Linfoma primario de base de cráneo presentándose como oftalmoplejia aguda / Primary skull base lynphoma presenting as acute ophtalmoplegia

Primary Skull base lymphoma (PSBL) represents a rare manifestation of extranodal lymphoma. Aggressive non-Hodgkin´s lymphoma such as diffuse large B-cell lymphoma, constitute the most commonly encountered subtype of PBSL. We report the case of a 70-year-oldwoman with acute diplopia and ptosis of the right eye. Neurological examination showed palsy of right III, IV and VI cranial nerves. Brain imaging studies showed a lesion showed invading the floor of the sella turcica, both cavernous sinuses, the clivus and part of the sphenoid sinus. The patient underwent endonasal endoscopic resection of the lesion. The histological diagnosis was diffuse large B-cell lymphoma. No systemic disease was found on staging the patient. (AU)

El linfoma primario de base de cráneo (LPBC) representa una variante poco frecuente del linfoma extranodal. Los linfomas no-Hodgkin agresivos, tales como el linfoma difuso de células grandes B son el subtipo más frecuente que se presentan como LPBC. Describimos el caso de una paciente mujer de 70 años que acude a nuestro centro con una clínica aguda de diplopía y posterior ptosis del ojo derecho. En la exploración neurológica se constató parálisis de III, IV y VI pares derechos. Los estudios de imagen cerebral mostraron una lesión que invadía el suelo de la silla turca, ambos senos cavernosos, el clivus y parte del seno esfenoidal. Se realizó una exéresis endoscópica endonasal de la lesión. El examen histológico de la lesión fue compatible con un linfoma difuso de células grandes B. No se constató enfermedad sistémica en los estudios de extensión. (AU)

Observational study of intravenous lacosamide in patients with convulsive versus non-convulsive status epilepticus.

BACKGROUND AND OBJECTIVES: Status epilepticus (SE) is an important emergency situation associated with high morbidity and mortality. The goal of pharmacological therapy-rapid seizure termination-is only achieved in just over half of patients with first-line anti-epileptic drug (AED) therapy and many patients require second and higher lines of AEDs to achieve seizure termination; therefore, there is a clear need for more effective treatment options. Lacosamide is a relatively new AED and the intravenous formulation has shown promise for treatment of SE. The aim of the current study was to compare electroencephalographic (EEG) response and seizure termination with intravenous lacosamide (±other AEDs) in patients with convulsive versus non-convulsive SE, in a Spanish intensive care setting. METHODS: In this prospective, observational study, patients with convulsive or non-convulsive SE who received intravenous lacosamide 400 mg/day for 8 days were compared in terms of EEG response and seizure termination. Adverse events were not specifically assessed. RESULTS: Fifty-three patients (69.8 % male; mean age 55.2 years) were treated with lacosamide (mean dose 390.6 mg) as first- (20.8 %), second- (34 %), third (22.6 %) or fourth-line (22.6 %) treatment for convulsive (n = 23, 43.4 %) or non-convulsive (n = 30, 56.6 %) SE. The majority of patients (73.6 %) had a comorbid condition, predominantly hypertension (35.8 %), and most (79.2 %) received at least one concomitant AED, including midazolam (54.7 %), valproic acid (52.8 %), and levetiracetam (30.2 %). Patient characteristics and treatment received did not differ significantly between the convulsive and non-convulsive SE groups. EEG recordings following lacosamide treatment demonstrated the elimination of paroxysmal activity (disappearance and/or attenuation of epileptiform activity in >60 % of recording time) in 56.6 % of patients; 69.6 % of convulsive and 46.7 % of non-convulsive SE groups. Among all patients, 90.6 % showed some EEG improvement (disappearance of epileptiform activity in <30 % total recording time or disappearance and/or attenuation of epileptiform activity in 30-60 % total recording time); and there was no significant between-group difference for achievement of seizure termination (90.0 vs. 91.3 % for non-convulsive vs. convulsive SE). CONCLUSIONS: Intravenous lacosamide (±other AEDs) was similarly effective in patients with convulsive or non-convulsive SE. Further investigation into the use of lacosamide in the treatment of SE is warranted.