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1.
J Investig Med High Impact Case Rep ; 9: 2324709620986302, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33648382

RESUMEN

With the outbreak of COVID-19 (coronavirus disease 2019) as a global pandemic, various of its neurological manifestations have been reported. We report a case of a 54-year-old male with new-onset seizure who tested positive for severe acute respiratory syndrome coronavirus 2 from a nasopharyngeal swab sample. Investigative findings, which included contrast-enhancing right posterior temporal lobe T2-hyperintensity on brain magnetic resonance imaging, right-sided lateralized periodic discharges on the electroencephalogram, and elevated protein level on cerebrospinal fluid analysis, supported the diagnosis of possible encephalitis from COVID-19 infection. The findings in this case are placed in the context of the existing literature.


Asunto(s)
Encéfalo/diagnóstico por imagen , Encefalitis Límbica/epidemiología , Pandemias , Convulsiones/etiología , Comorbilidad , Electroencefalografía , Humanos , Encefalitis Límbica/complicaciones , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Convulsiones/diagnóstico
2.
J Neurol Sci ; 423: 117377, 2021 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-33676146

RESUMEN

BACKGROUND: Abnormal movements in Covid-19 patients have been reported with varying degree of frequency, prompting neurologic consultation and additional diagnostic evaluation. We sought to evaluate the frequency and etiology of abnormal movements among hospitalized Covid-19 patients undergoing neurologic consultation. METHODS: We retrospectively analyzed the first 50 consecutive patients with confirmed Covid-19 hospitalized at our tertiary medical care center who underwent acute inpatient neurology consultation from March 2020 through May 2020. Indication for neurologic consultation and diagnostic studies performed were identified by electronic medical record review. RESULTS: Of the 50 initial consultation requests, 11 (22.0%) patients were evaluated for abnormal movements (nine male and two female). Myoclonus was diagnosed in 6/11 (54.5%) patients. Additionally, two patients were diagnosed with seizures (confirmed on EEG in one), while two additional patients were diagnosed with tremor (physiologic and probable functional). A single case of serotonin syndrome was also identified. CONCLUSION: Abnormal movements observed in hospitalized Covid-19 patients can have a wide range of etiologies and were a frequent initial indication for neurologic consultation. Myoclonus was the most frequent type of abnormal movement observed. Early clinical recognition and directed diagnostic work-up is essential for accurate diagnoses in these patients.


Asunto(s)
/complicaciones , Discinesias/etiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mioclonía/etiología , Estudios Retrospectivos , Convulsiones/etiología , Síndrome de la Serotonina/etiología , Centros de Atención Terciaria , Temblor/etiología
3.
Medicine (Baltimore) ; 100(12): e25118, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761675

RESUMEN

ABSTRACT: The aim was to examine whether clinical seizures and amplitude-integrated electroencephalogram (aEEG) patterns in infants with hypoxic ischemic encephalopathy (HIE) can predict the extent of brain injury on magnetic resonance images (MRI) and the long-term neurodevelopmental outcomes at 18∼24 months of age.HIE infants who underwent therapeutic hypothermia (TH) between June 2014 and March 2017 were included in this study. Infants with clinical seizure were analyzed for aEEG patterns and the extent of brain injury on MRI findings. Clinical seizure, aEEG, and brain MRI were assessed and compared with neurodevelopmental outcomes at 18∼24 months of age.Among the 97 HIE infants enrolled in this study with brain MRI scans, 78 (73.1%) TH-treated HIE infants exhibited clinical seizures. More abnormalities on a EEGs and more significant use of first and second antiepileptic drugs (AEDs) were significantly higher in the clinical-seizure group with longer hospitalized days. At a corrected 18 to 24 months of age, HIE infants in the clinical-seizure group with more extension of injury lesions on diffusion-weighted MRI scans exhibited significantly more delayed neurodevelopment. A risk factor analysis indicated that male infants who stayed in the hospital for more than 11 days were at a higher risk of having clinical seizures. The lesion size in MRI greater than 37 pixels was a risk factor with an 81.8% accuracy.Seizures in HIE infants may predict abnormal brain MRI scans and abnormal neurodevelopment at 18 to 24 months of age.


