Multiple back fractures as a result of the first seizure.

Non-traumatic fractures due to seizures are an overlooked diagnostic group. It is well known that patients with generalized tonic-clonic seizures have an increased trauma risk. However, the cause of fracture is rarely due to the violent forces of muscle contractions. Usually, the primary patient examination focuses on the aetiology of the seizure, which sometimes delays the diagnosis of fractures. This is a case report of a 19-year-old woman who sustained three compression fractures of the thoracic spine due to a generalized tonic-clonic seizure, and a discussion of the diagnostic challenges in such a rare case.

Congenital Cirsoid aneurysm communicating with the sagittal sinus and supplied by extra and intracranial arteries.

We describe the unique case of a 6-year old boy who presented with recalcitrant generalized tonic-clonic seizures and clinicoradiological features of congenital Cirsoid aneurysm. The lesion was supplied by occipital arteries and a large right parietal parasagittal intracranial feeding artery in a Yokouchi type C pattern. The venous drainage was communicating with the posterior part of the superior sagittal sinus. Six months after successful ligation of the feeding arteries and complete surgical excision of the lesion, the patient remains seizure free.

Clinical spectrum of Dyke-Davidoff-Masson syndrome in the adult: an atypical presentation and review of literature.

Dyke-Davidoff-Masson Syndrome (DDMS) is a rare condition usually diagnosed in paediatric patients with clinical features of hemiparesis, seizures, mental retardation and contralateral cerebral hemiatrophy on neuroimaging. This report follows the case of a 22-year-old man presenting with seizures and hemiatrophy and hemiparesis. On review of cases the most common neuroimaging findings were cerebral hemiatrophy (100%) followed by hemicalvarial thickening (71.4%) and hyperpneumatisation of sinuses (71.4%). Apart from our patient, all nine cases with data on epilepsy control had drug-resistant epilepsy. The onset of seizures in adulthood, block vertebra, short stature, absence of mental retardation and well-controlled epilepsy on monotherapy makes our case exceptional-even bringing to mind the possibility of a DDMS variant. This report exhaustively reviews the wide range of clinical and radiological manifestations of DDMS in the adult, thereby adding to the literature on an unusual syndrome that causes significant neurological morbidity.

[Neurological manifestations in atypical Kawasaki disease]. / Manifestaciones neurológicas en la enfermedad de Kawasaki atípica.

BACKGROUND: Kawasaki disease (KD) is a type of systemic vasculitis of unknown etiology. Atypical Kawasaki disease is defined as that where there are signs and symptoms not corresponding to the classical criteria for this nosological entity. Children with atypical Kawasaki disease may present with acute abdominal symptoms, meningeal irritation, pneumonia or renal failure. CLINICAL CASES: We describe 4 children with ages ranging from 2 to 12 years who had atypical Kawasaki disease, with neurological and gastrointestinal symptoms as part of the systemic presentation of the disease. Treatment consisted of immunoglobulin and corticosteroids with good evolution. CONCLUSIONS: KD is a systemic vasculitis that can involve many territories. Atypical manifestations can mislead the clinician and delay diagnosis. Pediatricians and sub-specialists should be aware of these neurological manifestations in order to provide adequate and opportune treatment.

Antecedentes: La enfermedad de Kawasaki es una vasculitis sistémica de etiología desconocida. La modalidad atípica se define como aquella en la cual hay signos y síntomas que no corresponden a los criterios clásicos de esta entidad nosológica. Los niños con enfermedad de Kawasaki atípica pueden presentar síntomas abdominales agudos, irritación meníngea, neumonía o falla renal. Casos clínicos: Describimos 4 niños con edades que oscilaron entre los 2 y 12 años que presentaron enfermedad de Kawasaki atípica, con síntomas neurológicos y gastroinstetinales como parte de la presentación sistémica de la enfermedad. El tratamiento se llevó a cabo con corticosteroides e inmunoglobulina, con los cuales los pacientes evolucionaron satisfactoriamente. Conclusiones: La enfermedad de Kawasaki es una vasculitis sistémica que puede involucrar numerosos aspectos. Las manifestaciones atípicas pueden confundir al clínico y retrasar el diagnóstico. Los pediatras y subespecialistas deben estar conscientes de estas manifestaciones neurológicas, con el fin de proporcionar tratamiento adecuado y oportuno.

