A 50-year-old woman from Northeast Thailand presented to the emergency department with generalized tonic-clonic seizure 30 minutes ago.

• The seizure duration was around 2 minutes. She was passed out for 5 minutes and gradually gained consciousness within 15 minutes without memory deficit.
• There was no history of fever, vomiting, headache, or visual disturbances. She denied history of previous accident, illicit drug use, or cancer.
• Her physical examination was normal.

Contrast-enhanced CT scan of brain demonstrated multiple calcified nodules and small rim-enhancing lesions with minimal perilesional edema in the cortico-subcortical junction of frontal lobe.

Chest x-ray was done. Subsequent plain radiograph of skull, pelvis, and bilateral femurs were as shown.

Questions: 

1. Please describe the radiological findings from plain radiographs of this patient.

2. What is the provisional diagnosis and the pathophysiology of the disease?

3. Please give the proper management.

โดย ร.อ.หญิง ปัทมพร  กิตติบัญชากุล แพทย์ประจำบ้านกองอายุรกรรม และ

น.อ.หญิง สัญสณีย์  พงษ์ภักดี อาจารย์หน่วยอายุรศาสตร์ประสาทวิทยา

กองอายุรกรรม รพ.ภูมิพลอดุลยเดช กรมแพทย์ทหารอากาศ

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