Alternating hemiplegia in 26 year old lady

by

Dr. R. Murali

This 26 year old lady teacher presented a month ago with sudden onset of headache, LOC and inability to speak with left hemiplegia. She regained consciousness after 24 hours and when I saw her she was alert, comprehension was intact and she was obeying simple commands, but was totally unable to speak.  She had a left UMN facial paresis and dense left hemiplegia with pyramidal signs. After a week she could communicate with signs and then by writing with her right hand.Hemiplegia and motor aphasia remained and gradually started improving after  3 weeks. She can now talk but not fluently and is ambulant with support.
No fever, heart problems, coagulation defects or HT .. ESR normal. other blood tests are normal.
 
Past medical history: She had a similar attack when she was 7 years old (1983) but had motor aphasia and RIGHT hemiplegia at that time.She recovered fully. She had a seizure (generalised) in 2000 and was put on anticonvulsants. She was advised a test which she did not have done due to reasons I cannot fully fathom. She became a teacher and was doing her job well and otherwise was a bright and active lady till this attack.
 
I have put up her 1983 CT of the brain ( not a good picture). what is your comment? She was asked to do an imaging study after thais but was not done. I will post  her current CT after 2 days.
 
What is the diagnosis and what is the test to be done?
I will put the  results of the 2 tests at intervals of a few days.

CT plain in 1983

CT with Constrast 1983

CT 2000

CT 2002 Plan

CT 2002 Contrast

MR Angiogram

Angiograms

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October 7, 2002

(c)2002 M.H. Rivner