What does epileptic nystagmus show us in cases presenting acute neurological symptoms?

PURPOSE: This study aims to determine the clinical significance of epileptic nystagmus in patients with acute neurological symptoms. METHOD: The clinical findings of patients with documented epileptic nystagmus, their original video and EEG data, and cranial imaging and laboratory tests were analyzed retrospectively. RESULTS: 20 patients were included in the study and 21 epileptic nystagmus attacks were determined from patients' clinical and video-EEG recordings. All recorded seizures with epileptic nystagmus were focal onset in nature. The ictal discharge pattern was rhythmic fast activity with a mean frequency of 15 Hz. The ictal discharges originated from the parieto-occipital (n = 8), temporo-occipital (n = 7), parieto-occipito-temporal (n = 3), temporal (n = 2), occipital (n = 1), and centroparietal (n = 1) areas. In the fast phase, the nystagmus was beating away from the side of ictal discharges. The origin of the ictal discharges on EEG images was compatible with the lesion localization at cranial MRI in all patients. Etiologies were epilepsy in seven patients, non-ketotic hyperglycemia in four, ketotic hyperglycemia in one, PRES in three, acute stroke in three, HSV encephalitis in one, and MELAS in one. CONCLUSIONS: Epileptic nystagmus represents a guide to the lateralization and localization of the lesion in cases presenting with acute neurological symptoms. In these patients, the lesion is frequently in the posterior regions of the hemispheres. Although various diseases affect these regions in terms of etiology, such cases should be evaluated in terms of the presence of hyperglycemia.

The effect of popliteal sciatic nerve block with methylprednisolone in the management of postinjection sciatic neuropathy after clinical and electrophysiological examination.

BACKGROUND: This study aimed to investigate the effects of popliteal sciatic nerve block (PSNB) in the treatment of postinjection sciatic neuropathy (PISN) resistant to conservative treatments. METHODS: Patients diagnosed with PISN were included in the study. A damaged branch of the sciatic nerve was detected after neurological and electrophysiologic studies (EPSs). Visual analogue scale (VAS) was administered before, one hour after, and one month after the procedure. Also Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS) was administered before and one month after the procedure. The effects of EPSs findings and loss of muscle strength on the VAS and LANSS scores that measured after PSNB were evaluated. RESULTS: PSNB was performed in 17 patients (12 males and 5 females) with a diagnosis of PISN. Their mean age was 54.95 ± 12.55 years, and the mean duration of symptoms was 3.53 ± 1.28 months. The EPS findings revealed a lateral truncus injury in 5, a medial truncus injury in 3, and injury to both in 9 patients. The initial muscle power scale scores were grade 0 in 2, grade 2 in 1, grade 3 in 7, grade 4 in 5, and grade 5 in 2 patients. The initial VAS and LANSS scores were 7.53 ± 1.06 and 17.35 ± 3.12. The mean VAS scores at the first hour and one month after the procedure decreased to 2.53 ± 1.70 and 4.18 ± 1.74 while the mean LANSS score one month after the procedure was reduced to 7.88 ± 5.84. The effects of EPSs findings and loss of muscle strength were found significant (p = 0.001), but the duration of symptoms was not found significant (p = 0.36) on the VAS and LANSS scores that measured after PSNB. DISCUSSION: The outcome of this research proved the effectiveness of PSNB with methylprednisolone in the management of PISN, especially in patients whose pain was located below the knee. EPSs findings and loss of muscle strength indicated the severity of the nerve damage affect the success of PSNB in pain management, but the length of time that elapsed after the nerve injury did not.