Lacosamida intravenosa en monoterapia en un caso de estado epiléptico parcial complejo / Intravenous lacosamide in monotherapy in a case of complex partial epileptic status

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[Non-convulsive status epilepticus secondary to subarachnoid haemorrhage as the presenting symptom of a cerebral amyloid angiopathy]. / Estado de mal epiléptico no convulsivo secundario a hemorragia subaracnoidea como forma de presentación de una angiopatía amiloide cerebral.

INTRODUCTION: Cerebral amyloid angiopathy is a frequent cause of haemorrhagic cerebrovascular disease in persons over the age of 65 and, sometimes, the initial symptoms can be epilepsy-like. CASE REPORT: A 62-year-old female with no relevant past history who was admitted to hospital due to non-convulsive status epilepticus, auditory hallucinations and ideomotor apraxia; an electroencephalogram performed on the patient revealed periodic lateralised epileptiform discharges in the right parietooccipital region. Susceptibility-weighted magnetic resonance imaging showed a sub-acute focal subarachnoid haemorrhage in the right parietotemporal region and cortico-subcortical microbleeding in different stages of the progression of the disease that were compatible with cerebral amyloid angiopathy. A critical simple single-photon emission tomography scan was performed and findings revealed an area of hyperperfusion in the same region. Antiepileptic treatment was established with clinical, neurophysiological and scintigraphic resolution. CONCLUSIONS: The article reports a case with non-convulsive status epilepticus as the initial symptom of cerebral amyloid angiopathy. It also highlights the usefulness of sequences of susceptibility-weighted magnetic resonance imaging and the physiopathogenesis of periodic lateralised epileptiform discharges as an element of epileptic activity is discussed.

Estado de mal epiléptico no convulsivo secundario a hemorragia subaracnoidea como forma de presentación de una angiopatía amiloide cerebral / Non-convulsive status epilepticus secondary to subarachnoid haemorrhage as the presenting symptom of a cerebral amyloid angiopathy

Introducción. La angiopatía amiloide cerebral es una causa frecuente de enfermedad cerebrovascular hemorrágica en mayores de 65 años y, en ocasiones, la sintomatología inicial puede ser de tipo epiléptico. Caso clínico. Mujer de 62 años de edad sin antecedentes de interés que ingresa por estado de mal no convulsivo con sintomatología de desconexión del medio, alucinaciones auditivas y apraxia ideomotora, con aparición de descargas periódicas lateralizadas epileptiformes en la región parietooccipital derecha en el electroencefalograma. La resonancia con secuencia de susceptibilidad magnética mostró una hemorragia subaracnoidea focal subaguda en la región parietotemporal derecha y microsangrados corticosubcorticales en distintos estadios evolutivos compatibles con angiopatía amiloide cerebral. Se realizó una tomografía computarizada por emisión de fotón único crítica que mostró una área de hiperperfusión en la misma región. Se inició tratamiento antiepiléptico con resolución clínica, neurofisiológica y gammagráfica. Conclusión. Se presenta un caso clínico con estado de mal no convulsivo como manifestación inicial de angiopatía amiloide cerebral, se señala la utilidad de las secuencias de susceptibilidad magnética de la resonancia y se discute la fisiopatogenia de las descargas periódicas lateralizadas epileptiformes como elemento de actividad epiléptica (AU)

Introduction. Cerebral amyloid angiopathy is a frequent cause of haemorrhagic cerebrovascular disease in persons over the age of 65 and, sometimes, the initial symptoms can be epilepsy-like. Case report. A 62-year-old female with no relevant past history who was admitted to hospital due to non-convulsive status epilepticus, auditory hallucinations and ideomotor apraxia; an electroencephalogram performed on the patient revealed periodic lateralised epileptiform discharges in the right parietooccipital region. Susceptibility-weighted magnetic resonance imaging showed a sub-acute focal subarachnoid haemorrhage in the right parietotemporal region and cortico-subcortical microbleeding in different stages of the progression of the disease that were compatible with cerebral amyloid angiopathy. A critical simple single-photon emission tomography scan was performed and findings revealed an area of hyperperfusion in the same region. Antiepileptic treatment was established with clinical, neurophysiological and scintigraphic resolution. Conclusions. The article reports a case with non-convulsive status epilepticus as the initial symptom of cerebral amyloid angiopathy. It also highlights the usefulness of sequences of susceptibility-weighted magnetic resonance imaging and the physiopathogenesis of periodic lateralised epileptiform discharges as an element of epileptic activity is discussed (AU)