1/57. fluorouracil-induced neurotoxicity.OBJECTIVE: To report a case of acute neurologic adverse effects related to fluorouracil administration and to review the neurotoxicity of this agent. CASE SUMMARY: A 73-year-old white man with a history of esophageal carcinoma was treated with fluorouracil 1,500 mg iv daily for four days. After completing treatment, he presented with sudden onset of confusion, cognitive disturbances, a cerebellar syndrome, and repeated seizures. A magnetic resonance image of the brain showed no structural abnormalities, and cerebrospinal fluid examination was normal; none of the other laboratory tests provided an explanation for his symptoms. The patient was treated with anticonvulsants, and the cognitive changes resolved in 72 hours. The cerebellar signs, however, did not resolve completely and persisted when the patient was examined two weeks after discharge. DISCUSSION: fluorouracil can cause both acute and delayed neurotoxicity. Acute neurotoxicity manifests as encephalopathy or as cerebellar syndrome; seizures, as seen in our patient, have rarely been reported. Acute neurotoxicity due to fluorouracil is dose related and generally self-limiting. Various mechanisms for such toxicity have been postulated, and treatment with thiamine has been recommended. Delayed neurotoxicity has been reported when fluorouracil was given in combination with levamisole; this form of subacute multifocal leukoencephalopathy is immune mediated and responds to treatment with corticosteroids. CONCLUSIONS: Clinicians should be aware of the adverse neurologic effects of fluorouracil and should include them in the differential diagnosis when patients receiving the drug present with neurologic problems.- - - - - - - - - - ranking = 1keywords = seizure (Clic here for more details about this article) |
2/57. Prolonged post-ictal confusion as a manifestation of continuous complex partial status epilepticus: a depth EEG study.We report a peculiar depth-EEG recording of prolonged post-ictal confusion which proved to be continuous complex partial status epilepticus. A 33 year old male with intractable medial temporal lobe epilepsy exhibited this ictal EEG recording. After repetitive habitual complex partial seizures, and an ensuing short lucid interval with intact memory and full communicability, the patient became more and more unresponsive and, finally, even cataleptic. Concurrent with this change in responsiveness, an EEG revealed a gradual and steady increase of ictal EEG activity. Immediately after intravenous diazepam infusion, this ictal EEG activity was suppressed and the patient began to move. This case confirms that a paradoxical excitation can occur after clustered complex partial seizures, instead of the well-known neuronal exhaustion.- - - - - - - - - - ranking = 1.8858526476167keywords = seizure, epileptic, epilepsy (Clic here for more details about this article) |
3/57. Non-convulsive status epilepticus: a treatable cause of confusion in pituitary apoplexy.confusion occurring in pituitary apoplexy is well described. We describe a case of pituitary apoplexy associated with confusion, occurring as a result of non-convulsive status epilepticus. electroencephalography should be performed in pituitary apoplexy associated with confusion if this treatable and potentially serious complication is not to be missed.- - - - - - - - - - ranking = 0.74193848063926keywords = epileptic (Clic here for more details about this article) |
4/57. Nonconvulsive status epilepticus causing acute confusion.PRESENTATION: an elderly patient presented with acute confusion and was found to have nonconvulsive status epilepticus. She responded to treatment with anti-epileptic drugs. OUTCOME: this case illustrates an important, under-recognized and reversible cause of acute prolonged confusion.- - - - - - - - - - ranking = 0.89032617676711keywords = epileptic (Clic here for more details about this article) |
5/57. Leptomeningeal glioblastoma presenting with multiple cranial neuropathies and confusion.glioblastoma multiforme (GBM) is the commonest primary malignant neoplasm of the CNS. Usually, patients present with seizures and headache but in the elderly, confusion and generalised cognitive decline are more frequently the initial features. Multiple cranial nerve lesions as a manifestation of leptomeningeal meningitis is a rare presentation of GBM. The diagnosis is not often suggestive on either brain computed tomography (CT) or magnetic resonance imaging (MRI) and is usually confirmed by cerebrospinal fluid (CSF) cytology or histology. We describe the case of an 80-year-old man, who presented with multiple cranial nerve palsies and confusion secondary to leptomeningeal gliomatosis, in whom GBM was detected along the intra-ventricular lining of the left lateral ventricle at ventriculoscopy, in the absence of a distinct parenchymal lesion.- - - - - - - - - - ranking = 0.5keywords = seizure (Clic here for more details about this article) |
6/57. lassa fever encephalopathy: lassa virus in cerebrospinal fluid but not in serum.The pathogenesis of neurologic complications of lassa fever is poorly understood. A Nigerian patient had fever, disorientation, seizures, and blood-brain barrier dysfunction, and lassa virus was found in cerebrospinal fluid (CSF) but not in serum. The concentration of lassa virus rna in CSF corresponded to 1 x 10(3) pfu/mL, as determined by a quantitative real-time polymerase chain reaction assay. To characterize the lassa virus in CSF, the 3.5-kb S rna was sequenced. In the S rna coding sequences, the CSF strain differed between 20% and 24.6% from all known prototype strains. These data suggest that lassa virus or specific lassa virus strains can persist in the central nervous system and thus contribute to neuropathogenesis. lassa virus infection should be considered in West African patients or in travelers returning from this area who present only with fever and neurologic signs.- - - - - - - - - - ranking = 0.5keywords = seizure (Clic here for more details about this article) |