Asunto(s)
Hipoxia-Isquemia Encefálica/complicaciones , Hipoxia-Isquemia Encefálica/diagnóstico por imagen , Imagen por Resonancia Magnética , Neuroimagen , Convulsiones/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Encéfalo/crecimiento & desarrollo , Desarrollo Infantil , Preescolar , Electroencefalografía , Análisis Factorial , Femenino , Humanos , Lactante , Recién Nacido , Tiempo de Internación , Masculino , Trastornos del Neurodesarrollo/diagnóstico por imagen , Trastornos del Neurodesarrollo/etiología , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Convulsiones/etiología , Factores Sexuales
4.
Undersea Hyperb Med ; 48(1): 43-51, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33648032

RESUMEN

Background: Hyperbaric oxygen (HBO2) therapy is a safe and well-tolerated treatment modality. Seizures, one of the most severe central nervous system side effects of HBO2 therapy, can occur. Episodes of seizures during HBO2 therapy have not yet been reported in countries such as Korea, where hyperbaric medicine is still in the developmental stage. Methods: The registry data of all patients treated with HBO2 therapy in a tertiary academic hospital in Korea were prospectively collected, and patients who developed seizures during HBO2 therapy between October 2016 and December 2019 were evaluated. In addition, we reviewed previous studies on occurrence of seizures during HBO2 therapy. Results: During the study period, a total of 10,425 treatments were provided to 1,308 patients. The most frequently treated indication was carbon monoxide (CO) poisoning ABSTRACT (n=547, 41.8%). During the HBO2 therapy sessions (total: 10,425), five seizure episodes occurred (patients with CO poisoning: n=4; patients with arterial gas embolism [AGE]: n=1). The frequency of seizures in patients with CO poisoning (0.148%) and AGE (3.448%) was significantly higher than that in patients with all indications (0.048%) (p=0.001). None of the patients had lasting effects due to the seizures. Conclusion: Our study revealed a similar frequency rate in terms of all indications and CO poisoning, and a slightly higher rate in AGE. Seizures were observed in patients with CO poisoning and AGE. Therefore, if clinicians plan to operate a hyperbaric center in a country like Korea, where there are several patients with acute CO poisoning, they should be prepared to handle seizures that may occur during HBO2 therapy.


Asunto(s)
Oxigenación Hiperbárica/efectos adversos , Convulsiones/epidemiología , Adulto , Intoxicación por Monóxido de Carbono/terapia , Embolia Aérea/terapia , Femenino , Humanos , Oxigenación Hiperbárica/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , República de Corea/epidemiología , Convulsiones/etiología
5.
BMJ Case Rep ; 14(3)2021 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-33762283

RESUMEN

COVID-19 has now emerged from a respiratory illness to a systemic viral illness with multisystem involvement. There is still a lot to learn about this illness as new disease associations with COVID-19 emerge consistently. We present a unique case of a neurological manifestation of a patient with structural brain disease who was COVID-19 positive and developed mental status changes, new-onset seizures and findings suggestive of viral meningitis on lumbar puncture. We also review the literature and discuss our case in the context of the other cases reported. We highlight the value of considering seizures and encephalopathy as one of the presenting features of COVID-19 disease.


Asunto(s)
Encefalopatías/etiología , Convulsiones/etiología , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Adulto , Alanina/análogos & derivados , Alanina/uso terapéutico , Anticonvulsivantes/uso terapéutico , Antivirales/uso terapéutico , Encefalopatías/diagnóstico , Encefalopatías/terapia , /terapia , Confusión/complicaciones , Humanos , Inmunización Pasiva/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Reacción en Cadena de la Polimerasa , Radiografía/métodos , Convulsiones/terapia , Resultado del Tratamiento
6.
Medicine (Baltimore) ; 100(12): e25171, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761695

