1/28. colitis may be part of the antiepileptic drug hypersensitivity syndrome.PURPOSE: To show that colitis may be part of the antiepileptic hypersensitivity syndrome. methods: Description of two case histories. RESULTS: The first patient was a 47-year-old man who developed fever, lymphadenopathy, influenza-like symptoms, facial edema, skin rash and diarrhea after 3 weeks of carbamazepine (CBZ) treatment. laparotomy because of severe abdominal pain 2 weeks later showed severe colitis with perforations. The second patient was a 41-year-old woman who developed fever, diarrhea, and skin rash 4 weeks after start of CBZ treatment. A colon biopsy confirmed colitis. Stool examinations did not show pathogenic microorganisms, and there was no evidence of Crohn's disease or ulcerative colitis. Both patients had elevated liver enzymes, peripheral eosinophilia, and eosinophils in the infiltrate of the colon. CONCLUSIONS: In view of the close temporal relation between start of CBZ intake and development of colitis, the presence of fever, lymphadenopathy, and rash, and improvement after discontinuation of CBZ, we conclude that the two patients developed an AED hypersensitivity syndrome. Our case histories demonstrate that severe colitis may be part of this syndrome.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
2/28. A family with hemiplegic migraine and focal seizures.Familial hemiplegic migraine is a distinctive form of migraine with autosomal dominant inheritance. The patients undergo attacks of migraine complicated by hemiplegia. seizures have not been reported as comprising a part of this syndrome. We describe three generations of a family with hemiplegic migraine and focal seizures occurring concurrently with the migrainous attacks. There were five affected family members whose clinical features included unilateral headache and transient hemiplegia. Two family members also had focal seizures during the migrainous attacks. One of the patients was treated with carbamazepine with good results. The only associated neurological finding was ataxia which was found in the oldest patient. The presence of focal seizures during an episode of hemiplegic migraine suggests that the two phenomena of migraine and focal seizures may share the same underlying pathophysiology.- - - - - - - - - - ranking = 1.1267530198991keywords = headache (Clic here for more details about this article) |
3/28. Recurrent abdominal pain: when should an epileptic seizure be suspected?Recurrent episodes of abdominal pain are common in childhood. Among the diagnostic possibilities are migraine and abdominal epilepsy (AE). AE is an infrequent syndrome with paroxystic episodes of abdominal pain, awareness disturbance, EEG abnormalities and positive results with the introduction of antiepileptic drugs. We present one 6 year-old girl who had short episodes of abdominal pain since the age of 4. The pain was followed by cry, fear and occasionally secondary generalization. MRI showed tumor in the left temporal region. As a differential diagnosis, we report a 10 year-old boy who had long episodes of abdominal pain accompanied by blurring of vision, vertigo, gait ataxia, dysarthria, acroparesthesias and vomiting. He received the diagnosis of basilar migraine. In our opinion, AE is part of a large group (partial epilepsies) and does not require a special classification. Pediatric neurologists must be aware of these two entities that may cause abdominal pain.- - - - - - - - - - ranking = 9keywords = abdominal pain (Clic here for more details about this article) |
4/28. epilepsy with severe abdominal pain.We describe a patient who experienced recurrent episodes of abdominal pain as a prominent feature of his seizure disorder. Treatment with carbamazepine could not prevent these painful sensations, but a selective amygdalohippocampectomy completely controlled the episodic pain and the seizures associated with loss or alteration of consciousness. During the presurgical evaluation, the episodes of abdominal pain correlated with amygdalar seizure discharges.- - - - - - - - - - ranking = 6keywords = abdominal pain (Clic here for more details about this article) |
5/28. Occipital seizures presenting with bilateral visual loss.Transient visual loss may occur with occipital seizures as an ictal or post-ictal phenomenon. Its duration varies from less than one minute to days, or can be permanent. We describe a 61-year-old man presenting with headache, vomiting and bilateral visual loss. EEG revealed persistent spike discharge in the occipital lobes suggesting occipital seizures. His vision improved with carbamazepine.- - - - - - - - - - ranking = 1.1267530198991keywords = headache (Clic here for more details about this article) |
6/28. Partial seizure: an unusual cause of recurrent vomiting.Partial seizure is a rare cause of nausea and vomiting. We report an adult patient with abdominal discomfort lasting 15 years accompanied by nausea and vomiting at least twice a week. On admission, physical examination and detailed laboratory tests were normal. Abdominal ultrasound examination, upper gastrointestinal endoscopy and CT scanning of the brain did not reveal any evidence of disease. electroencephalography revealed bilateral synchronous sharp wave discharges and spike wave activities. The diagnosis of partial seizure was considered and the patient was administered sodium valproate. The patient's symptoms subsided and he has been asymptomatic for the past 20 months. We conclude that partial seizure should be considered in patients suffering from abdominal complaints who do not have any underlying gastrointestinal disorder.- - - - - - - - - - ranking = 0.015968721937346keywords = upper (Clic here for more details about this article) |
