Ictal paralysis with tonic eye gazing mimicking a pontine infarction.
Seizure
; 15(8): 637-42, 2006 Dec.
Article
en En
| MEDLINE
| ID: mdl-16996281
ABSTRACT
PURPOSE:
Concomitant positive and negative motor phenomena in a single seizure have not been reported before.METHOD:
We used an extensive history review, neurological examination, EEG, MRI and SPECT study to demonstrate a rare combination of motor presentations as an ictal phenomenon.RESULT:
A 64-year-old male was brought to the emergency room with dizziness, progressive drowsiness and left hemiparesis. A spontaneous eye deviation to the left side with nystagmus was observed. A right pontine lesion was tentatively diagnosed. However, a focal motor seizure of the patient's left face and limbs occurred 3.5h later. A brain MRI revealed a high signal in the right amygdala, hippocampus and thalamus, instead of the pons. An EEG showed periodic epileptic discharges in the right posterior temporal parietal region. Regional hyperperfusion was found by brain SPECT. The level of consciousness improved dramatically after adequate phenytoin treatment.CONCLUSION:
A posterior temporal-parietal seizure can present with a prolonged ictal paralysis, a positive ocular nystagmoid deviation and an altered level of consciousness. The EEG is essential for a correct diagnosis, especially with a negative or an unexplainable MRI study. The SPECT has an additional role for the differential diagnosis.
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Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Paresia
/
Convulsiones
/
Epilepsia
/
Amígdala del Cerebelo
Tipo de estudio:
Diagnostic_studies
Límite:
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Seizure
Asunto de la revista:
NEUROLOGIA
Año:
2006
Tipo del documento:
Article
País de afiliación:
Taiwán