1/19. status epilepticus-induced brain damage and opercular syndrome in childhood.This study reports on a girl with a permanent cerebral lesion and opercular syndrome after status epilepticus (SE). She had previously been healthy and had her first focal motor seizure at 5 years of age, which was controlled with intravenous phenytoin and rectal diazepam. Twenty-four hours later, she developed partial SE consisting of right facial twitching and right-hand clonic movements. These uncontrollable seizures lasted for 5 days, after which the partial SE changed to generalized SE, and the seizures continued for another 5 days. CT performed the day before onset of SE revealed no brain abnormality. Another CT performed a year later disclosed bilateral brain lesions, more severe in the left hemisphere. Follow up at 16 years of age revealed moderate motor sequelae of the right-hand side of the body, anarthria, difficulty chewing, dysphagia, bilateral facial weakness, and drooling, all of which clinically characterize opercular syndrome. An MRI study performed at 14 years of age showed a cerebral parenchymatous lesion which extended between the parietal cortices of both hemispheres, more severe on the left side, and which crossed the corpus callosum, destroying the posterior-middle zone. Evidence from the CT indicates that the lesion was not present before onset of SE. It seems likely that the focal SE caused the focal brain damage, but the possibility that the subsequent generalized SE played a role cannot be excluded.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
2/19. Development of focal chronic epilepsy following focal status epilepticus in adult patients.In several experimental models, status epilepticus (SE) leads to secondary brain hyperexcitability and epileptogenesis. In humans, such phenomena have been rarely demonstrated, particularly in cases of SE involving the neocortical structures. We report a 36 year old woman that presented partial SE in May 1991 involving the right cerebral hemisphere. The patient was then treated in the intensive care unit with artificial ventilation and anesthesia by pentobarbital and clometiazole. MRI showed transient right parietal and temporal posterior cortical hyperintensity. The cause of SE was not determined. Three months later, the patient developed partial complex seizures with aura characterized by vertigo, nausea and auditory hallucination. Ictal video/EEG recording showed a clear right temporal posterior onset of the discharges. We speculate that status epilepticus created the lesions which subsequently caused the focal chronic epilepsy.- - - - - - - - - - ranking = 2keywords = posterior (Clic here for more details about this article) |
3/19. diffusion-weighted magnetic resonance imaging abnormalities in bartonella encephalopathy.The authors describe 2 patients with new-onset, refractory status epilepticus and serological evidence for bartonella infection. brain magnetic resonance imaging (MRI) in patient 1 showed transient diffusion abnormalities in the posterior (pulvinar) thalami. In patient 2, brain MRI showed several enhancing cortical lesions, of which one lesion was bright on diffusion-weighted imaging (DWI). In patients with unexplained, refractory seizures, the presence of DWI abnormalities warrants a search for unusual infectious or inflammatory disorders, like bartonella encephalitis.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
4/19. Ictal magnetoencephalographic discharges from elementary visual hallucinations of status epilepticus.PURPOSE: To report the rare opportunity to study ictal magnetoencephalography (MEG) in a 26 year old man with simple partial status epilepticus that presented as elementary visual hallucinations (EVHs) in the right upper visual field. methods: The patient described his EVHs as "snowing on TV," "flickering lights," and "rotating coloured balls" that continued for several days. MEG and simultaneous EEG were recorded twice: during an episode of EVHs (ictal recordings) and after EVHs were controlled by medications (interictal recordings). RESULTS: During EVHs, MEG showed continuous periodic epileptiform discharges over the left posterior superior temporal region, while simultaneous EEG showed rhythmic theta waves and sporadic spikes over the left temporal region. The MEG discharge consisted of a three phase spike complex. Equivalent current dipoles (ECDs), modelled from spike complexes, localised in the left superior temporal area. After drug treatment controlled the EVHs, interictal MEG and EEG showed rare spikes over the same left temporal region. The average ictal ECD moment (mean (SD)) (128.7 (32.8 nAm)) was significantly weaker than the average interictal ECD moment (233.0 (63.9) nAm) (p<0.05). CONCLUSIONS: The continuous, periodic, and clustered discharges seen on ictal MEG were the sources of EVH. The weaker ictal ECD sources were frequently not detected by scalp EEG, while the stronger interictal sources, presumably originating from an extensive interictal zone, were sufficiently large to be seen as EEG spikes.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
5/19. Neonatal seizures: the overlap between diagnosis of metabolic disorders and structural abnormalities. Case report.Inborn metabolic errors (IME) and cortical developmental malformations are uncommon etiologies of neonatal seizures, however they may represent treatable causes of refractory epilepsy and for this reason must be considered as possible etiological factors. This case report aims to demonstrate the importance of neuroimaging studies in one patient with neonatal seizures, even when there are clues pointing to a metabolic disorder. CASE REPORT: A previously healthy 14 day-old child started presenting reiterated focal motor seizures (FMS) which evolved to status epilepticus. Exams showed high serum levels of ammonia and no other abnormalities. A metabolic investigation was conducted with normal results. During follow-up, the patient presented developmental delay and left side hemiparesia. seizures remained controlled with anti-epileptic drugs for four months, followed by relapse with repetitive FMS on the left side. Temporary improvement was obtained with anti-epileptic drug adjustment. At the age of 6 months, during a new episode of status epilepticus, high ammonia levels were detected. Other metabolic exams remained normal. The child was referred to a video-electroencephalographic monitoring and continuous epileptiform discharges were recorded over the right parasagittal and midline regions, with predominance over the posterior quadrant. A new neuroimaging study was performed and displayed a malformation of cortical development. Our case illustrates that because newborns are prone to present metabolic disarrangement, an unbalance such as hyperammonemia may be a consequence of acute events and conduct to a misdiagnosis of IME.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
