Subject(s)
Abdominal Muscles/diagnostic imaging , Brain Ischemia/diagnostic imaging , Cerebral Cortex/diagnostic imaging , Epilepsia Partialis Continua/diagnostic imaging , Video Recording/methods , Abdominal Muscles/physiopathology , Aged , Brain Ischemia/complications , Brain Ischemia/physiopathology , Epilepsia Partialis Continua/etiology , Epilepsia Partialis Continua/physiopathology , Humans , Male , Myoclonus/diagnostic imaging , Myoclonus/etiology , Myoclonus/physiopathologySubject(s)
Dura Mater/surgery , Lumbosacral Region/surgery , Meningitis/diagnosis , Parietal Lobe/surgery , Adult , Disease Progression , Female , Glucocorticoids/therapeutic use , Humans , Meningitis/drug therapy , Meningitis/surgery , Methylprednisolone/therapeutic use , Middle Aged , Treatment OutcomeABSTRACT
BACKGROUND: To describe a case of auto-immune encephalitis in an adolescent with favorable outcome despite prolonged status epilepticus. METHODS: A 17 year old Asian man without previous medical history developed alteration of consciousness and partial seizures. The diagnosis of anti-N-methyl-D-aspartate receptor encephalitis was confirmed by the detection of specific antibodies in both cerebrospinal fluid and serum. RESULTS: The clinical course was complicated by prolonged status epilepticus which was refractory to a large number of antiepileptic drugs, including barbiturate coma. Immunomodulatory therapy included steroids, plasma exchanges, and intravenous immunoglobulins. After 86 days of intensive therapy, the patient regained consciousness progressively. Brain magnetic resonance imaging never demonstrated any lesion. Extensive search for a tumor was negative. At 12 month follow-up, the patient had made an excellent recovery. CONCLUSION: Auto-immune encephalitis is likely underdiagnosed in adolescents. In their most severe presentation, seizures may be resistant to a large number of anti-epileptic drugs, and the clinical improvement seems to be mainly because of the immunomodulatory therapy. Relapse is possible, as well as the delayed development of a teratoma or other tumor.
Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis/drug therapy , Anticonvulsants/therapeutic use , Immunosuppressive Agents/therapeutic use , Status Epilepticus/drug therapy , Adolescent , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/complications , Humans , Male , Status Epilepticus/etiology , Treatment OutcomeABSTRACT
Toxic causes of seizures are numerous: alcohol and other substances of abuse, drugs, and industrial and household products. However, in the absence of a clearly suggestive history and/or associated symptoms and signs, identification of the toxic origin of new-onset seizures may be extremely difficult. We report here the case of a patient admitted in our hospital after a single generalized tonic-clonic seizure. The remarkable coincidence that a colleague of his, with whom he was working to clean the same workshop, had been admitted 1 week earlier for respiratory distress, coma, and de novo nonconvulsive focal status epilepticus, led us to consider a possible toxicologic etiology. Urine analysis revealed a high nickel concentration, suggestive of acute nickel poisoning.
