ABSTRACT
PURPOSE: This study aims to determine the clinical significance of epileptic nystagmus in patients with acute neurological symptoms. METHOD: The clinical findings of patients with documented epileptic nystagmus, their original video and EEG data, and cranial imaging and laboratory tests were analyzed retrospectively. RESULTS: 20 patients were included in the study and 21 epileptic nystagmus attacks were determined from patients' clinical and video-EEG recordings. All recorded seizures with epileptic nystagmus were focal onset in nature. The ictal discharge pattern was rhythmic fast activity with a mean frequency of 15 Hz. The ictal discharges originated from the parieto-occipital (n = 8), temporo-occipital (n = 7), parieto-occipito-temporal (n = 3), temporal (n = 2), occipital (n = 1), and centroparietal (n = 1) areas. In the fast phase, the nystagmus was beating away from the side of ictal discharges. The origin of the ictal discharges on EEG images was compatible with the lesion localization at cranial MRI in all patients. Etiologies were epilepsy in seven patients, non-ketotic hyperglycemia in four, ketotic hyperglycemia in one, PRES in three, acute stroke in three, HSV encephalitis in one, and MELAS in one. CONCLUSIONS: Epileptic nystagmus represents a guide to the lateralization and localization of the lesion in cases presenting with acute neurological symptoms. In these patients, the lesion is frequently in the posterior regions of the hemispheres. Although various diseases affect these regions in terms of etiology, such cases should be evaluated in terms of the presence of hyperglycemia.
Subject(s)
Epilepsy , Hyperglycemia , Nystagmus, Pathologic , Electroencephalography/adverse effects , Epilepsy/diagnosis , Epilepsy/diagnostic imaging , Humans , Hyperglycemia/complications , Nystagmus, Pathologic/diagnosis , Nystagmus, Pathologic/etiology , Retrospective Studies , Seizures/complicationsABSTRACT
Paraplegia after percutaneous iliac angioplasty is very rare, and is typically associated with spinal cord ischemia (SCI). Presently described is a case of SCI and paraplegia developing after bilateral iliac stenting. This complication may be caused by a change in spinal blood flow in patients with diffuse atherosclerosis, and should be kept in mind.
Subject(s)
Arterial Occlusive Diseases/therapy , Iliac Artery , Paraplegia/diagnosis , Spinal Cord Ischemia/diagnosis , Stents/adverse effects , Aged , Angioplasty/adverse effects , Diagnosis, Differential , Electromyography , Humans , Magnetic Resonance Imaging , Male , Paraplegia/diagnostic imaging , Paraplegia/etiology , Paraplegia/physiopathology , Spinal Cord Ischemia/diagnostic imaging , Spinal Cord Ischemia/etiology , Spinal Cord Ischemia/physiopathologyABSTRACT
OBJECTIVE: Lumbar spinal stenosis (LSS) is a chronic degenerative disease with pain in the back, buttocks and legs aggrevated by walking and relieved after rest without associated vascular disease of lower extremities observed in patients between 50 and 60 years. Several studies, using different methods indicated an association between slowing or blocking of root-nerve conduction and LSS. None of the previous research had applied the more conceivable methods such as recording the cauda equina potentials from the lumbar level or stimulating the spinal roots within the canal using either leg nerves or muscles. In this study, electrical lumbar laminar stimulation was used to demonstrate prolongation of cauda equina motor conduction time in lumbar spinal stenosis. METHODS: Twenty-one LSS patients and age matched 15 normal control subjects were included in the study. Lumbar laminar electrical stimulation from L1 and L5 vertebra levels were applied by needle electrodes. Compound muscle action potential (CMAP) from gastrocnemius muscles were recorded bilaterally. Latency difference of CMAPs obtained from L1 and L5 spine levels were accepted as the cauda equina motor conduction time (CEMCT). RESULTS: CEMCT was significantly longer in patient group when compared to normal controls. Mean latency difference was 3.59 ± 1.07 msec on the right side, 3.49 ± 1.07 msec on the left side in LSS group, it was 1.45 ± 0.65 msec on the right side, 1.35 ± 0.68 msec on the left side on normal control group (p<0.0001). CONCLUSIONS: The prolongation of CEMCT was statistically and individually significant in patient group. This may indicate that lower lumbosacral motor roots were locally and chronically compressed due to lumbar spinal stenosis. Lumbar spinal stenosis may have induced local demyelination at the cauda equina level. SIGNIFICANCE: Since the prolongation of CEMCT was found only in patients with LSS, the method of laminar stimulation can be chosen for patients with uncertain diagnosis of LSS.
