 2 episodes of GTCS three hours before coming to hospital. On

arrival in the ER he was conscious and oriented to time, place and person. His GCS was E3V4M6. No

motor or sensory deficit was present. He was afebrile, mild dehydration was present. His rest of vitals were

within normal range. He had a past history of hypertension and diabetes for which he was taking regular

medicines. MRI brain was done on the same day, which showed generalized age related cerebral atrophy

with periventricular chronic ischemic changes. No evidence of acute infarct or bleed was seen. Supportive

treatment started and he was shifted to ICU for further management. A diagnostic lumbar puncture was

done, which was within normal limits. No malignant cell seen in CSF. His vitals remained stable and

within normal limits. There was no evidence of any new seizure. He was normally talking and following all

treatment related advises. However, on the second day of ICU admission his son during ICU visiting hour

noted that though he was understanding and answering all his questions correctly, but his responses were

slightly delayed than usual (apathy)(1,2,3). A repeat MRI was done which showed acute infarct involving

left basal ganglia and adjacent corona radiata region with restriction on diffusion weighted images. Apart

from subtle apathy there was no other sign or symptom suggestive of stroke. The patient was managed

conservatively and was discharged to home with uneventful recovery.

Conclusion-A new onset seizure in an elderly patient should be evaluated for cerebrovascular disease and

stroke.Only apathy could be symptom of basal ganglia stroke. Further family members and primary caregiver

should be included during neurological assessment to find out subtle neurological changes.