A 5-year-old girl presents with symptoms of vertigo and intermittent episodes of slurred speech for 1 day. This morning she had a “popping” headache localized bilaterally to the sides and the back of the head. Her headache spontaneously resolved within 20 minutes, although she later experienced “a spinning sensation” and her knees buckled, causing her to fall backward. There is no history of ataxia, visual changes, weakness, or fatigue before the fall. Similarly, there is no history of altered mental status or evidence of injury afterward.

Six months earlier, she had been diagnosed as having localization-related epilepsy. It was likely that her epilepsy was of genetic origin and considered benign because of normal brain magnetic resonance imaging (MRI) findings, electrographic abnormalities noted on video electroencephalography (EEG), and semiology that was noted during 3 witnessed episodes of tonic-clonic movements. Her epilepsy was initially well controlled with levetiracetam and oxcarbazepine therapy. In...

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