RESUMEN

RATIONALE: Acute necrotizing encephalopathy (ANE) is a specific type of encephalopathy usually followed by febrile infection. It has an aggressive clinical course; however, it usually does not recur after recovery in cases of spontaneous ANE. Nevertheless, there are several studies reporting recurrences in familial ANE with RAN-binding protein 2 (RANBP2) mutation. There are few cases of familial ANE with RANBP2 mutation in Asian populations. PATIENTS CONCERNS: A 21-month-old Korean boy who was previously healthy, presented with seizure following parainfluenza - a virus and bocavirus infection, followed by 2 recurrent seizure episodes and encephalitis after febrile respiratory illnesses. Meanwhile, his 3-year-old sister had focal brain lesions on neuroimaging studies when evaluated for head trauma. The siblings also had an older brother who presented status epilepticus after febrile respiratory illness at the age of 10 months old. DIAGNOSIS: Brain magnetic resonance imaging was performed to evaluate the seizure and neurologic symptoms. Imaging findings showed variable spectrum - from non-specific diffuse white matter injury pattern to typical "tricolor pattern" of the ANE on diffusion-weighted images. The other 2 siblings showed focal lesions in both external capsules and severe diffuse brain edema. Genetic tests identified a heterozygous missense mutation in the RANBP2 [c.1754C>T (p.Thr585Met)] in 2 siblings and their mother. INTERVENTIONS: Patients were treated conservatively with anticonvulsive agents, intravascular immunoglobulin, and steroids. OUTCOMES: Among the 3 siblings, 2 male siblings died from familial ANE, whereas the female sibling was asymptomatic. LESSONS: These cases highlight the radiological aspects of familial ANE with incomplete penetrance of the RANBP2 gene in 3 family members, showing variable involvements of the brain and natural history on magnetic resonance images. Radiologists should be aware of the typical and atypical imaging findings of familial ANE for prompt management of affected patients.


Asunto(s)
Grupo de Ascendencia Continental Asiática/genética , Leucoencefalitis Hemorrágica Aguda/diagnóstico por imagen , Leucoencefalitis Hemorrágica Aguda/genética , Chaperonas Moleculares/genética , Mutación Missense , Proteínas de Complejo Poro Nuclear/genética , Corticoesteroides/uso terapéutico , Anticonvulsivantes/uso terapéutico , Preescolar , Imagen de Difusión por Resonancia Magnética , Femenino , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Lactante , Leucoencefalitis Hemorrágica Aguda/complicaciones , Leucoencefalitis Hemorrágica Aguda/tratamiento farmacológico , Masculino , Penetrancia , Convulsiones/tratamiento farmacológico , Convulsiones/etiología , Sustancia Blanca/diagnóstico por imagen , Adulto Joven
7.
Artículo en Inglés | MEDLINE | ID: mdl-33530431

RESUMEN

Background: Epilepsy associated with strokes is a significant clinical and public health problem and has a negative impact on prognosis and clinical outcome. A late epileptic seizure occurring seven days after stroke is actually equated with poststroke epilepsy due to the high risk of recurrence. Predictive models evaluated in the acute phase of stroke would allow for the stratification and early selection of patients at higher risk of developing late seizures. Methods: The most relevant papers in this field were reviewed to establish multifactorial predictors of late seizures and attempt to standardize and unify them into a common prognostic model. Results: Clinical and radiological factors have become the most valuable and reproducible predictors in many reports, while data on electroencephalographic, genetic, and blood biomarkers were limited. The existing prognostic models, CAVE and SeLECT, based on relevant, readily available, and routinely assessed predictors, should be validated and improved in multicenter studies for widespread use in stroke units. Conclusions: Due to contradictory reports, a common and reliable model covering all factors is currently not available. Further research might refine forecasting models by incorporating advanced radiological neuroimaging or quantitative electroencephalographic analysis.


Asunto(s)
Epilepsia , Accidente Cerebrovascular , Electroencefalografía , Epilepsia/diagnóstico , Epilepsia/epidemiología , Epilepsia/etiología , Humanos , Pronóstico , Factores de Riesgo , Convulsiones/diagnóstico , Convulsiones/epidemiología , Convulsiones/etiología
8.
Medicine (Baltimore) ; 100(4): e24303, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530220

RESUMEN

RATIONALE: Pheochromocytoma (PHEO) is a rare neuroendocrine tumor arising from chromaffin cells of the adrenal medulla. Most pediatric PHEOs are functional tumors, and clinical manifestations are related to catecholamine hypersecretion and/or tumor mass effects. PATIENT CONCERNS: We report here a case of a 10-year-old boy with a highly functional adrenal PHEO detected after the evaluation of a generalized tonic-clonic seizure in the patient. His vital signs at admission were: blood pressure up to 220/135 mm Hg; pulse, 112 beats/min; temperature, 37.4°C; respiratory rate, 22 breaths/min. DIAGNOSIS: A 24-hour urine collection for catecholamines test showed a marked increase in Vanillylmandelic acid levels (338.9 µmol/L). An abdominal magnetic resonance imaging revealed a well-defined left adrenal gland mass measuring ∼5 cm in its largest dimension. INTERVENTIONS: The mass was surgically removed, and histopathological examination revealed PHEO with low malignant potential (Adrenal Gland Scaled Score/PASS/ < 4). OUTCOMES: The patient was discharged on the 10th postoperative day in good condition. At 24-month follow-up, the patient was doing well without complications such as tumor recurrence, elevated blood pressure, and seizure. LESSONS: PHEO should be considered in the differential diagnosis of children with seizures presenting in the emergency department. A multidisciplinary approach to the evaluation and treatment of PHEO is also crucial for a successful outcome.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales/diagnóstico , Feocromocitoma/diagnóstico , Convulsiones/diagnóstico , Neoplasias de las Glándulas Suprarrenales/complicaciones , Niño , Diagnóstico Diferencial , Humanos , Masculino , Feocromocitoma/complicaciones , Convulsiones/etiología
9.
Epilepsy Behav ; 116: 107774, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33549939

