1/6. carbamazepine-induced thrombocytopenia defined by a challenge test.carbamazepine (CBZ), a widely used anticonvulsant, occasionally causes serious hematologic disorders. A 12-year-old boy was admitted because of a diffuse petechial rash and profound thrombocytopenia (10 x 10(9) platelets/l), after having been treated for epilepsy with CBZ for 12 days. Seven days following withdrawal of CBZ and initiation of prednisolone therapy, the platelet count recovered. In a subsequent challenge test with CBZ, platelet counts again decreased, and the levels of platelet-associated IgG and serum interleukin-6 increased. No antibodies against platelet glycoprotein IIb/IIIa or Ib were detected in plasma. We believe that this is the first reported occasion when CBZ-induced thrombocytopenia has been defined by a rechallenge test.- - - - - - - - - - ranking = 1keywords = epilepsy (Clic here for more details about this article) |
2/6. SPECT in a patient with postictal PLEDs: is hyperperfusion evidence of electrical seizure?The pathophysiological relation between periodic lateralized epileptiform discharges (PLEDs) and epileptic seizures is not known and the exact causative mechanism of PLEDs still remains unclear. In this report, the authors present a case in which the EEG displayed PLEDs after a complex partial seizure. This patient, with a long history of complex partial seizures, had previously undergone right standard anterior temporal lobectomy with hippocampectomy, with a diagnosis of mesial temporal sclerosis. She had one complex partial seizure 72 days after operation and was admitted to hospital. Her brain MRI revealed changes due to temporal lobectomy and small residual posterior hippocampic anomalies. PLEDs over the right temporal lobe were seen in postictal EEGs and persisted for 4 days despite the patient's normal mental status and normal neurologic examination. brain perfusion scintigraphy with Tc-99m-HMPAO during PLEDs was performed on the second day after the seizure, and right temporal hyperperfusion was detected. EEGs and scintigraphic imaging were repeated after cessation of PLEDs. The repeated brain scan displayed right temporal hypoperfusion. PLEDs during the postictal period may actually be an ictal pattern, and if hyperperfusion in the brain SPECT studies during PLEDs is seen, further aggressive antiepileptic drug therapy may be necessary in some cases.- - - - - - - - - - ranking = 13.605779392879keywords = seizure (Clic here for more details about this article) |
3/6. Postictal psychosis in temporal lobe epilepsy.PURPOSE: Postictal psychosis is a well-known complication, occurring especially in patients with temporal lobe epilepsy. It usually runs a benign course. The literature on this topic is sparse, and the underlying pathogenic mechanisms are not known. methods: We report five patients with temporal lobe epilepsy in whom postictal psychosis developed during the course of video-EEG monitoring; they were studied with hexamethyl-propyleneamine-oxime single-photon emission computed tomography (HMPAO-SPECT) during and after the psychotic event. RESULTS: In comparison to the interictal state, all SPECT scans obtained during postictal psychosis were remarkable for bifrontal and bitemporal hyperperfusion patterns. Some studies also demonstrated unilateral left lateral frontal hyperperfusion. These cortical blood-flow patterns appeared to be distinct from those obtained during complex partial seizures. CONCLUSIONS: Our data suggest that postictal psychoses in patients with temporal lobe epilepsy are associated with hyperactivation of both temporal and frontal lobe structures. This hyperperfusion may reflect ongoing (subcortical) discharges, active inhibitory mechanisms that terminate the seizure, or simply a dysregulation of cerebral blood flow.- - - - - - - - - - ranking = 10.023506531751keywords = seizure, epilepsy (Clic here for more details about this article) |
4/6. Focal nonconvulsive status epilepticus associated to PLEDs and intense focal hyperemia in an AIDS patient.PURPOSE: Periodic lateralised epileptiform discharges (PLEDs) can be seen associated to nonconvulsive status epilepticus (NCSE), although their pathophysiological meaning remains questionable. functional neuroimaging has suggested that, in this setting, PLEDs may indeed be an ictal pattern. In this report we describe perfusional changes in a patient with AIDS, PLEDs and NCSE. methods: A 37-year-old man with AIDS, cryptococcosis and recurrent epileptic seizures was admitted. After initial treatment, he remained comatose, and had MRI and serial EEG recordings performed. technetium-99m-ethyl cysteinate dimer (99mTc-ECD) SPECT scans were also obtained, before and after continuous benzodiazepine infusion. RESULTS: EEG disclosed PLEDs over the right fronto-polar region while MRI revealed meningeal thickening and scattered unspecific findings. SPECT revealed marked focal hyperperfusion overlapping the areas with PLEDs, both resolved after continuous midazolam infusion and clinical improvement. CONCLUSIONS: This report demonstrates association of PLEDs, NCSE, and focal hyperperfusion on SPECT, additionally supporting the concept of PLEDs as an ictal pattern. Considering that status epilepticus may eventually not be detected by conventional approaches alone, we advocate the use of functional neuroimaging to assess suspected patients with impaired consciousness.- - - - - - - - - - ranking = 726.72308271084keywords = nonconvulsive, seizure (Clic here for more details about this article) |
5/6. Delayed deterioration following mild head injury in children.A series of 42 children is described who, following a seemingly minor or trivial head injury, developed neurological signs after a lucid or symptom-free period. This group constitutes 4.34 per cent of 967 consecutive patients aged 2 months to 17 years who were seen by members of the neurological staff during the years 1978-1981. Only one patient had an intracranial haematoma. The majority of patients showed a benign transient syndrome consisting of either convulsive or nonconvulsive signs with a spontaneous and full recovery. There were, however, 3 deaths in this series, apparently due to severe and uncontrollable unilateral or diffuse brain swelling, demonstrating the malignant counterpart of this benign syndrome. The theories seeking to explain these phenomena are reviewed. Special reference is made to the hypotheses of Bruce and his associates regarding brain swelling as a causative factor. It is considered that an adequate theory to explain the pathogenesis is still lacking. It is concluded that the juvenile brain responds to cranial trauma in a manner different from the adult brain. This implies a different approach in policy to hospital admission.- - - - - - - - - - ranking = 145.04226588899keywords = nonconvulsive (Clic here for more details about this article) |
6/6. Hyperemic receptive aphasia on neuroSPECT.NeuroSPECT of regional cerebral blood flow (rCBF) with Tc-99m HMPAO demonstrated left temporoparietal hyperemia in two patients with acute receptive aphasia. This finding prompted further testing with electroencephalography that added to the impression of ictal dysphasia. The differential diagnosis in one case included complicated migraine. NeuroSPECT depicts blood flow abnormalities in acute aphasic disorders, either due to ischemia, which is most commonly the cause, or due to hyperemia secondary to migraine or epilepsy. The treatment and prognosis of these latter conditions differ from stroke, and thus SPECT plays a role in patient management.- - - - - - - - - - ranking = 1keywords = epilepsy (Clic here for more details about this article) |