Neuroendocrine tumour metastatic brain disease during immunosuppressive treatment for paraneoplastic GABAB receptor antibodies encephalitis: Is immunosuppression always beneficial?

BACKGROUND: Limbic autoimmune encephalitis (LE) should be considered in any patient with acute or subacute neuropsychiatric manifestations, without other common causes of encephalitis. Y-Aminobutyric-acid-B-receptor (anti-GABABR) antibodies are rarely encountered in association with LE. CASE REPORT: A 74-year-old patient presented with a progressive cognitive degradation and generalized tonic-clonic seizures, with positive anti-GABABR. He declined under immunosuppression treatment. Control magnetic resonance revealed brain lesions, which became positive for pulmonary neuroendocrine tumour metastatic disease. CONCLUSION: The occurrence of diversified neurological manifestations of an underling tumour is difficult to manage. We speculate if in some cases, immunosuppression can itself facilitate tumour progression.

Can syncope cause convulsive seizures in adults?

PURPOSE: Convulsive epileptic seizures triggered by transient cerebral hypoperfusion 'reflex anoxic seizures' are well-described in children but are not commonly recognized in adults. METHODS: We report a case series of 12 adults who presented acutely after generalized tonic-clonic seizures with a clear syncopal phase before the convulsion. We describe the aetiology, semiology and natural history of these events. RESULTS: Four patients (33.3%) had relevant risk factors for development of seizures/active epilepsy. Five patients (41.7%) had recurrent events prior to initial review by an epileptologist, but when anti-syncope measures were instituted there were no seizure recurrences over a median follow-up period of 34.5 (interquartile range 29.3-41.8) months. CONCLUSIONS: Syncope may be an under-recognized trigger for convulsive acute symptomatic seizures. Avoidance of syncope may be more effective than anti-seizure medications in preventing reflex anoxic seizures.

Ivabradine attenuates the anticonvulsant potency of lamotrigine, but not that of lacosamide, pregabalin and topiramate in the tonic-clonic seizure model in mice.

Hyperpolarization-activated cyclic nucleotide-gated (HCN) channels are involved not only in synaptic transmission and neuronal excitability under physiological conditions, but also in seizure activity. To determine the influence of ivabradine (an HCN channel inhibitor) on the anticonvulsant potency of four novel antiepileptic drugs (AEDs: lacosamide, lamotrigine, pregabalin and topiramate) in the mouse maximal electroshock-induced seizure (MES) model. Adult male albino Swiss mice were challenged with maximal electroconvulsions (electric current of 25mA delivered via auricular electrodes). Total brain concentrations of AEDs were measured with high-pressure liquid chromatography. Ivabradine (10mg/kg, i.p.) significantly reduced the anticonvulsant potency of lamotrigine by elevating the ED50 value of the AED from 7.48 (6.15-9.11) to 10.07 (8.85-11.45) mg/kg (P<0.05) in the mouse MES model. In contrast, ivabradine (10mg/kg, i.p.) did not significantly affect the anticonvulsant potency of lacosamide, pregabalin or topiramate in the mouse MES model. Additionally, ivabradine had no impact on total brain concentrations of all the studied AEDs in mice. A special caution is advised when combining ivabradine with lamotrigine in epilepsy patients due to the possible pharmacodynamic reduction of the anticonvulsant action of the later drug. The combinations of ivabradine with lacosamide, pregabalin and topiramate seem to be pharmacodynamic and neutral from a preclinical viewpoint.

[Unexpected Complications in the Withdrawal Treatment of the Research Chemical AH-7921]. / Unerwartete Komplikationen während des Entzugs vom Research Chemical AH-7921.

We describe the case of a young male patient who had consumed the morphine-like substance AH-7921 which is available via the internet. He was initially admitted to hospital because of obstipation and presented within a day of inpatient treatment for the first time with a generalized tonic-clonic epileptic seizure with subsequent urinary retention. Within a few hours, the patient then also developed bradycardia, while at the same time describing symptoms of physical opioid withdrawal which gradually deteriorated within the following hours. We initiated a treatment with buprenorphine which resulted in a considerable reduction of withdrawal symptoms, so the patient could be discharged from hospital.

A possible role for IL-17 in Clarkson's disease.