RESUMEN

BACKGROUND: Large hypothalamic hamartomas (HH) are often associated with difficult-to-treat, refractory seizures. Although magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a useful tool to treat these challenging lesions, postoperative outcomes are variable and potentially related to differences in surgical targeting. PURPOSE: We sought to identify differences in the anatomic localization of laser ablations that either did or did not result in seizure freedom. METHODS: Four children who underwent MRgLITT for large HH (3 seizure-free and 1 not seizure-free) were included in the analysis. Ablation volumes were segmented, normalized, and overlaid on a high-resolution hypothalamic atlas. For each lesion, the size, spatial extent, and degree of overlap with key hypothalamic nuclei and surrounding brain regions were computed and compared between ablations that did and did not result in seizure freedom. RESULTS: Ablation masks that resulted in seizure freedom were smaller and located more centrally than the ablation mask that did not. In addition, ablation masks that resulted in seizure freedom overlapped with regions including the paraventricular nucleus, the posterior hypothalamus and the zona incerta, fornix, and mammillothalamic tract, whereas the single non-seizure-free ablation did not. CONCLUSION: Differences in the size, position, and anatomical localization of ablation volumes may be a potential contributor to the variability in postoperative outcomes of large HH treated with MRgLITT. A novel, high-resolution MRI atlas of the hypothalamus identifies a number of regions at the interface of large HH that are preferentially disconnected in seizure-free patients. This method of anatomical localization not only serves as a potential clinical tool for surgical targeting but may also provide novel insights into the mechanisms of epileptogenesis in hypothalamic hamartomas.


Asunto(s)
Epilepsia Refractaria , Hamartoma , Enfermedades Hipotalámicas , Terapia por Láser , Niño , Epilepsia Refractaria/diagnóstico por imagen , Epilepsia Refractaria/cirugía , Libertad , Hamartoma/complicaciones , Hamartoma/cirugía , Humanos , Enfermedades Hipotalámicas/complicaciones , Enfermedades Hipotalámicas/cirugía , Rayos Láser , Imagen por Resonancia Magnética , Convulsiones/etiología , Convulsiones/cirugía , Resultado del Tratamiento
10.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33542005

RESUMEN

Acute cerebellar ataxia is a rare primary manifestation of neuropsychiatric systemic lupus erythematosus (NPSLE). We report a case of a 22-year-old woman who presented with gait instability, behavioural changes and new-onset seizures. The tempo of disease progression was explained by an autoimmune cause, eventually fulfilling the criteria for systemic lupus erythematosus. The patient's neurological symptoms improved markedly following administration of steroids and immunomodulators. A review of literature on cerebellar ataxia in NPSLE and a summary of all reported cases to date are also presented.


Asunto(s)
Antiinflamatorios/uso terapéutico , Ataxia Cerebelosa/etiología , Vasculitis por Lupus del Sistema Nervioso Central/diagnóstico , Vasculitis por Lupus del Sistema Nervioso Central/tratamiento farmacológico , Prednisona/uso terapéutico , Adulto , Antimaláricos/uso terapéutico , Femenino , Análisis de la Marcha , Cefalea/etiología , Humanos , Hidroxicloroquina/uso terapéutico , Vasculitis por Lupus del Sistema Nervioso Central/complicaciones , Convulsiones/etiología
11.
Am J Forensic Med Pathol ; 42(1): 77-80, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33555675

RESUMEN

ABSTRACT: Mass lesions in the brain encompass a wide range neoplastic and nonneoplastic entities. These can present as a diagnostic pitfall, with nonspecific, overlapping symptoms and similar appearances on radiology. They may cause death through varied mechanisms, either specific to the underlying pathophysiology or due to the space-occupying effect of the lesion. We report a case of fatal hemorrhagic cerebral pseudocyst, a rare mass lesion, associated with a cerebral varix, causing death in a morbidly obese individual. To the best of our knowledge, there is no previous documentation in the postmortem literature of this entity as a cause of death. This case aims to document this rare entity in the differential diagnosis of a tumor-like lesion in the brain, highlight the clinical difficulty in its assessment, and demonstrate an uncommon mechanism of death, of a mass lesion acting as a focus causing seizures, with resulting hypoxia due to effects of morbid obesity and heart failure.


