Post-traumatic epilepsy (PTE) is a well-known delayed complication of traumatic brain injury (TBI). In primary care, recognition can be challenging when seizures present only as sensory phenomena, such as olfactory auras, rather than convulsive episodes. These subtle manifestations may lead to underdiagnosis and delayed treatment, affecting patients’ quality of life and functional outcomes. We describe the clinical follow-up of a young adult male with a history of moderate TBI involving multiple intracranial haemorrhages and diffuse axonal injury type II. He later developed a generalized tonic–clonic seizure preceded by a persistent olfactory aura described as a “smell of gasoline.” Neurological examination, brain MRI, EEG, and response to antiepileptic therapy were evaluated.Olfactory auras are rare in post-traumatic epilepsy and often overlooked in general practice. This case uniquely correlates mesial temporal structural changes with clinical presentation, emphasizing MRI as a crucial diagnostic tool even when EEG appears normal. Subtle sensory auras can be the first manifestation of structural post-traumatic epilepsy.   MRI should be prioritized in atypical or non-convulsive cases regardless of EEG findings.    Family physicians must remain vigilant for non-classical seizure forms to prevent diagnostic delays and optimize neurological outcomes. MRI revealed left hippocampal atrophy with subtle T2-FLAIR hyperintensity compatible with early mesial temporal sclerosis, while EEG remained normal. Levetiracetam controlled convulsive seizures but not olfactory auras. Switching to lacosamide initially caused irritability, prompting temporary withdrawal, after which a new seizure occurred temporally associated with cannabis use. Gradual reintroduction of lacosamide (150 mg twice daily) achieved full seizure control. This case highlights the importance of correlating MRI findings with clinical features, especially when EEG results are inconclusive.In patients with delayed-onset epilepsy following TBI, olfactory auras may represent focal temporal seizures. MRI-based assessment can guide targeted therapy and improve outcomes. Primary care physicians play a key role in recognizing atypical seizure patterns and coordinating timely referral for neuroimaging and specialist evaluation.