Cases reported "Seizures"

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21/88. October 2002: 27-year-old female with epilepsy.

    The October 2002 Case of the Month (COM). The patient was a 27-year-old woman with a history of partial complex seizures at age 7. At age 20 her seizures changed in character and became progressively worse. neuroimaging studies showed atrophy of the right hemisphere and contralateral cerebellar atrophy. Following a biopsy, she was scheduled for a surgical procedure, but unfortunately she expired at home during her sleep a week later. Examination of the brain confirmed the hemi-atrophy of the right cerebral hemisphere and left cerebellum. Microscopic examination showed severe gliosis and perivascular lymphocytic infiltrates in many areas. A diagnosis of Rasmussen's encephalitis was made. Rasmussen's encephalitis is a chronic neurological disorder, first described in 1958. The active neurological decline lasts from 1 to 20 years and the patients then remain stable with a fixed neurological deficit and residual seizures. Pathological examination shows a chronic encephalitis confined to one hemisphere. In the active phase, neuronophagia, activated microglial cells (rod cells), microglial nodules, and perivascular lymphocytic infiltrates, are present. In the more chronic phase neuronal loss and gliosis predominate. The etiology of Rasmussen's encephalitis is unknown but viral infection and autoimmunity have been implicated. The treatment of choice is functionally complete hemispherectomy with complete disconnection of the frontal and occipital lobes.
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ranking = 1
keywords = encephalitis
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22/88. A case of subacute sclerosing panencephalitis preceded by epileptic seizures: evolutional EEG changes.

    We reported a patient with subacute sclerosing panencephalitis (SSPE) in whom EEG had been serially performed before the onset. She was referred to our hospital due to epileptic seizures at 2 years of age. Focal spikes were seen on EEG at the time of her first seizure (2 years 4 months). At the time of the second unprovoked seizure (9 years 8 months), EEG showed poorly organized background activity associated with focal spikes and a few diffuse spike-and-waves. Then, diffuse paroxysms became predominant, followed by periodic synchronous discharges. In our case, EEG abnormalities were recognized before mental deterioration. Unexpected EEG changes in a patient with epilepsy could be a clue as to the diagnosis of SSPE.
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ranking = 1.25
keywords = encephalitis
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23/88. Congenital infection with human herpesvirus 6 variant B associated with neonatal seizures and poor neurological outcome.

    Human herpesvirus 6 (HHV 6) has neurotropic and neuroinvasive properties. The virus has been found in the cerebrospinal fluid of many children with aseptic meningoencephalitis. Intrauterine transmission has been documented by HHV 6 dna detection in cord blood specimens of apparently healthy newborns and in fetuses following spontaneous abortions. A patient is described with early neonatal afebrile seizures resulting from a congenital HHV 6 variant B infection disclosed by repeated detection of viral genome by polymerase chain reaction (PCR) in cerebrospinal fluid in the first days of life. At follow-up, magnetic resonance imaging (MRI) studies disclosed hyperintensities in the periventricular white matter and basal ganglia, associated with cerebral atrophy. Further follow-up at 18 months revealed poor neurological outcome with mild neurodevelopmental retardation, strabismus and hypertonia of legs. This report provides evidence of neurological involvement after HHV 6 vertical transmission, and the association with neurological sequelae.
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ranking = 0.25775025529828
keywords = encephalitis, meningoencephalitis, herpes
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24/88. subacute sclerosing panencephalitis presenting with hemiparesis in childhood: case report.

    subacute sclerosing panencephalitis is a chronic and fatal disease of the central nervous system. Most patients present with progressive psychointellectual disturbances. A 14-month-old girl was admitted to our hospital because of left-sided hemiparesis. During hospitalization, focal and generalized seizures occurred. The electroencephalogram (EEG) revealed that periodic lateralized discharges consisted of polyspike and high-voltage slow waves in the left hemisphere. The clinical and EEG findings and positive serology of measles in the cerebrospinal fluid were consistent with subacute sclerosing panencephalitis. In conclusion, we suggest that subacute sclerosing panencephalitis be considered in the differential diagnosis of focal neurologic signs in infants.
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ranking = 1.75
keywords = encephalitis
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25/88. Cerebral malakoplakia associated with neonatal herpes virus infection.