Asunto(s)
Neoplasias Encefálicas/patología , Quistes del Sistema Nervioso Central/patología , Hemorragia Cerebral/patología , Adulto , Encéfalo/irrigación sanguínea , Hemorragia Cerebral/etiología , Femenino , Cefalea/etiología , Paro Cardíaco/etiología , Humanos , Obesidad Mórbida/complicaciones , Lóbulo Parietal/patología , Convulsiones/etiología , Várices/patología
12.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541949

RESUMEN

We report the case of a 70-year-old diabetic woman who presented to the emergency department with multiple seizure episodes and coma, prompting the need for sedation and mechanical ventilation. She was transferred to our institution for neurosurgical evaluation as the initial CT scan identified hyperdense lesions in the left basal ganglia, interpreted as acute intracranial haemorrhage. On admission, laboratory tests were mostly normal except for blood glucose of 413 mg/dL. Medical records revealed a history of poorly controlled diabetes mellitus and non-adherence to therapy. After seizure control and lifting sedation, right-sided ataxia/involuntary movements were observed. Considering the patient's history and these findings, the CT scan was reviewed and the striatal region hyperdensities interpreted as lesions typical of non-ketotic hemichorea-hemiballismus. MRI was latter performed and confirmed the diagnosis, even though the unusual presentation. Levetiracetam initiation and glycaemic control optimisation led to great neurological improvement without seizure recurrence.


Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Diagnóstico Diferencial , Discinesias/diagnóstico , Hiperglucemia/diagnóstico , Cumplimiento de la Medicación , Anciano , Anticonvulsivantes/uso terapéutico , Ganglios Basales/diagnóstico por imagen , Glucemia/análisis , Coma/etiología , Femenino , Humanos , Hemorragias Intracraneales/diagnóstico por imagen , Levetiracetam/uso terapéutico , Imagen por Resonancia Magnética , Convulsiones/tratamiento farmacológico , Convulsiones/etiología , Tomografía Computarizada por Rayos X
13.
Adv Clin Exp Med ; 30(1): 29-34, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33529504

RESUMEN

BACKGROUND: Cerebrovascular disease is an important cause of epilepsy. The incidence may significantly vary (from 2.3% to 43%). Post-stroke seizures occur within 2 weeks of stroke onset (as early-onset seizures) or 2 weeks after a stroke (as late-onset seizures). OBJECTIVES: To retrospectively evaluate and differentiate predictive factors for post-stroke seizures. MATERIAL AND METHODS: We retrospectively analyzed the medical histories of 164 adult patients diagnosed with post-stroke seizures but no epilepsy recognized prior to the stroke who were hospitalized at the Neurology Clinic of Wroclaw Medical University between 2012 and 2018. The seizures were classified according to the criteria of the International League Against Epilepsy (ILAE) from 2017. The relevant demographic data, type of stroke (ischemic/hemorrhagic), time of occurrence of seizures in relation to the type of stroke, score on the modified Rankin Scale, presence of cardiovascular risk factors, electroencephalography (EEG) recording, and antiepileptic treatment (AED) were collected. In the case of ischemic stroke (IS), the size of the stroke lesion was rated on the ASPECTS scale. RESULTS: The study involved 164 patients (average age = 68.83 years), including 86 men (average age = 66.2 years). In 20 out of 164 patients, the seizures were associated with hemorrhagic stroke (HS); in 144 out of 164 patients, the post-stroke epilepsy was associated with IS. Generalized tonic-clonic seizures occurred in 101 out of 164 patients, focal aware seizures occurred in 19 out of 164 patients and focal impaired-awareness seizures occurred in 44 out of 164 patients. CONCLUSIONS: Our study has confirmed that generalized seizures occur mostly after an IS and are late complications of it. Early-onset seizures occur mostly after HS associated with severe disability. Seizures are more likely to happen due to the cortical location of the stroke. There is a shift from generalized to focal seizures with an increase in the extent of IS as evaluated using the ASPECTS scale.