INTRODUCTION: Systemic capillary leak syndrome (SCLS) is a rare disease characterized by recurrent episodes and a triad of "leak attacks": hypovolemic shock, generalized edema, hemoconcentration and paradoxical hypoalbuminemia. CASE STUDY AND DISCUSSION: Here we report a case of pediatric idiopathic SCLS with an episode of cough and fever followed two days later by myalgia, livedo, acrocyanosis, and five days later by edema, tachycardia, hypotension, and generalized tonic-clonic seizure. Moreover, we provide evidence for an LPS-induced overproduction of interferon-gamma and interleukin-17 by the patient's peripheral blood mononuclear cells one year after the attack. CONCLUSION: This observation suggests the involvement of IL-17 in the pathogenesis of this disease.

Remote preoperative tonic-clonic seizures do not influence outcome after surgery for temporal lobe epilepsy.

OBJECTIVES: Tonic-clonic seizures are associated with greater chance of seizure relapse after anterior temporal lobectomy. We investigated whether the interval between the last preoperative tonic-clonic seizure and surgery relates to seizure outcome in patients with drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS: In this retrospective study, patients were prospectively registered in a database from 1986 through 2014. Postsurgical outcome was categorized as seizure freedom or relapse. The relationship between surgical outcome and the interval between the last preoperative tonic-clonic seizure and surgery was investigated. RESULTS: One-hundred seventy-one patients were studied. Seventy nine (46.2%) patients experienced tonic-clonic seizures before surgery. Receiver operating characteristic curve of timing of the last preoperative tonic-clonic seizure was a moderate indicator to anticipate surgery failure (area under the curve: 0.657, significance; 0.016). The best cutoff that maximizes sensitivity and specificity was 27months; with a sensitivity of 0.76 and specificity of 0.60. Cox-Mantel analysis confirmed that the chance of becoming free of seizures after surgery in patients with no or remote history of preoperative tonic-clonic seizures was significantly higher compared with patients with a recent history (i.e., in 27months before surgery) (p=0.0001). CONCLUSIONS: The more remote the occurrence of preoperative tonic-clonic seizures, the better the postsurgical seizure outcome, with at least a two year gap being more favorable. A recent history of tonic-clonic seizures in a patient with MTLE may reflect more widespread epileptogenicity extending beyond the borders of mesial temporal structures.

Anti-N-Methyl-D-Aspartate Receptor Encephalitis, an Underappreciated Disease in the Emergency Department.

Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis is a novel disease discovered within the past 10 years. Antibodies directed at the NMDAR cause the patient to develop a characteristic syndrome of neuropsychiatric symptoms. Patients go on to develop autonomic dysregulation and often have prolonged hospitalizations and intensive care unit stays. There is little literature in the emergency medicine community regarding this disease process, so we report on a case we encountered in our emergency department to help raise awareness of this disease process.

Type II Odontoid Fracture with Atlantoaxial Dislocation Presenting as Symptomatic Seizures: A Case Report.

OBJECTIVE AND BACKGROUND: To report symptomatic seizures of a patient with an old type II odontoid fracture with atlantoaxial dislocation. The type II odontoid fracture is a dangerous disease and presents as neurological deficits. Because of the compression of upper cervical cord, without timely diagnosis and treatment, a type II odontoid fracture may result in sudden death. Although it has been shown that epileptic seizures may lead to type II odontoid fracture, there is no report of symptomatic seizures in patients with odontoid fracture. METHODS: A 16-year-old adolescent boy with neurological deficits, especially grand mal seizures for duration of 5 years, was diagnosed as an old type II odontoid fracture with atlantoaxial dislocation and treated in our hospital. A 1-year follow-up was performed. RESULTS: Systematic analyses of the clinical history, manifestations, physical examination, and radiologic results of the patient revealed an old type II odontoid fracture. Magnetic resonance imaging showed spinal cord compression and degeneration. The patient received posterior atlantoaxial fixation and fusion procedure following successful closed reduction. The frequency of seizures was reduced to once a month and there was a thorough recovery in other neurological functions 1 year after the operation. CONCLUSIONS: Old type II odontoid fracture might present as symptomatic seizures in addition to other neurological deficits. Posterior atlantoaxial screw-plate fixation and fusion is an effective treatment for old type II odontoid fracture.