    Cerebral malakoplakia has been recognized as a complication of probable neonatal herpes encephalitis and may be associated with persistent neurologic deficits including seizures. At autopsy, an eight-month-old boy had a discrete cystic gliotic lesion in his left inferior frontal lobe with malakoplakia. Perinatal herpetic cutaneous lesions were seen and were successfully treated with medication at two weeks of age. Subsequent discontinuation of his anti-epileptic drugs was followed by sudden unexpected death. Immunohistochemical stains and electron microscopy of his brain failed to reveal herpes simplex virus.
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ranking = 0.25331894629577
keywords = encephalitis, herpes
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26/88. Onset of generalized seizures after intrathecal interferon therapy of SSPE.

    An 11-year-old male was admitted with inability to walk and speech abnormality. He was diagnosed with subacute sclerosing panencephalitis on the basis of clinical and laboratory findings. Therapy with inosiplex (100 mg/kg/day orally) plus intrathecal interferon-alpha (3 million units/dose twice per week) and ribavirin (15 mg/kg/day orally) was initiated. ribavirin was given orally because of a lack of parenteral form in our country. During follow-up, he complained about fever and widespread body pains after intrathecal therapy. On the sixth month of follow-up, generalized tonic-clonic seizures, associated with high fever, and lasting approximately 1-2 minutes occurred about 6 hours after giving interferon-alpha. Four days after the first seizures, a similar seizure attack reoccurred after intrathecal IFN-alpha. An antiepileptic agent was not administered because electroencephalogram results did not indicate epileptic discharges. At the current time, he is in the ninth month of follow-up and remains seizure-free. In conclusion, our case demonstrated that standard dose intrathecal interferon-alpha might cause seizures in children. We think that this unfortunate condition was more common in subacute sclerosing panencephalitis children treated with intrathecal interferon-alpha.
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ranking = 0.5
keywords = encephalitis
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27/88. drug hypersensitivity syndrome to carbamazepine and human herpes virus 6 infection: case report and literature review.

    We describe a patient with a drug-induced hypersensitivity syndrome to carbamazepine and a concomitant active infection with human herpes virus 6 (HHV-6). The potential role of HHV-6 regarding the drug-induced hypersensitivity syndrome is discussed and the main clinical features of this potentially fatal adverse drug reaction are highlighted.
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ranking = 0.0027657885798105
keywords = herpes
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28/88. Rasmussen syndrome and long-term response to thalidomide.

    We report a 13-year-old female who experienced symptoms and signs of Rasmussen encephalitis for the first time at the age of 5 years. Various therapeutic procedures, including conventional and new antiepileptic drugs, steroids, immunoglobulin, plasma exchanges, and partial hemispherectomy, were applied, but their results were unsatisfactory. During one of the exacerbations, when the patient's life was endangered, thalidomide was administered. Frequency and intensity of epileptic seizures were reduced significantly, and the quality of her life improved. Except for moderate neutropenia, the other adverse effects were not recognized. In our opinion, thalidomide is not a first-choice drug for Rasmussen encephalitis but is a good alternative only for cases refractory to other well-known and accepted therapeutic procedures.
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ranking = 0.5
keywords = encephalitis
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29/88. Rasmussen encephalitis with active inflammation and delayed seizures onset.

    Severe focal epilepsy is regarded as a clinical hallmark of Rasmussen encephalitis (RE). The authors report two children with progressive hemiparesis, contralateral hemispheric atrophy, and pathologic features characteristic for RE. At histologic diagnosis and over several months, neither patient experienced seizures. The report enlarges the clinical spectrum of RE and suggests that seizures are not an obligatory presenting symptom of the disorder.
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ranking = 1.25
keywords = encephalitis
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30/88. frontal lobe seizures and uveitis associated with acute human parvovirus B19 infection.

    We report a 5-year-old girl who developed repeated episodes of behavioral alterations shortly after human parvovirus B19 infection and uveitis. Video-electroencephalographic study demonstrated that these brief episodes were frontal lobe seizures. seizures responded promptly to antiepilepsy medications. Further diagnostic testing did not reveal any rheumatologic disorders. Human parvovirus B19 infections in children are more commonly associated with febrile seizures and meningoencephalitis. Our case demonstrates that, rarely, it may be associated with the development of partial epilepsy.
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ranking = 0.25498446671847
keywords = encephalitis, meningoencephalitis
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