Asunto(s)
Epilepsia , Accidente Cerebrovascular , Anciano , Anticonvulsivantes , Electroencefalografía , Epilepsia/tratamiento farmacológico , Epilepsia/epidemiología , Epilepsia/etiología , Femenino , Humanos , Masculino , Estudios Retrospectivos , Convulsiones/tratamiento farmacológico , Convulsiones/epidemiología , Convulsiones/etiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/tratamiento farmacológico
14.
Medicine (Baltimore) ; 100(1): e24234, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429822

RESUMEN

RATIONALE: Myelin oligodendrocyte glycoprotein (MOG) antibody (MOG-Ab) disease (MOG-AD) is a type of demyelinating disease of the central nervous system characterized by a high frequency of optic neuritis (ON) attacks. anti-Nmethyl-D-aspartate receptor (NMDAR) encephalitis (anti-NMDARe) is an autoimmune disorder characterized by memory deficits, conscious disturbance, and seizures. Cases of simultaneous occurrence of MOG-Ab and anti-NMDARe antibody (anti-NMDARe-Ab) are rarely reported and could be mistaken for overlapping MOG-antibody disease (MOG-AD) and NMDARe. The diagnosis of such patients is challenging. PATIENT CONCERNS: We report the case of a 37-year-old man who presented with recurrent headaches for 3 months and worsening symptoms over 2 weeks. He had a history of ON. He had a generalized seizure after 7 days in the hospital. DIAGNOSIS: Brain magnetic resonance imaging (MRI) and cerebrospinal fluid tests showed no apparent abnormalities. Repeat MRI showed slight lesions 7 days later, and cerebrospinal fluid tests showed the simultaneous occurrence of MOG-Ab and anti-NMDARe-Ab. INTERVENTIONS: He completely recovered after treatment with low doses of oral corticosteroids. OUTCOMES: Two months and 2 years follow-up showed that his condition was stable. LESSONS: The co-occurrence of MOG-Ab and anti-NMDAR-Ab does not indicate the co-occurrence of MOG-AD and anti-NMDARe. Laboratory findings should be combined with the clinical features to achieve an accurate and suitable diagnosis.


Asunto(s)
Encefalitis Antirreceptor N-Metil-D-Aspartato/diagnóstico , Enfermedades Autoinmunes Desmielinizantes SNC/diagnóstico , Glicoproteína Mielina-Oligodendrócito/inmunología , Neuritis Óptica/etiología , Receptores de N-Metil-D-Aspartato/inmunología , Adulto , Encefalitis Antirreceptor N-Metil-D-Aspartato/líquido cefalorraquídeo , Encefalitis Antirreceptor N-Metil-D-Aspartato/complicaciones , Encefalitis Antirreceptor N-Metil-D-Aspartato/diagnóstico por imagen , Enfermedades Autoinmunes Desmielinizantes SNC/líquido cefalorraquídeo , Enfermedades Autoinmunes Desmielinizantes SNC/complicaciones , Enfermedades Autoinmunes Desmielinizantes SNC/diagnóstico por imagen , Diagnóstico Diferencial , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Convulsiones/etiología
15.
Neurology ; 96(10): e1443-e1452, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33495377

RESUMEN

OBJECTIVE: To develop a diagnostic test that stratifies epileptic seizures (ES) from psychogenic nonepileptic seizures (PNES) by developing a multimodal algorithm that integrates plasma concentrations of selected immune response-associated proteins and patient clinical risk factors for seizure. METHODS: Daily blood samples were collected from patients evaluated in the epilepsy monitoring unit within 24 hours after EEG confirmed ES or PNES and plasma was isolated. Levels of 51 candidate plasma proteins were quantified using an automated, multiplexed, sandwich ELISA and then integrated and analyzed using our diagnostic algorithm. RESULTS: A 51-protein multiplexed ELISA panel was used to determine the plasma concentrations of patients with ES, patients with PNES, and healthy controls. A combination of protein concentrations, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), intercellular adhesion molecule 1 (ICAM-1), monocyte chemoattractant protein-2 (MCP-2), and tumor necrosis factor-receptor 1 (TNF-R1) indicated a probability that a patient recently experienced a seizure, with TRAIL and ICAM-1 levels higher in PNES than ES and MCP-2 and TNF-R1 levels higher in ES than PNES. The diagnostic algorithm yielded an area under the receiver operating characteristic curve (AUC) of 0.94 ± 0.07, sensitivity of 82.6% (95% confidence interval [CI] 62.9-93.0), and specificity of 91.6% (95% CI 74.2-97.7). Expanding the diagnostic algorithm to include previously identified PNES risk factors enhanced diagnostic performance, with AUC of 0.97 ± 0.05, sensitivity of 91.3% (95% CI 73.2-97.6), and specificity of 95.8% (95% CI 79.8-99.3). CONCLUSIONS: These 4 plasma proteins could provide a rapid, cost-effective, and accurate blood-based diagnostic test to confirm recent ES or PNES. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that variable levels of 4 plasma proteins, when analyzed by a diagnostic algorithm, can distinguish PNES from ES with sensitivity of 82.6% and specificity of 91.6%.


