Case Presentation:
A 55-year-old man was diagnosed with a left temporo-insulo-parietal left
tumor after developing focal cognitive seizures with aphasia and complex
visual hallucinations (fig. 1). He underwent partial tumor resection
resulting in persistent dysphasia. The histopathology diagnosis was
compatible with a glioblastoma. He was medicated with levetiracetam and
sodium valproate due to increasing of seizure frequency, characterized
by transitory worsening of previous dysphasia. He started treatment with
chemotherapy and radiotherapy (according to STUPP protocol), with an
initial good radiological response. While undergoing oral chemotherapy
cycles, he was admitted in the Emergency Room, desperately screaming due
to acute and excruciating pain on the right arm and ipsilateral face,
described as shock-like and stabbing. Each episode lasted a few seconds
but they had been repeating in cluster for over an hour. General blood
analyses were unremarkable and the electroencephalography showed a left
central frontal rhythmic activity during the pain episodes (fig. 2). The
add-on of intravenous lacosamide resolved the painful complaint in a few
minutes. The brain MRI performed a few days later showed local tumor
recurrence (fig. 2).