Negative myoclonus associated with tramadol use / 영남의대학술지

Negative myoclonus (NM) is a shock-like jerky involuntary movement caused by a sudden, brief interruption of tonic muscle contraction. NM is observed in patients diagnosed with epilepsy, metabolic encephalopathy, and drug toxicity and in patients with brain lesions. A 55-year-old man presented with NM in both his arms and neck. He has taken medications containing tramadol at a dose of 80–140 mg/day for 5 days due to common cold. He had no history of seizures. Acute lesions were not observed during magnetic resonance imaging, and abnormal findings in his laboratory tests were not noted. His NM resolved completely after the discontinuation of tramadol and the oral administration of clonazepam. Our case report suggests that tramadol can cause NM in patients without seizure history or metabolic disorders, even within its therapeutic dose.

Acute Symptomatic Seizures in Patients with Acute Ischemic Stroke: Incidence and Predictive Factors

BACKGROUND: The aim of this study was to establish the incidence, predictive factors, characteristics, and clinical outcomes of acute symptomatic seizures (ASS) after acute ischemic stroke (AIS). METHODS: In total, 2,528 consecutive patients with first-ever AIS were included. Patients with a history of epilepsy or provoked seizures due to tumor, head trauma, brain surgery, or high fever were excluded. Onset seizure (OS) and ASS were defined as seizures occurring within 24 hours and 7 days after AIS, respectively. The incidence of ASS, type of seizures, presence of late unprovoked seizure (LUS), MRI, and electroencephalogram were analyzed. RESULTS: ASS and OS occurred in 23 patients (0.9%) and 15 patients (0.6%), respectively; 20 of the patients with ASS (87.0%) had partial seizures and 4 (17.4%) developed status epilepticus. The incidence rates of ASS were 1.3%, 0.3%, and 0.2% in AIS caused by large-artery atherosclerosis, small-vessel occlusion, and cardioembolism, respectively. Of the 23 patients with ASS, the cortex was involved in 19 (82.6%), 16 patients (69.6%) had medium-sized to large lesions, the anterior circulation territory was involved in 21 patients (91.3%), and 4 patients (17.4%) developed MRI-confirmed hemorrhagic transformation of the lesions. Epileptiform discharges were observed in 9 (45%) of the 20 patients with ASS. Three of the 23 patients with ASS (13.0%) developed LUS. CONCLUSIONS: The incidence of ASS was 0.9% and was highest in the large-artery atherosclerosis group. The development of ASS was significantly associated with cortical involvement, medium-sized to large lesions, and lesions in the anterior circulation territory. Three of 23 patients (13%) developed LUS.

Cisplatin-Induced Encephalopathy With Status Epilepticus

A 75-year old man with esophageal cancer presented with mental status change and seizures. He was under cisplatinand developed several times of generalized tonic-clonic seizures. The EEG (electroencephalography) showed triphasic waves and slowed background activity. He was diagnosed with status epilepticus and encephalopathy caused by cisplatin. He was treated with anticonvulsants and cisplatin was replaced by docetaxel. His mentality recovered completely and he had no more seizure. We conclude that physician using cisplatin should be aware of this rare complication.

Bacterial Meningitis and Cerebrospinal Fluid Rhinorrhea Related to Rhinoplasty

No abstract available.