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---
-title: "Epilepsy, Adult"
-docid: "c936f9e1-b6c6-4c4a-afc6-f2e1a968a7b0"
-breadcrumbs:
-  - "Brain"
-  - "Differential Diagnosis"
-  - "Brain Parenchyma, General"
-  - "Clinically Based Differentials"
-  - "Epilepsy, Adult"
---
-# ESSENTIAL INFORMATION
-
- ## Key Differential Diagnosis Issues
-  
-  
-    - Adult-onset seizures are more likely acquired
-          - Acute symptomatic seizure ≤ 1 week of brain injury
-          - Remote symptomatic seizure: Beyond 1 week
-                  - Encephalomalacia and gliosis can also cause seizures
-          - Epilepsy: When 2 or more seizures occur 24 hours apart
- ## Helpful Clues for Common Diagnoses
-  
-  
-    - **Trauma**
-          - Diffuse axonal injury and contusions
-          - Intracranial hemorrhage (subdural hemorrhage and subarachnoid hemorrhage) can also present with seizures without parenchymal findings
-    - **Stroke**
-          - Most common cause in older adults
-    - **Infection**
-          - All cerebral and meningeal infection can cause seizure
-                  - Meningitis, encephalitis, and abscess
-          - Look for herpes encephalitis
-          - CNS tuberculosis and neurocysticercosis are common causes outside of USA
-    - **Drug Use and Withdrawal**
-          - Withdrawal from alcohol, benzodiazepines, barbiturates
-          - Illicit drug use and drugs, which lower seizure threshold
-    - **Metabolic**
-          - Hyper- or hypoglycemia
-          - Hyponatremia, hypocalcinemia, hypomagnesemia, hypothyroidism
-          - Hyperammonemia from hepatic encephalopathy
-          - Uremic encephalopathy
-    - **Neoplasms**
-          - Glioblastoma most common in older adults
-          - Cortically based tumors primarily in older children to young adults
-    - **Neurodegenerative Disease**
-          - Dementia: Alzheimer
-          - Demyelinating disease: Multiple sclerosis
- ## Helpful Clues for Less Common Diagnoses
-  
-  
-    - **Oligodendroglioma, IDH-Mutant and 1p/19q-Co-Deleted**
-          - 70-90% present with seizures
-          - Cortically based T2-hyperintense mass, rare enhancement
-    - **Mesial Temporal Sclerosis**
-          - Most common cause of intractable temporal lobe seizures
-          - Hippocampal atrophy and sclerosis
-          - May see ipsilateral mammillary body and forniceal atrophy
-    - **Paraneoplastic and Autoimmune Encephalitis**
-          - Both paraneoplastic and nonparaneoplastic
-          - 80% have bilateral/unilateral edema of temporal lobes
-          - Limbic system most common, also brainstem, cerebellum, and spinal cord
-    - **Posterior Reversible Encephalopathy Syndrome**
-          - 60-75% present with seizure
-          - Patchy parietooccipital cortical/subcortical T2/FLAIR hyperintense edema
-          - Associated with hypertension, chemotherapy, high-dose steroids, immunomodulation, sepsis, kidney failure, preeclampsia/eclampsia, autoimmune disease
- ## Helpful Clues for Rare Diagnoses
-  
-  
-    - **Pleomorphic Xanthoastrocytoma**
-          - 75% of patients present with seizures
-          - Cortical cyst + enhancing nodule is classic
-          - Reactive involvement of adjacent meninges typical: Dural tail