Asunto(s)
Proteínas Sanguíneas/análisis , Encefalitis/sangre , Encefalitis/complicaciones , Epilepsia/etiología , Convulsiones/etiología , Adolescente , Adulto , Algoritmos , Anticonvulsivantes/uso terapéutico , Área Bajo la Curva , Diagnóstico Diferencial , Electroencefalografía , Epilepsia/tratamiento farmacológico , Femenino , Humanos , Masculino , Trastornos Mentales/etiología , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Convulsiones/tratamiento farmacológico , Adulto Joven
16.
Epilepsy Behav ; 115: 107544, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33423016

RESUMEN

OBJECTIVE: The purpose of this prospective study was to identify predictive factors of the evolution of the number of seizures. METHODS: We included 85 individuals with a diagnosis of Psychogenic Nonepileptic Seizure (PNES) who completed at least two clinical interviews spaced by 6 months during a 24-month follow-up. Participants underwent a structured interview with an experimented clinician in PNES to complete standardized evaluation and validated scales. We collected sociodemographic and clinical data on PNES (number of seizures, duration of the disease), anxiety, depression, history of traumas, alexithymia, dissociation, and post-traumatic stress disorder (PTSD). We used a multivariate linear regression analysis to predict the characteristics independently associated with the evolution of the number of seizures in percentage. RESULTS: Dissociation score was significantly associated with a negative evolution of the number of seizures (p < 0.002). Conversely, the diagnosis of PTSD at inclusion was correlated to a positive evolution of the number of seizures (p < 0.029). CONCLUSION: Dissociation was related to a more pejorative evolution of the number of seizures while PTSD diagnosis was associated with a decreased number of seizures. It is therefore essential to improve detection and treatment of post-traumatic dissociation. Further studies are required to understand the impact of PTSD on the evolution of the number of seizures.


Asunto(s)
Convulsiones , Trastornos por Estrés Postraumático , Trastornos de Ansiedad , Trastornos Disociativos , Electroencefalografía , Humanos , Estudios Prospectivos , Convulsiones/diagnóstico , Convulsiones/epidemiología , Convulsiones/etiología , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología
17.
Int J Mol Sci ; 22(2)2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-33445535

RESUMEN

This study aimed to investigate whether the Protaetia brevitarsis seulensis (PB)' water extract (PBWE) ameliorates trimethyltin (TMT)-induced seizures and hippocampal neurodegeneration. To investigate the potential neuroprotective effect of the PBWE in vitro, a lactate dehydrogenase (LDH) assay was conducted in TMT-treated primary cultures of mouse hippocampal neurons. In TMT-treated adult C57BL/6 mice, behavioral and histopathological changes were evaluated by seizure scoring and Fluoro-Jade C staining, respectively. In our in vitro assay, we observed that pretreating mice hippocampal neuron cultures with the PBWE reduced TMT-induced cytotoxicity, as indicated by the decreased LDH release. Furthermore, pretreatment with the PBWE alleviated seizures and hippocampal neurodegeneration in TMT-treated mice. The antioxidant activity of the PBWE increased in a dose-dependent manner; moreover, pretreatment with the PBWE mitigated the TMT-induced Nrf2 stimulation. In addition, six major compounds, including adenine, hypoxanthine, uridine, adenosine, inosine, and benzoic acid, were isolated from the PBWE, and among them, inosine and benzoic acid have been confirmed to have an essential antioxidative activity. In conclusion, the PBWE ameliorated TMT-induced toxicity in hippocampal neurons in both in vitro and in vivo assays, through a potential antioxidative effect. Our findings suggest that the PBWE may have pharmacotherapeutic potential in neurodegenerative diseases such as seizures or epilepsy.