6/19. dialysis disequilibrium: another reversible posterior leukoencephalopathy syndrome?dialysis disequilibrium syndrome is a disorder of the central nervous system in patients on dialysis. The underlying etiology is thought to be primarily due to cerebral edema; however, neuroradiologic findings have not been described previously. We describe a patient who presented with new onset headaches and status epilepticus after beginning hemodialysis. Her neuroimaging studies revealed white matter changes in the posterior parietal and occipital lobes similar to those seen in patients with reversible posterior leukoencephalopathy syndrome (RPLS). This case suggests that dialysis disequilibrium syndrome and RPLS may represent a spectrum of disorders in which the underlying mechanism is vasogenic edema.- - - - - - - - - - ranking = 23770.506233957keywords = leukoencephalopathy syndrome, leukoencephalopathy, posterior (Clic here for more details about this article) |
7/19. Epileptic nystagmus in a patient with nonconvulsive status epilepticus.Epileptic nystagmus (EN) is a rare form of rhythmic eye oscillations occurring during seizure activity. Not only convulsive states, but also nonconvulsive status may represent with EN and this phenomenon may be the only motor manifestation of seizure activity. Epileptic activation of a cortical saccade region may be distinguished from activation of a cortical pursuit region clinically as activation of pursuit regions results in nystagmus slow phases that bring the eyes across the midline. Horizontal EN results most commonly from seizure activity involving the occipital cortex. In this report, horizontal EN in a patient with nonconvulsive status epilepticus (NCSE) is described with clinical, radiological and electrophysiological findings that occur probably due to posterior leukoencephalopathy syndrome.- - - - - - - - - - ranking = 4753.9012467915keywords = leukoencephalopathy syndrome, leukoencephalopathy, posterior (Clic here for more details about this article) |
8/19. Transient cortical abnormalities on magnetic resonance imaging after status epilepticus: case report.INTRODUCTION: Transient neuroimaging findings associated with seizure activity have received relatively little attention in the neurosurgical literature. These abnormalities may mimick neoplastic or ischemic changes on magnetic resonance imaging (MRI), possibly leading to additional studies and surgical treatment. CASE DESCRIPTION: A 17-year-old right-handed male was transferred to emergency room in status epilepticus. A MRI obtained 5 months before admission was negative. On the day of admission, he had multiple intermittent upper-left extremity partial seizures and prolonged secondary generalized seizures. An electroencephalogram (EEG) showed frequent epileptiform discharges over the right hemisphere posteriorly. A MRI study performed 2 days after admission revealed non-hemorrhagic abnormalities involving the right occipital region that were hyperintense on fluid-attenuated inversion recovery (FLAIR) and T2 weighted sequences. The apparent diffusion coefficient map was unremarkable. Follow-up MRIs, 3 and 11 months after admission, showed complete resolution of these lesions. CONCLUSION: Imaging findings after status epilepticus may raise suspicion of ischemic or neoplastic lesions. These findings may be reversible. Further follow-up imaging may prevent unnecessary intervention.- - - - - - - - - - ranking = 1keywords = posterior (Clic here for more details about this article) |
9/19. Transient diffusion-weighted imaging changes in a patient with reversible leukoencephalopathy syndrome.A 66-year-old man developed a focal status epilepticus and left hemiparesis 4 days after an orthotopic liver transplantation and administration of FK 506. The magnetic resonance image revealed areas of increased signal on diffusion-weighted imaging (DWI) equally distributed to all vascular territories, most of which resolved completely within 2 weeks after discontinuation of FK 506. We conclude that DWI cannot reliably distinguish between reversible and irreversible lesions and that the presence of hyperintense lesions on DWI is not a definitive predictor of poor prognosis in reversible leukoencephalopathy patients.- - - - - - - - - - ranking = 19053.141747838keywords = leukoencephalopathy syndrome, leukoencephalopathy (Clic here for more details about this article) |
10/19. Necrotizing leukoencephalopathy associated with nonconvulsive status epilepticus and periodic short-interval diffuse discharges: a clinicopathological study.We describe the clinical, neuroimaging and neuropathological features of an immunocompromised patient diagnosed as having refractory nonconvulsive status epilepticus (NCSE), and whose consecutive electroencephalograms (EEGs) revealed persistent periodic short-interval diffuse discharges (PSIDDs). Prominent subcortical white matter lesions in keeping with the diagnosis of multifocal necrotizing leukoencephalopathy may be neuropathological substrate of NCSE with persistent PSIDDs.- - - - - - - - - - ranking = 207.68380336004keywords = leukoencephalopathy (Clic here for more details about this article) |
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