Frequency, causes, and findings of brain CT scans of neonatal seizure at Ardabil City Hospital, Ardabil, Iran

Background: Neonatal seizures are the primary and most important signs of neurologic function disorders that often lead to serious complications. However, this disorder is predictable and manageable with suitable diagnostic and therapeutic methods. The aim of this study was to investigate the frequency, causes, and findings of brain CT scans of neonatal seizure.Methods: This descriptive cross-sectional study has been done on 70 neonates with seizures who hospitalized in Ardabil city hospital during 2016-2017. CT scans were done for all patients. Necessary information for each patient was recorded in a checklist including demographic data, history of diabetes mellitus, hypertension, and maternal endocrine disorders, and history of resuscitation and clinical data including type of seizure and its duration, Cause of seizure and CT scan findings (cerebral hemorrhage, local ischemic lesions, hypoxemic-ischemic encephalopathy, and anatomical cerebral malformations).Results: The mean age of neonates was 12.41±9.33 days. Of them, 61.4% were boys, 3.24% LBW and 40% were preterm at birth time. Of all neonates, 21.4% had history of seizure in their relative degree family members. Fever was the most common symptom accompanying seizures (40%). The most common form was tonic seizure (n=30, 42.9%) and its duration time was 4.99 minute.  A total of 41.4% of neonates (29 cases) had abnormal CT scan reports. Hypoxic-ischemic encephalopathy (47%) was the most common findings in the CT scans of neonates with seizures.Conclusions: Results showed that, a considerable number of neonates had abnormal CT findings and the most common abnormal form was hypoxemic-ischemic encephalopathy.

Clinical manifestation of post-traumatic epilepsy features of its course / Монголын Анагаах Ухаан

Introduction. Traumatic brain injury (TBI) account for 20% of the symptomatic epilepsies in general population. Post traumatic epilepsy (PTE) may be presented with various clinical manifestations of seizure and clinical course of illness varies as well. The incidence of PTE varies with the time period after injury and the population age range under study, as well as the spectrum of severity of the inciting injuries ranges from 4% to 53%. In this study, we aimed to describe clinical characteristics and course of illness of patients with PTE.Materials and Methods. This hospital-based descriptive study was done 2012-2013 in Ulaanbaatar city. We retrospectively obtained number of patients with PTE reported in 2011-2012 from statistical reports of the National Health Center. In this study 109 patients with PTE, aged 16-72 were involved wrom which we collected detailed information on socio-demographic characteristics, history of illness, clinical manifestations including features of seizure and course of illness through pre-developed questionnaire. Medical examination was conducted after the interview to evaluate the seizures in accordance with semiological classification of epileptic seizures and the international classification International Leaque Against Epilepsy. Frequencies of variables including socio-demographic, clinical characteristics and clinical manifestations and, association between type of TBI and clinical manifestations were calculated. Correlation between diagnostic tests and clinical outcomes were also tested. Statistical analysis was conducted using SPSS 17.0 program. Ethical approval was obtained from the Ethical Committee of the School of Medicine, HSUM. Each participant had signed a consent form before involving in the study.Results. 81 (74.3%) participants of 109 were men and 28 (25.3%) were woman. Off our study participants, 98 (90%) were sufferng from generalized tonic clonic seizures. Off all participants, 43 (53.1%) males and 14 (50%) females presented moderate TBI. The mean duration of PTE is 9.6+-9.3 years, participants suffer from PTE 0-5 year. Of all, 19 (23.5%) males have a seizure once a week, 9(32.1%) female have seizure once a month. There were some differences in the forms of brain injury depending from gender; 57(70.4%) of males and 19(67.9%) of females had brain contusion. Only 5 (6.3%) of males had brain concussion, whereas for 6 (22.2%) females had this symptom. For males, intracranial hematoma accounted in 14 (17.7%), but for females in 2 (7.4%). Significant association was observed between clinical form of TBI and duration of loss of consciousness after the injury and injury severity (p<0.002). Of all, 21(19.3%) patients who had TBI were treated surgically. Its occurrence was positively correlated with early onset seizures (P<0.05). The frequency of seizure was not correlated with the structural brain abnormalities, but there was inverse association between frequency of seizure and duration of PTE (r= -0.32, p<0.001). As PTE continues longer the frequency of seizures decreases. Conclusion: Patients particularly surgically treated are suffer from PTE which is presented by generalized seizure. Patients with brain contusion, compression seem to be prone to post traumatic epilepsy. The course of PTE characterized long duration with high frequency of seizure, short time following by severe brain injury.

