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84 year old woman with spells of right upper limb weakness and numbness
Teaching NeuroImagesNeurology
Resident and Fellow Section
© 2014 American Academy of Neurology
Vignette
• History of: – Prior strokes to left parietal and right occipital
lobes.– Metastatic breast cancer with skull involvement.
O’Gorman et al© 2014 American Academy of Neurology
Imaging
O’Gorman et al© 2014 American Academy of Neurology
Imaging
O’Gorman et al© 2014 American Academy of Neurology
EEG pattern associated with a skull osteolytic lesion in breast cancer
• Breach effect or breach rhythm – a focal increase in amplitude of alpha, beta and mu
rhythms detected at or near the site of a bony skull defect.[1]
– Usually associated with surgical skull defects.– Also seen in osteolytic lesions of the skull.[2]– No association with epilepsy.– EEG alteration may be confused with focal
epileptiform discharges.• Final diagnosis: focal seizure
O’Gorman et al© 2014 American Academy of Neurology