First seizure, 70+

The patient had an episode of amnesia yesterday. He recalls seeing flashes of multi-coloured "circles and squiggles on the left" and then recalls telephoning his wife, who was not at home. He has no recollection of walking from there but was found at some distance from where he was at the time of his last memory. His wife found him lying, face down, with bruises to his forehead and a fresh laceration to his tongue. He was confused when found by his wife and paramedics were subsequently summonsed. He recalls having a 2nd visual hallucination, identical to the above. He also reports a similar event 5 years ago.

Standard EEG:

Figure 2:

Figure 3:

The cause for the asymmetry of alpha rhythms is apparent on the CT scan of the brain.

There is evidence of an old right occipital ischaemic stroke and hence the inability of the right occipital region to generate alpha rhythms. An asymmetry of alpha rhythms is the most notable finding.

There are a few delta waves at M1-F7 on the EEG. You can see an example of these between the 8th and 10th ECG beats of the last of the EEG images above. On balance of probabilities, these most likely relate to microvascular disease.