Epistaxis during a generalized seizure leading to an atypical ictal SPECT finding at the skull base

INTRODUCTION: Generalized tonic-clonic seizures (GTCS) are among the most dramatic types of epileptic seizures and may be accompanied by rising blood pressure and pulse rate, physical injuries from falling, muscular convulsions, tongue biting, or aspiration pneumonia. Epistaxis is an uncommon complication of generalized seizures and investigations should exclude local or systemic disorders. OBJECTIVE: We aim to report a 29-year-old male patient with medically intractable right temporal lobe epilepsy whose ictal SPECT showed a conspicuous high extracerebral accumulation of the tracer at the skull base. METHODS: The tracer 99mTc-ECD was injected during a GTCS complicated by simultaneous epistaxis during a long term video-electroencephalographic monitoring. RESULTS: Initially, SPECT images showed an unexpected hot spot at the skull base suggesting pharyngeal or pituitary tumors. Clinical history disclosed chronic sinusitis and rare episodes of epistaxis. White and red cells blood count, platelet count, serum biochemistry, coagulation tests, and rest arterial blood pressure were normal. Computed tomography and MRI excluded sinusoidal expansive or vascular lesions, head trauma, fractures or acute infections. Subtracted SPECT disclosed a focal high concentration of the radiotracer within the left sphenoid sinus, probably related to the nose bleeding. CONCLUSION: This is a singular case of a brain SPECT artifact secondary to a nasal bleeding during a generalized seizure that was misinterpreted as neoplastic disease. Also, this case raises concerns about the pathophysiological relationship among epileptic seizures, nasal bleedings and chronic sinusitis.

INTRODUÇÃO: As crises generalizadas tônico-clônicas (CGTC) constituem-se em formas dramáticas de crises epilépticas e podem acompanhar-se de aumento da pressão arterial e da freqüência cardíaca, traumas decorrentes de quedas, abalos musculares, mordedura de língua e pneumonias aspirativas. A epistaxe é uma complicação incomum e investigações médicas devem excluir distúrbios locais ou sistêmicos. OBJETIVO: Relatar o caso de um paciente de 29 anos de idade com epilepsia do lobo temporal direito clinicamente intratável e cujo SPECT crítico mostrou uma área de acúmulo anormal do traçador na base do crânio. MÉTODO: O traçador 99mTc-ECD foi injetado durante uma CGTC complicada por simultânea epistaxe na narina esquerda durante a monitorização vídeo-eletroencefalográfica. RESULTADOS: O SPECT crítico evidenciou área de acúmulo anormal do traçador na base do crânio sugerindo tumor de natureza neuronal ou glial e de origem faríngea ou pituitária. A história clínica evidenciou sinusite crônica e raros episódios de epistaxe. Exames hematológicos das series branca e vermelha, contagem de plaquetas, bioquímica sérica, testes de coagulação e medidas de pressão arterial em repouso foram normais. A Tomografia Computadorizada e a Ressonância Magnética (RM) excluíram lesões expansivas ou vasculares, trauma craniano, fraturas ou infecções agudas. A subtração baseada em voxel das imagens de SPECT crítico e intercrítico alinhada ao espaço 3D da RM evidenciou uma alta concentração do traçador no seio esfenoidal esquerdo. CONCLUSÃO: Este é um caso singular de um artefato ao SPECT crítico secundário ao sangramento nasal durante uma crise epiléptica e que foi inicialmente interpretado como doença neoplásica. Este caso também indaga sobre o possível relacionamento fisiopatológico entre crises epilépticas, sangramentos nasais e sinusite crônica.

The Surgical Effect of Callosotomy in the Treatment of Intractable Seizure

We evaluated the surgical effects of the callosotomy, particularly with respect to the effect of callosotomy in some seizure types and the extent of surgery. Twenty-one patients with a minimum follow-up of two year were enrolled. The most significant effect of callosotomy was the complete suppression of the generalized seizures associated with drop attack in 12 of 21 patients and seizure reduction of more than 75% in 6 of 21 patients. The surgical effect on the partial seizures was very variable. Transient disconnection syndrome appeared in 4 patients after anterior callosotomy. Total callosotomy by staged operation significantly suppressed generalized seizures associated with drop attack without any disconnection syndrome. Our data show that callosotomy is quite a good approach to the surgical treatment of drop attacks accompanied by disabling generalized seizures.

