Simple partial status epilepticus presenting with jargon aphasia and focal hyperperfusion demonstrated by ictal pulsed arterial spin labeling MRI

@#We report a case of 74-year-old lady, presented with recurrent jargon aphasia as simple partial status epilepticus (SPSE) which lasted for a few days to a few weeks, following a brain abscess removal from the left temporo-parieto-occipital region at the age of 71 years. The ictal activity on electroencephalogram was documented at left posterior quadrant, where marked hyperperfusion was clearly visualized by perfusion image acquired with magnetic resonance imaging (MRI) using pulsed arterial spin-labeling (PASL). Jargon aphasia as a primary feature of simple partial status epilepticus is so uncommon that only few cases have been reported. Furthermore, this report suggests that MRI using PASL is a promising method not only to localize the seizure foci but also to follow up the corresponding regional cerebral blood flow changes noninvasively.

Arterial Spin Labeling Perfusion MRI of Crossed Cerebellar Diaschisis in a Patient with Simple Partial Status Epilepticus

Crossed cerebellar diaschisis (CCD) is known to be due to a contralateral supratentorial lesion decreasing blood flow and the metabolism in a cerebellar hemisphere. Arterial spin labeling (ASL) is an imaging technique that utilizes arterial blood water as a tracer for quantifying the regional cerebral blood flow in magnetic resonance imaging (MRI). This case was a patient with simple partial status epilepticus (SPSE) and CCD confirmed by ASL-perfusion MRI. Controlling the SPSE resulted in improvement of CCD being observed in the follow-up ASL-perfusion MRI.

Complex Partial Status Epilepticus Caused by Hyponatremia

A 67-year-old female presented with stuporous mentality. She ingested a bowel-preparation agent and 4 L of water in preparation for a colonoscopy the day before presentation, and subsequently developed severe diarrhea and vomiting. Laboratory tests demonstrated hyponatremia (120 mEq/L). Her EEG exhibited continuous spike- or polyspike-and-wave discharges on the left frontal area. We diagnosed complex partial status epilepticus caused by hyponatremia in this patient. Her mental status and EEG recovered completely after administration of an anticonvulsant and correction of hyponatremia.

Complex partial status epilepticus in the elderly: clinical features and causes of misdiagnosis / 中华神经医学杂志

Objective To investigate the clinical features and causes of misdiagnosis of complex partial status epilepticus (CPSE) in the elderly. Methods The clinical data of elderly patients with CPSE admitted in our department between January and December, 2008 with previous misdiagnosis were reviewed. The diagnosis of CPSE was established according to the diagnostic criteria of the International League Against Epilepsy (ILAE). All the patients underwent video-EEG examination, head magnetic resonance imaging (MRI), and routine biochemical examination, and were followed up for at least 3 months. Results Seven female CPSE patients were involved in this analysis including 2 with frontal lobe epilepsy and 5 with temporal lobe epilepsy. The conditions were misdiagnosed as a variety of diseases including Alzheimer's disease, cerebral infarction, coronary heart disease, encephalitis, hysterism, and schizophrenia, and the duration of the misdiagnoses ranged from 2 days to 40 years. Video-EEG showed slow background, continuous interictal discharges or high-voltage slow waves in the temporal or frontal lobe, or ictal discharges of complex partial seizures. After treatment with antiepileptic medications, 3 patients were free of epileptic episodes within 3 months, 3 still remained in complex partial status, and 1 had repeated CPSE. Conclusions Complex symptoms, atypical EEG, co-morbidity and social factors all contribute to misdiagnosis of CPSE in the elderly. Suspected patients should undergo video-EEG examination for a definite diagnosis as early as possible.

Vasogenic Edema in a Patient with Partial Status Epilepticus / 대한간질학회지

We report a patient who showed vasogenic edema on MRI in association with partial status epilepticus. The patient, for a month, experienced clonic movements of the right arm and leg. As the amplitude and frequency of the clonic movements increased, resulting in epilepsia partialis continua, MRI showed characteristic vasogenic edema features;normal or decreased signal on diffusion-weighted imaging, and increased apparent diffusion coefficient value in the left parasagittal frontal region with strong leptomeningeal enhancement. This region was corresponded to the leg motor area, which was correlated with the degree of hypemetabolism of ictal FDG-PET findings. Considering limited progression of the seizure activity and focal slow waves on EEG, time-locked by clonic jerks, which might result from synaptic inhibition, this case suggests that vasogenic edema may be associated with a lower intensity of the seizure activity compared with cytotoxic edema noted in most of the reported patients.

