Abstract
BACKGROUND: According to the recommendations of the International League against Epilepsy, a timely workup with a brain MRI is recommended after a first epileptic seizure. However, if the MRI is unrevealing, it is normally not repeated. CASE PRESENTATION: We present a patient with an unprovoked epileptic seizure and only slight focal abnormalities in the EEG and a normal brain MRI. Only 35 days later, after a third seizure and now a focally pathological EEG, we repeated the brain MRI and discovered a large mass in the left temporal lobe, which was resected and histologically classified as glioblastoma multiforme. CONCLUSION: This case of a very fast-growing tumor suggests that recurrent seizures, with or without anti-seizure medications, or new changes in the EEG should prompt the clinician to consider a repeat brain MRI, even if the first scan was normal.