ABSTRACT
Ictal blindness is a deficient symptomatology of partial seizure arising from visual cortex and usually short lived. When the blindness is the initial semiology of seizures, epileptic discharge arising from the primary visual cortex is associated. Ictal blindness has been reported in many patients with occipital lobe epilepsy, but prolonged ictal blindness called status epilepticus amauroticus has been reported only in few patients. We report a 45-year-old woman who had suffered prolonged epileptic blindness. The epileptic blindness was accompanied with rapid eyelid blinking and upward turning of head and eyeballs. Motor seizure and mental changes were not occurred. Ictal EEG showed 11-13 Hz repetitive spikes on the right occipital area followed by propagation to ipsilateral temporal area and contralateral occipital area. On T2-weighted MRI, abnormal lesions with high signal intensity were noted within bilateral occipital areas. She had been improved dramatically by loading dose of intravenous phenytoin.
Subject(s)
Female , Humans , Middle Aged , Blindness , Blinking , Electroencephalography , Epilepsies, Partial , Epilepsy , Eyelids , Head , Magnetic Resonance Imaging , Phenytoin , Seizures , Status Epilepticus , Visual CortexABSTRACT
Isaacs' syndrome consists of spontaneously occurring muscle activity of peripheral nerve origins. This syndrome arises in association with/without polyneuropathy and rarely with malignancy. A 63-year-old man was admitted to our hospital due to generalized painful muscle stiffness. He complained of difficulty with standing and with finger exten-sion after grasping. Chvostek's and Trousseau's signs were noticed. Electrolytes, calcium, CK, and LDH were in the normal range. Small cell lung cancer was diagnosed by a needle biopsy. Electrophysiological testing revealed normal nerve conduction studies with the exception of a grossly abnormal EMG. Continuous neuromyotonic discharges with firing rates of 120-200 Hz were seen at rest. The amplitude of the response typically waned with 0.5-1.5 seconds of duration. The discharges persisted throughout sleep, after diazepam injection, and with brachial plexus blockage.Muscle stiffness improved with the administration of oral phenytoin. Under chemotherapy and radiotherapy, tumor remission was partially achieved and neurological symptoms markedly improved.
Subject(s)
Humans , Middle Aged , Biopsy, Needle , Brachial Plexus , Calcium , Diazepam , Drug Therapy , Electrolytes , Fingers , Fires , Hand Strength , Isaacs Syndrome , Neural Conduction , Peripheral Nerves , Phenytoin , Polyneuropathies , Radiotherapy , Reference Values , Small Cell Lung CarcinomaABSTRACT
Cranial mononeuropathies, manifesting particulary as opthalmoplegia or facial palsy, are common entities in the dia-betic population. However, sequential multiple cranial neuropathies due to diabetes are much less common. It is often associated with other conditions such as a brain tumor or head trauma. A 61-year-old diabetic man presented with ptosis, opthalmoplegia, and facial palsy which were manifestations of multiple cranial neuropathies involving the left 3rd, 4th, 6th, and 7th cranial nerves throughout five weeks. The pupils were not involved. The neurologic evaluation included a CSF study and a brain MRI with MRA. None of them produced any significant results. Blink reflexes revealed evidence of a left facial nerve lesion. The blood glucose was strictly controlled and steroid therapy was administered. The ptosis of the patientanjx left eyelid improved during treatment and he was discharged after 13 days. In a follow-up examination 3 months after onset, focal neurological deficits including opthalmoplegia and facial palsy on the left side were greatly improved and barely noticeable.