7/57. confusion and dysphoria with low-dose topiramate in a patient with bipolar disorder.BACKGROUND: Topiramate, a newer antiepileptic agent, may benefit several neurological and psychiatric states, including bipolar disorder. CASE REPORT: A physically healthy, stockily built, 47-year-old, hypomanic Asian male with a >20-year history of uneventful use of psychotropic agents received topiramate in a dose that was stepped up to 100 mg/day across 10 days. He developed dysphoria, confusion, word-finding difficulties, and difficulties in maintaining a train of thought; the symptoms vanished within a week of drug discontinuation, and reappeared 1-2 days after rechallenge at a dose of 25 mg/day. CONCLUSION: It appears that, while confusion is usually a dose-dependent adverse effect of topiramate, certain patients may idiosyncratically develop this adverse effect at very low doses.- - - - - - - - - - ranking = 0.14838769612785keywords = epileptic (Clic here for more details about this article) |
8/57. De novo absence status of late onset following withdrawal of lorazepam: a case report.The aim of this report is to describe the clinical and electroencephalographic findings seen in an elderly woman without previous history of seizures who developed a nonconvulsive generalized status epilepticus following acute withdrawal of lorazepam. scalp video-EEG monitoring was obtained using the standard 10/20 system of electrode placement. Cognitive and speech functions were specifically tested during the evaluation. Continuous irregular rhythmic generalized 2.0-2.5 Hz sharp-and-slow wave complexes intermixed with spikes and polyspikes more prominent over the frontocentral areas were seen on the EEG. This epileptic activity was continuous and unmodified by sensory stimulation and eyes opening and closing. Intravenous injection of diazepam caused a rapid normalization of the EEG with disappearance of the clinical manifestations. De novo absence status is a specific epileptic condition that should be suspected in all elderly subjects on chronic treatment with psychotropic drugs presenting in a confusional state. An urgent EEG is essential to confirm the diagnosis.- - - - - - - - - - ranking = 0.94516308838356keywords = seizure, epileptic (Clic here for more details about this article) |
9/57. Seizure disorder mimicking an acute confusional state as clinical presentation of neurocysticercosis: neuroimaging, EEG findings and clinical correlations.epilepsy is the main clinical manifestation of neurocysticercosis (NC). We studied an adult subject who presented a seizure disorder mimicking an acute confusional state as clinical expression of NC. diagnosis was made with neuroimaging and western blot determination of specific antibodies on serum. Computed tomography and magnetic resonance imaging displayed multiple calcifications and a few transitional cysts in the cerebral parenchyma. electroencephalography showed a pattern of periodic lateralized epileptiform discharges (PLEDs) which could be related topographically to a cystic lesion located in the left parietal lobe. In our view there was a clear pathogenic correlation between the seizure disorder and the parasitic cyst located in the left parietal lobe. Neither antiepileptic drugs nor steroids were prescribed. Follow-up to one year ruled out other clinical manifestations of the disease. This case is an example of acute symptomatic seizure related to a transitional cystic lesion of NC.- - - - - - - - - - ranking = 1.6483876961279keywords = seizure, epileptic (Clic here for more details about this article) |
10/57. Effect of posterior temporal-parietal hematoma on orbital frontal chemistry in relation to a cognitive and anxiety state: a combined 1H-MRS and neuropsychological study of an unusual case as compared with 16 healthy subjects.The authors report the unusual case of a 58-year-old woman (MJP) suffering from left temporal throbbing headache, associated with confusion. magnetic resonance imaging showed a 5 x 3 x 2 cm hematoma at the left posterior temporal--parietal junction (PTPJ). Repeated MRI of MJP's brain performed during a 4-month follow-up period showed decrease in hematoma size (2.3 x 1.5 x 1) with evidence for development of encephalomalacia and resorption of blood products involving the area of hemorrhage. MJP had mild transcortical sensory aphasia characterized by difficulty with reading and processing, with semantic paraphasic errors while speaking and some difficulty with repetition. MJP had remained normotensive and seizure free, on Vasotec therapy and Dilantin prophylaxis. An in vivo proton magnetic resonance spectroscopy (1H-MRS) performed during an 8-month follow-up period showed reduced concentration for N-acetyl aspartate (NAA) by 19.3% (F=4.09, P<0.04), and myo-inositol by 32.0% (F=5.16, P<0.02) in the left orbital frontal cortex (OFC) as compared with 16 healthy subjects (age- and sex-matched). Cognitive tests (the Wechsler abbreviated scale of intelligence (WASI) and the Stroop color--word interference) showed a significant impairment suggesting involvement of higher-order cognitive functioning (memory, learning, and general intelligence) and attentional system. The Spielberger state-trait anxiety inventory (STAI) showed increased anxiety at the moment of the current examination and decreased tendency to be anxious over a long period of time. The Beck anxiety and depression Inventory revealed minimal anxiety and mild to moderate levels of depression. It is hypothesized that the PTPJ hematoma triggered long-distance pathways linking PTPJ area and frontal lobe, including OFC, which resulted in abnormal chemical changes in the left OFC and in cognitive tests impairment, and in long-term anxiety state changes.- - - - - - - - - - ranking = 0.5keywords = seizure (Clic here for more details about this article) |
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