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.