RESUMO
A 53-year-old immunocompromised woman developed acute left eye blindness and paraparesis suspected to be due to neuromyelitis optica (NMO). During treatment for NMO, right eye blindness and progressive multiple cranial neuropathies developed. Cerebrospinal fluid polymerase chain reaction (PCR) revealed Varicella zoster virus (VZV). This case emphasizes the importance of considering VZV in individuals, particularly the immunocompromised, presenting with a constellation of neurological signs and symptoms, even in the absence of rash.
Assuntos
Cegueira/diagnóstico , Doenças dos Nervos Cranianos/diagnóstico , Encefalite por Varicela Zoster/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Neuromielite Óptica/diagnóstico , Síndrome de Necrose Retiniana Aguda/diagnóstico , Antivirais/uso terapêutico , Cegueira/tratamento farmacológico , Cegueira/imunologia , Cegueira/virologia , Doenças dos Nervos Cranianos/tratamento farmacológico , Doenças dos Nervos Cranianos/imunologia , Doenças dos Nervos Cranianos/virologia , Encefalite por Varicela Zoster/tratamento farmacológico , Encefalite por Varicela Zoster/imunologia , Encefalite por Varicela Zoster/virologia , Feminino , Herpesvirus Humano 3 , Humanos , Hospedeiro Imunocomprometido , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/virologia , Pessoa de Meia-Idade , Neuromielite Óptica/tratamento farmacológico , Neuromielite Óptica/imunologia , Neuromielite Óptica/virologia , Síndrome de Necrose Retiniana Aguda/tratamento farmacológico , Síndrome de Necrose Retiniana Aguda/imunologia , Síndrome de Necrose Retiniana Aguda/virologia , Ativação ViralRESUMO
INTRODUCTION: The authors tested the hypothesis that the EEG feature generalized polyspike train (GPT) is associated with drug-resistant idiopathic generalized epilepsy (IGE). METHODS: The authors conducted a single-center case-control study of patients with IGE who had outpatient EEGs performed between 2016 and 2020. The authors classified patients as drug-resistant or drug-responsive based on clinical review and in a masked manner reviewed EEG data for the presence and timing of GPT (a burst of generalized rhythmic spikes lasting less than 1 second) and other EEG features. A relationship between GPT and drug resistance was tested before and after controlling for EEG duration. The EEG duration needed to observe GPT was also calculated. RESULTS: One hundred three patients were included (70% drug-responsive and 30% drug-resistant patients). Generalized polyspike train was more prevalent in drug-resistant IGE (odds ratio, 3.8; 95% confidence interval, 1.3-11.4; P = 0.02). This finding persisted when controlling for EEG duration both with stratification and with survival analysis. A median of 6.5 hours (interquartile range, 0.5-12.7 hours) of EEG recording was required to capture the first occurrence of GPT. CONCLUSIONS: The findings support the hypothesis that GPT is associated with drug-resistant IGE. Prolonged EEG recording is required to identify this feature. Thus, >24-hour EEG recording early in the evaluation of patients with IGE may facilitate prognostication.