A 37-year-old man with known epilepsy and craniopharyngioma presented with 11 tonic–clonic seizures followed by right hemiparesis, hemianopia and dysphasia. The initial head CT suggested a left hemispheric stroke and it was suspected that the tumour compressed the left MCA causing ischaemia. However, normal CT angiogram and MRI with DWI excluded this diagnosis. Follow-up MRI showed resolution of changes which corresponded to complete clinical recovery within 2 weeks suggesting a diagnosis of hemispheric oedema secondary to seizures masquerading as TACS. Brain oedema may follow prolonged seizures but is usually focal and rarely involves the whole hemisphere imitating a stroke.
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