Case History/examination:
A 15 years old Saudi male, right handed with unremarkable family
history. He is a son of a healthy non - consanguineous parents with no
family history of psychomotor delay, epilepsy or CVG. There is an
unremarkable antenatal history except for C section delivery and 3 days
PICU admission due to respiratory distress. Patient had a normal and
active childhood until he started to have difficulty speaking, change in
personality and weakened academic performance at the age of 9 and was
diagnosed with epilepsy.
Initially he was given lacosamide with significant improvement, until it
was out of stock and he was shifted to levetiracetam and carbamazepine
in 2021. During these years, the patient had episodes of visual
hallucinations and dizziness which resolved after the 3rd year of
treatment. Afterwards, the patient showed great improvement and the last
documented convulsion was 3 years ago, so he was prescribed only
levetiracetam once daily.
One year before the patient was diagnosed with epilepsy, he complained
of diffused swelling over the scalp associated with headache and
irritation. The swelling was non tender, non itchy and skin colored.
Over the period of multiple months, swelling has become more diffused
and severe to the extent it caused folds formation and hair loss.
Patient did not seek any medical advice regarding this swelling, until 2
months ago he presented to our clinic, as a result of continuous
bullying at school. Patient denied any ophthalmological or cardiac
complain.
On examination: A soft diffused swelling covering the back of the scalp
was noticed. There were folds (7) and furrows running in an
anteroposterior direction on the parietal and occipital areas of the
scalp. There were oily scales between the folds associated with bad
odor. Lesions are not flattened by direct pressure or traction.