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CASE REPORT
Drug-resistant epilepsy, early-onset hypertension and white matter lesions: a hidden paraganglioma
  1. Katri Silvennoinen1,2,
  2. Alison J Waghorn3,
  3. Simona Balestrini1,2 and
  4. Sanjay M Sisodiya1,2
  1. 1 Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
  2. 2 The Chalfont Centre for Epilepsy, Chalfont St Peter, UK
  3. 3 Royal Liverpool University Hospital, Liverpool, UK
  1. Correspondence to Sanjay M Sisodiya, s.sisodiya{at}ucl.ac.uk

Abstract

We describe the case of a 35-year-old man with focal epilepsy since age 16. Due to a refractory course, several treatments were tried over the years, including insertion of a deep brain stimulator. At the time of his first assessment at our unit, he had recently been diagnosed with hypertension. An MR scan of brain revealed multiple T2 hyperintense white matter lesions, and evidence of previous haemorrhage in the left basal ganglia and pons. On follow-up imaging, the changes were considered to be in keeping with hypertensive arteriopathy. He was referred for further assessment of his hypertension and was found to have a para-aortic paraganglioma. This was excised 16 months after his initial presentation to us. The surgery was associated with an improvement in his seizure control. This case serves as a reminder of the need to be vigilant about the possibility of coexisting conditions in people with epilepsy.

  • epilepsy and seizures
  • hypertension
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Footnotes

  • Contributors KS: literature review and drafting of the report. AJW, SB and SMS: critical review of the report.

  • Funding This study was funded by Muir Maxwell Trust, Epilepsy Society.

  • Competing interests SMS reports grants from Epilepsy Society and the Muir Maxwell Trust during the conduct of the study; personal fees from UCB, Eisai and Nutricia and grants from Vitaflo, outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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