A woman in her sixties with epilepsy and syncope. / En kvinne i 60-årene med epilepsi og synkope.

BACKGROUND: A woman in her sixties had been diagnosed with generalised epilepsy twenty years earlier. The diagnosis was confirmed by EEG, and an MRI scan revealed hippocampal sclerosis, which is not uncommon in patients with epilepsy. Treatment with carbamazepine was initiated. CASE PRESENTATION: Due to a rise in the patient's cholesterol, carbamazepine was replaced with oxcarbazepine. At a follow-up, the patient reported a recent episode with loss of consciousness. Unstable epilepsy was suspected and the oxcarbazepine dose increased. The patient had had a minor stroke shortly before the check-up. As part of the diagnostic workup, a 24-hour ECG was performed. On removal of the apparatus, the patient described an episode with loss of consciousness that same morning. The ECG showed asystole at that point in time due to total AV block. A pacemaker was implanted, and the patient has had no episodes since. INTERPRETATION: The patient retrospectively reported recurrent episodes with loss of consciousness over many years. The diagnosis of epilepsy was convincing, but was the heart condition linked to her epilepsy, her medication or was it a separate entity? When seizures become more frequent or change character in a previously stabilised patient with epilepsy, it is important to look for non-epileptic causes, and cardiac arrhythmias should be high on the list.

Eosinophils and mast cells: a comparison of nasal mucosa histology and cytology to markers in nasal discharge in patients with chronic sino-nasal diseases.

Allergic rhinitis (AR), nasal polyps (NP) as well as chronic rhinosinusitis (CRS) are all known to be associated with eosinophilic infiltration and elevated numbers of mast cells (MC) within the mucosa. Both cell types and their markers eosinophilic cationic protein (ECP) and tryptase are utilized in the diagnosis and management of chronic sino-nasal diseases. Mucosal cytology samples were gathered by cytobrush, histological samples were obtained from the inferior turbinate. In both sample sets, the number of eosinophils and MC was determined. Their corresponding markers ECP and tryptase were quantified from nasal discharge. Patients were grouped with reference to their main diagnosis: AR (n = 34), NP (n = 25), CRS (n = 27) and controls (n = 34). Eosinophil counts from cytobrush and ECP levels were significantly elevated in NP compared to all other groups-31- and 13-fold over control, respectively. However, histologic review did not reveal any difference in eosinophil count among groups. Tryptase was significantly elevated threefold in AR versus CRS and controls. No correlation to cytological and histological MC counts could be found. ECP levels in nasal discharge as well as eosinophil counts can provide useful information with regard to the diagnosis. Likewise, tryptase concentrations can do. The presented data show that the measurement of markers in nasal discharge is superior in differentiating among diagnosis groups. Given that the collection of nasal secretions is more comfortable for patients than the more invasive techniques, we recommend first line ECP and tryptase testing performed on nasal secretions.

Combined variants in reading epilepsy; coexisting anterior and posterior variants camouflaged as heat cramps where the patient finds his own diagnosis searching the internet.

Reading epilepsy is a form of reflex-induced seizures. Two entities are postulated as part of a clinical spectrum; one anterior variant with jaw jerks and orofacial myoclonia and another posterior variant with visual symptoms and alexia or dyslexia. We present a case with suggestible evidence of both conditions coexisting within the same patient, a finding that, to our knowledge, has not been previously reported. The diagnosis in this specific case was contributed to by the patient searching the internet.