Asunto(s)
Productos Biológicos/química , Productos Biológicos/farmacología , Escarabajos/química , Hipocampo/efectos de los fármacos , Fármacos Neuroprotectores/química , Fármacos Neuroprotectores/farmacología , Animales , Productos Biológicos/aislamiento & purificación , Biomarcadores , Cromatografía Líquida de Alta Presión , Escarabajos/anatomía & histología , Escarabajos/clasificación , Escarabajos/genética , Modelos Animales de Enfermedad , Técnica del Anticuerpo Fluorescente , Genes de Insecto , Pruebas Genéticas , Hipocampo/metabolismo , Hipocampo/patología , Degeneración Nerviosa/tratamiento farmacológico , Degeneración Nerviosa/etiología , Degeneración Nerviosa/metabolismo , Degeneración Nerviosa/patología , Neuronas/efectos de los fármacos , Neuronas/metabolismo , Fármacos Neuroprotectores/aislamiento & purificación , Estrés Oxidativo , Fenotipo , Convulsiones/tratamiento farmacológico , Convulsiones/etiología , Compuestos de Trimetilestaño/efectos adversos
19.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: mdl-33431530

RESUMEN

Granulomatosis with polyangiitis (GPA) is a necrotising vasculitis of unknown cause that has several systemic manifestations. The disease is characterised by the classical triad involving acute inflammation of the upper and lower respiratory tracts with renal involvement. However, the disease pathology can involve the central nervous system. This case report presents a case of GPA with facial nerve palsy as the first manifestation of the disease, which has been rarely reported in the medical literature.


Asunto(s)
Parálisis Facial/etiología , Granulomatosis con Poliangitis/diagnóstico , Perforación del Tabique Nasal/etiología , Convulsiones/etiología , Adolescente , Anticuerpos Anticitoplasma de Neutrófilos/sangre , Encéfalo/diagnóstico por imagen , Ciclofosfamida/administración & dosificación , Parálisis Facial/sangre , Parálisis Facial/diagnóstico , Parálisis Facial/terapia , Femenino , Granulomatosis con Poliangitis/sangre , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/terapia , Humanos , Imagen por Resonancia Magnética , Metilprednisolona/administración & dosificación , Perforación del Tabique Nasal/diagnóstico , Tabique Nasal/diagnóstico por imagen , Senos Paranasales/diagnóstico por imagen , Plasmaféresis , Quimioterapia por Pulso , Convulsiones/sangre , Convulsiones/diagnóstico , Convulsiones/terapia , Tomografía Computarizada por Rayos X
20.
BMC Infect Dis ; 21(1): 110, 2021 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-33485297

RESUMEN

BACKGROUND: Compelling evidence indicates that status epilepticus is a prevalent cause of rhabdomyolysis. However, cases of rhabdomyolysis induced by a single seizure accompanied by viral encephalitis are rarely reported. Herein, we present a case of adult Herpes Simplex Encephalitis complicated with rhabdomyolysis. CASE PRESENTATION: A 32-year-old male was patient presented with fever accompanied by episodes of convulsions, myalgia, and oliguria, which exacerbated the delirium. Routine blood examination showed impaired kidney function and elevated myoglobin (Mb) and creatine phosphokinase (CK) levels. MRI scanning revealed a damaged frontotemporal lobe and limbic system. In addition, herpes simplex virus (HSV) pathogen was identified in the cerebrospinal fluid thus indicating HSV infection. Therefore, a diagnosis of rhabdomyolysis triggered by HSV infection accompanied by epilepsy was made. Notably, the patient recovered well after early intervention and treatment. CONCLUSION: The case presented here calls for careful analysis of rhabdomyolysis cases with unknown causes, minor seizures, and without status epilepticus. This case also indicates that HSV virus infection might contribute to the rhabdomyolysis.


Asunto(s)
Encefalitis por Herpes Simple/complicaciones , Encefalitis por Herpes Simple/diagnóstico , Rabdomiólisis/diagnóstico , Rabdomiólisis/etiología , Adulto , Fiebre/diagnóstico , Fiebre/etiología , Fiebre/patología , Fiebre/fisiopatología , Humanos , Masculino , Rabdomiólisis/patología , Rabdomiólisis/fisiopatología , Convulsiones/diagnóstico , Convulsiones/etiología , Convulsiones/patología , Convulsiones/fisiopatología , Simplexvirus/aislamiento & purificación
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