30th September 2021

A 16-year-old girl presents to the neurologist accompanied by her mother

A 16-year-old girl presents to the neurologist accompanied by her mother. She presents with a history of increasing headaches and has had 2 seizures in the past, of which she has difficulty remembering. The girl is also quite quiet, and often the conversation is between the doctor and the mother.

The history of seizures appears to be non-epileptic in origin, and more likely a manifestation of a migraine or exhaustion. The mother mentions that previous brain MRIs ordered by other neurologists have suggested that the girl may have a brain tumour in the pineal region, as an explanation for the headaches and seizures. The mother is keen to get this possibility explored and even mentions that she has done a lot of research on the matter herself and is aware that the surgery to get it removed would pose a lot of risk to her daughter, but she thinks it would be the best option for her.

What would be the next best investigation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.