Presentation of Case A 40-year-old right-handed man was admitted to the hospital because of questionable recurrence of a brain tumor. He was well until 13 years earlier, when a grand-mal seizure occurred. Evaluation elsewhere included an electroencephalogram that was reported to be normal. One year later another grand-mal seizure occurred, and phenytoin and primidone were begun. The patient had no subsequent grand-mal seizures, although focal seizures involved the left arm and hand several times weekly. Ten years before entry a cranial computed tomographic (CT) scan was reported to show a low-density abnormality in the white matter of the right cerebral.
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