Tonic-clonic seizures as first symptom of a disseminated supraglottic laryngeal cancer.

A 60-year-old man was found unconscious at work, without any signs of trauma. At the site, he presented with tonic-clonic seizures, central facial palsy and eye deviation. A CT scan of the cerebrum did not find bleeding or thrombosis, but contrast enhancement at the superior sagittal sinus and pathological cervical lymph nodes. The MRI demonstrated multiple intracerebral metastases, while a supplementary fluoro-deoxy-glucose positron emission tomography scan revealed metastatic lesions above and below the diaphragm, without signs of a primary tumour. An ear, nose and throat examination found a small supraglottic tumour and cervical lymph node metastases. Following a multidisciplinary team discussion, biopsies from the duodenal mucosa and an inguinal lymph node were performed, showing squamous cell carcinoma with its origin in the head and neck. The patient was diagnosed with a T1N2cM1 supraglottic laryngeal cancer, receiving palliative whole brain radiation therapy but died 11 weeks after the debut of symptoms. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.