Non-ketotic Hyperglycemia Manifested as Occipital Lobe Complex Partial Status Epileticus

A 48-year-old woman presented with right visual aura evolving into versive and clonic seizures. The seizures were controlled not by anticonvulsants but bynormalization of blood sugar and not by anticonvulsants. T2-weighted MRI (T2WI) showed subcortical hypointensity and cortical hyperintensity with a low apparent diffusion coefficient (ADC) value in left occipital area, which reversed into a high ADC value at in follow-up images. Serial MRIs including diffu-sion- weighted images seemed to reveal tissue injury after partial status epilepticus and regional ischemia associated with non-ketotic hyperglycemia.

Aphasic Status Epilepticus: Two Cases / 대한간질학회지

BACKGROUND & SIGNIFICANCE: Aphasic status epilepticus is an uncommon presentation of a simple partial status epilepticus characterized by prolonged speech impairment with clinical-EEG correlation in the absence of an altered level of consciousness. There has been no published report in Korea. This study reports two adult patients with prolonged aphasia and EEG abnormalities. CASES: Total three episodes of aphasic status epilepticus were documented in two patients. Patients were right-handed 58-year-old and 79-year-old women. The cause was intracranial plasma cell granuloma involving left temporal lobe and old left temporo-parietal hemorrhage respectively. Aphasic symptoms of these patients were characterized by difficult comprehension and jargon speech with clear consciousness. The duration of aphasia ranged 9-14 days. EEG showed continuous periodic lateralized sharp waves in one patient and discrete rhythmic theta to alpha activities in left temporo-parieto-occipital region in the other patient. COMMENTS: Although rare in adults, aphasic status epilepticus should be considered in the differential diagnosis of aphasia.

Ictal PET Findings of Complex Partial Status Epilepticus

We performed an 18F-fluorodeoxyglucose (FDG) position emission tomography (PET) in two patients with complex partial status epilepticus (CPSE). Ictal FDG studies usually occur by chance, because of the unpredictable nature of seizures and the short half-life of flourine-18. In addition to that, ictal PET studies are often contaminated by postictal hypometabolism due to the relatively long FDG uptake period. We experienced two patients with prolonged states of mental confusion. During the confused state, eletrophysiologic and neuroimaging studies were done to confirm the diag-nosis of CPSE. Ictal PET studies showed hypermetabolism during status epilepticus compared with interictal PET. There has been no case report about ictal PET in Korea. We present two cases of ictal PET with a review of the literature

Ictal PET Findings of Complex Partial Status Epilepticus

We performed an 18F-fluorodeoxyglucose (FDG) position emission tomography (PET) in two patients with complex partial status epilepticus (CPSE). Ictal FDG studies usually occur by chance, because of the unpredictable nature of seizures and the short half-life of flourine-18. In addition to that, ictal PET studies are often contaminated by postictal hypometabolism due to the relatively long FDG uptake period. We experienced two patients with prolonged states of mental confusion. During the confused state, eletrophysiologic and neuroimaging studies were done to confirm the diag-nosis of CPSE. Ictal PET studies showed hypermetabolism during status epilepticus compared with interictal PET. There has been no case report about ictal PET in Korea. We present two cases of ictal PET with a review of the literature

Neuronal damage confirmed by 1H-MRS in occipital lobe complex partial status epilepticus

A 74-year old woman presented with partial and secondarily generalized status epilepticus lasted for 11 days. Initially her seizures consisted of only unformed visual hallucination, which progressed to formed hallucinations, and then memory disturbance and GTCs. During the period of recurrent formed visual hallucinations, T2-weighted brain MRI revealed high signal intensities in the left occipital lobe. After intravenous phenytoin loading, she did not develop any further GTCs but visual hallucinations persisted. Follow-up MRI performed after complete recovery of seizures showed complete recovery of the previous focal lesions, however, 1H-MRS showed a significant decrease of NAA in the recovered area. These features suggested the neuronal loss in the area of seizure focus, despite the complete recovery of transient focal abnormalities in MRI. This case provides a supportive evidence of neuronal damage even in focal status epilepticus, which stress the importance of early treatment and EEG confirmation of the complete seizure control after the disappearance of clinically obvious seizures.