Comparative Study for the Diagnostic Usefulness of Brain MRI and CT in Children with Seizure / 대한소아신경학회지

PURPOSE: This study was performed to know and compare the diagnostic usefulness of Magnetic Resonance Imaging(MRI) and Computed Tomography(CT) for the evaluation of patients with seizure. METHODS: We studied retrospectively 96 children who visited Hanyang University Hospital due to seizure and took a brain CT between January 1996 and June 1999, and 60 children who visited Hanyang University Hospital due to seizure and took a brain MRI between June 1999 and March 2002. All children who were enrolled in this study divided into few groups according to seizure type and EEG findings. RESULTS: Among 96 children who took a brain CT, 12 patients had brain abnormalities on CT, and among 60 children took a brain MRI, 13 patients had brain abnormalities on MRI. Abnormalities on CT were more frequently seen in children with focal seizure and/or focal abnormalities on EEG, but contrarily in MRI, abnormalities were more frequently seen in children with generalized seizure. CONCLUSION: Even the MRI is more expensive to be taken than the CT, MRI isrecommended when there is a need to evaluate the causes of seizures even for thepatients with generalized seizure as a result of our study.

Comparative Study for the Diagnostic Usefulness of Brain MRI and CT in Children with Seizure / 대한소아신경학회지

PURPOSE: This study was performed to know and compare the diagnostic usefulness of Magnetic Resonance Imaging(MRI) and Computed Tomography(CT) for the evaluation of patients with seizure. METHODS: We studied retrospectively 96 children who visited Hanyang University Hospital due to seizure and took a brain CT between January 1996 and June 1999, and 60 children who visited Hanyang University Hospital due to seizure and took a brain MRI between June 1999 and March 2002. All children who were enrolled in this study divided into few groups according to seizure type and EEG findings. RESULTS: Among 96 children who took a brain CT, 12 patients had brain abnormalities on CT, and among 60 children took a brain MRI, 13 patients had brain abnormalities on MRI. Abnormalities on CT were more frequently seen in children with focal seizure and/or focal abnormalities on EEG, but contrarily in MRI, abnormalities were more frequently seen in children with generalized seizure. CONCLUSION: Even the MRI is more expensive to be taken than the CT, MRI isrecommended when there is a need to evaluate the causes of seizures even for thepatients with generalized seizure as a result of our study.

Systemic Lupus Erythematosus with Central Nervous System Involvement: Case Report

Systemic lupus erythematosus(SLE) is a disease of unknown cause in which tissues and cells are damaged by pathogenic autoantibodies and immune complexes. Clinical manifestations which fulfill American Rheumatism Association criteria for a diagnosis of SLE include malar or discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal, neurologic, hematologic or immunologic disorder, and antinuclear antibodies. Central nervous system (CNS) events may be single or multiple. Clinical manifestations of CNS involvement include organic brain syndromes, focal infarcts, headache, transverse myelitis, optic neuritis, cranial nerve palsies, depression, and anxiety. A 34-year-old female presented with generalized seizure. Antinuclear antibody and antibody to Sm were positive, and low levels of C3 and C4 were detected. On MRI, mild, non-enhancing, low signal intensity was seen on T1 weighted images, and illdefined higher intensities on T2 weighted images. On stereotactic biopsy, three pieces of yellowish material were obtained. Microscopically, coagulative necrosis and neutrophilic infiltration were seen, and the patient underwent steroid therapy. Two months later, MRI no longer showed abnormal signal intensity.

Electroencephalographic, Behavioral and Pathologic Characteristics in Experimental Complex Partial Seizure Induced by Microinjection of Kainic Acid into the Unilateral Amygdala in the Rat

Kainic acid(KA) is an excitotoxic analogue of glutamate which is now widely used in the studies of epilepsy. Electroencephalographic, behavioral and pathologic observation were done for 2 months after microinjection of kainic acid(Kainic acid group;0.4 microgram, 0.8 microgram, 1.2 microgram, 1.6 microgram, 2.0 microgram, 3.0 microgram) and phosphate buffer solution(Control group) into the left basolateral amygdala(AMG) in 30 Spaque-Doley rats. The control group showed no change in EEG and behavior during the observation period and pathologic findings were normal. One of four rats which 1.2 microgram of KA was injected, four of six rats of 1.6 microgram, all six rats of 2.0 microgram, one of four rats of 3.0 microgram developed acute complex partial seizure and multiple epileptic spikes with high amplitude in EEG. One of four rats of 1.2 microgram, one of six rats of 1.6 microgram, three of six rats of 2.0 microgram, showed spontaneous limbic seizure 14~21days after kainic acid injection. Among those which developed spontaneous limbic seizure, two rats demonstrated spontaneous secondarily generalized seizure 30~60days after kainic acid injection. Pathological examination revealed focal necrosis with perifocal gliosis at the tip of the cannula in the left amygdala. Neuronal cell loss was observed in the CA3 portion of pyramidal cell layer of the hippocampus on the injected side of KA, which developed spontaneous secondarily generalized seizure. But the cellular architecture was normal in the contralateral hippocampus. This is regarded as a good medel of spontaneous generalized complex partial seizure, which is similar to that of temporal lobe epilepsy in human.