At home he asked his wife about the source of the smell of cabbage but she responded that she was not cooking and that she did not smell anything unusual.
She then noticed he was making grimacing faces which included lip-smacking and swalling.
He went to the TV set but did nothing but stare above it for about 15 minutes after which he behaved normally. He did not acknowledge his odd behavior even when his wife told him of it. Neurologic exam showed that he had normal mental status and no significant findings other than an upper left quandrantic anopsia.
Periods of olfactory hallucination and memory losses suggest seizure activity. Lip movements and swallowing suggest a seizure focus in olfactory-related areas of the medial and inferior aspects of the temporal lobe.
The left sided quandrantic anopsia indicates more precisely the side and location of the lesion i.e., optic radiation fibers of the left superior visual fields loop far forward into the right temporal lobe.
EEG studies and MRI suggested a space taking mass producing episodic cortical irritation. Biopsy indicated a glioma.
Extended Explanation
While the seizure activity described is suggestive of temporal lobe involvement, the visual loss indicates more precisely the side and location of the lesion.
The homonymous left-sided visual field loss indicates a post-chiasmal lesion on the right. Optic radiation fibers of superior visual fields loop far forward into the temporal lobe.
EEG studies also confirmed abnormalities that were consistent with a lesion of the anterior-medial pole of the temporal lobe.
The history of headache preceding the other signs suggested the slow growth of a space-taking mass which was confirmed by MRI. Biopsy indicated a glioma.
