Clinical Reasoning: A 21-Year-Old Patient Presenting With Penile Hemidystumescence

This case presents a 21-year-old male patient with recurrent episodes of lost consciousness that exhibited both features of seizure and syncope that were ultimately diagnosed as syncope secondary to autonomic seizures. Notably, review of systems revealed stereotyped erectile dysfunction, characterized by unilateral penile tumescence ("hemidystumescence") occurring peri-ictally. Neurologic workup revealed left temporal slowing on EEG, and antiseizure medication led to resolution of both the loss-of-consciousness events and the hemidystumescence. This case represents a novel manifestation of focal epilepsy, suggesting that stereotyped erectile dysfunction may hold localizing value.