Seizure Localization

Question 1

Somatosensory phenomenon:

• Jacksonian March
• Well Defined
• Slow spread

Answer 1

(mostly CL)

Primary somatosensory area (Parietal lobe)

Question 2

Somatosensory phenomenon: Ill defined, may be accompanied by pain. Fast spread

Answer 2

(IL or CL)
Supplementary somatosensory
- Posterior Insula
- Parietal operculum

Question 3

• Diffuse contralateral or Bilateral tingling

- Sensation of movement

Answer 3

Supplementary Motor Area

Question 4

• Cephalic sensation

- Nonvertiginous Dizziness

Answer 4

(often) frontal lobe

Question 5

• Ictal Headache

Answer 5

(IL)

Temporal or Occipital

Question 6

Gustatory Aura (metalic / rubbery)

Answer 6

• Insula
• Rolandic Operculum
• Parietal

Question 7

Elementary Auditory

Answer 7

(CL)

- Contralateral primary auditory cortex

Question 8

Olfactory Aura

Answer 8

Anterior mesial temporal (“uncinate fits”)

Question 9

Visual aura

Answer 9

Contralateral Occipital

Question 10

Ictal Blindness

Answer 10

Contralateral occipital

Question 11

Deja vous / Jamais vou

Answer 11

Mesiotemporal (w/o lateralization)

Question 12

Forced thinking: more verbal

Answer 12

Dominant frontal

Question 13

Forced thinking: more emotional

Answer 13

Dominant mesiotemporal

Question 14

Ictal Fear

Answer 14

Amygdala or Cingulate

Question 15

Ecstatic Aura

Answer 15

Amygdala or Cingulate

Question 16

Orgasmic Aura

Answer 16

• Non-Dominant Mesiotemporal

- Parasaggital

Question 17

initial autoscopy (“out of body” sensation)

Answer 17

Non-dominant parietal

Question 18

Forced Head turn (>5 sec)

Answer 18

94% PPV CL (mostly temporal or frontal)

Question 19

Head turn: early, non-forced)

Answer 19

IL

• Temporal
• Basal Ganglia

Question 20

Head / Eye deviation AFTER GTC

Answer 20

typically Ipsilateral

Question 21

“Y sign”

Answer 21

SSMA or SMA

Question 22

Tonic Seizure

Answer 22

often frontal lobe (medial SMA)

Question 23

Gyratory Seizures with forced head turn

Answer 23

CL frontotemporal

Question 24

Gyratory Seizure with en bloc version

Answer 24

IL

Question 25

Gyratory seizure with rotation to prone

Answer 25

frontal

Question 26

Ictal smile

Answer 26

non-dominant parietal

Question 27

ictal pouting (chapeau de gendarme)

Answer 27

- Mesial frontal | - Angulate cingulate

Question 28

Behavioral arrest

Answer 28

- Temporal | - Orbitofrontal

Question 29

Bizarre behavior

Answer 29

Orbitofrontal

Question 30

Automatisms: manipulative unilateral limb

Answer 30

Ipsilateral

Question 31

Automatisms: proximal, non-manipulative

Answer 31

Contralateral temporal

Question 32

Oral automatisms (lip smacking, chewing, sucking, swallowing)

Answer 32

- Temporal - inferomedial - hippocampal

Question 33

Automatisms: bipedal

Answer 33

Frontal

Question 34

Ictal cough

Answer 34

Dominant

Question 35

postictal cough

Answer 35

non-dominant

Question 36

Ictal eyeblinks: unilateral

Answer 36

Ipsilateral

Question 37

Ictal eyeblinks: Bilateral

Answer 37

Occipital

Question 38

Gelastic

Answer 38

- Hypothalamic - Mesial temporal - Frontal cingulate

Question 39

Ictal crying / weeping (Dacrystic seizures) w/o gelastic component

Answer 39

- Non-dominant mesiotemporal | - Non-dominant mesial frontal

Question 40

Ictal crying / weeping (Dacrystic) WITH gelastic component

Answer 40

hypothalamic

Question 41

Genital aura

Answer 41

Ipsilateral

Question 42

Ictal nystagmus

Answer 42

CL frontal / Occipital

Question 43

Ictal spitting

Answer 43

Non-dominant temporal

Question 44

postictal nose wiping

Answer 44

IL temporal (90% PPV)

Question 45

Ictal / postictal drinking

Answer 45

Non-dominant temporal

Question 46

Ictal tachycardia

Answer 46

No localization

Question 47

Ictal bradycardia / asystole

Answer 47

Temporal >> frontal

Question 48

Ictal Dyspnea

Answer 48

links to insula

Question 49

ictal urinary urge

Answer 49

non-dominant temporal

Question 50

Ictal emesis

Answer 50

- Non-dominant temporal / anterior insula | - Benign occipital (Panayiotopoulos syndrome)

Question 51

piloerection

Answer 51

IL (often dominant) temporal

Question 52

Ictal Vertigo

Answer 52

Insular-temporal-parietal junction

Question 53

Epigastric rising

Answer 53

Temporal > orbitofrontal > Cingulate

Question 54

Ictal speech arrest / Jargon

Answer 54

Dominant Temporal

Question 55

postictal dysphasia / aphasia

Answer 55

Dominant Temporal

Question 56

PRESERVED SPEECH during seizure

Answer 56

Non-dominant temporal

Question 57

Guttural vocalizations

Answer 57

frontal lobe (orbitofrontal or parasagittal)

Question 58

Ictal humming / singing

Answer 58

Poorly lateralized - temporal lobe - pre-frontal cortex