7/28. Sandifer syndrome misdiagnosed as refractory partial seizures in an adult.We report a 27 year-old man with intellectual disability and no prior history of seizures who presented with episodes of abdominal pain, head/eye version and unresponsiveness that were misdiagnosed and treated as partial seizures. Associated vomiting and haematemesis led to the correct diagnosis and treatment of reflux oesophagitis. The episodes immediately resolved and a diagnosis of Sandifer syndrome was made. This is only the second report of Sandifer syndrome in adult, a movement disorder of unknown mechanism that occurs almost exclusively in young children, often misdiagnosed as epilepsy or episodic dystonia. (Published with videosequences).- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
8/28. Palliative temporal resection for the treatment of intractable bioccipital epilepsy.RATIONALE: Temporal resection is usually ineffective in patients with occipital seizures. However, when seizures are unilateral occipital resections are now, occasionally, considered. When bilateral seizures and visual field defects exist, occipital resection can not be carried out. When predominantly lateralized, temporal seizure onset can be shown in such patients, palliative temporal resection may be justified. methods: We report two patients with medically refractory, bilateral occipital lobe seizures. Clinical and electrophysiological patterns suggested consistent spread of the ictal discharge to temporal lobe structures. Long-term EEG video monitoring was followed by stereoelectroencephalography (SEEG) to assess involvement of temporal and occipital regions symmetrically. RESULTS: Both patients had non-lateralized, elementary visual aura followed by loss of contact, automatisms, frequent falls and occasionally secondary generalization. brain MR imaging revealed bilateral parieto-occipital ischemic lesions without concomitant temporal volumetric abnormalities. They had bilateral or unilateral visual field defects. scalp EEGs showed bilateral temporal or temporo-parieto-occipital interictal and ictal epileptic abnormalities. Intracranial SEEG recordings confirmed the presence of multifocal, temporo-occipital epileptic abnormalities. In both however, disabling seizures originated in, or rapidly spread to the right hippocampus. Since occipital resections were inadvisable, both patients underwent selective, right amygdalohippocampectomy. seizures continued in both (two-year follow-up), but were much less severe, not associated with falling or secondary generalization, not followed by fatigue or headache and with faster recovery. CONCLUSION: When occipital resection is inadvisable because of bilateral or diffuse visual problems, palliative temporal resection may be considered in patients with lesional, bilateral occipital lobe epilepsy, and rapid seizure spread to mesial temporal structures. (Published with videosequences).- - - - - - - - - - ranking = 1.1267530198991keywords = headache (Clic here for more details about this article) |
9/28. Recurrent peritonitis with massive ascites as the initial manifestation of systemic lupus erythematosus: report of one case.Systemic lupus erythematosus (SLE) rarely presents with massive ascites secondary to severe peritonitis before the occurrence of major diagnostic features. We described a 13-year-old girl who developed four episodes of severe abdominal pain with massive ascites. During the first episode, the patient experienced deterioration with massive ascites over a 3-day period, after a 3-month history of intermittent abdominal pain. This episode resolved under conservative treatment. During the second episode, her acute abdominal findings mimicked appendicitis or gynecologic emergency. An exploratory laparotomy was initially planned, but not performed. thrombocytopenia postponed the surgical intervention and led to further investigation. Autoimmune studies confirmed SLE and prompted steroid therapy, which rapidly improved her painful ascites and spared an unnecessary operation. After improvement of peritonitis with ascites, and following discharge, other major clinical features of SLE ensued. The third episode of peritonitis with massive ascites responded well to steroid pulse therapy. The fourth episode of ascites was accompanied by intracranial hemorrhage that led to her death. To the best of our knowledge, this is the first case report of recurrent peritonitis with massive ascites as the initial and major manifestation of SLE in a pediatric patient.- - - - - - - - - - ranking = 2keywords = abdominal pain (Clic here for more details about this article) |
10/28. Stormy onset with prolonged loss of consciousness in benign childhood epilepsy with occipital paroxysms.In nine of 62 children with benign occipital epilepsy (BOE) the onset was stormy and alarming. The first and often only seizure was characterised by prolonged loss of consciousness lasting up to 12 hours, suggesting an acute cerebral insult. In all but one case there was a tonic aversion either of eyes alone or of both head and eyes which was interpreted as conjugate deviation. The other accompanying ictal motor phenomena were either partial or generalised convulsions. In five patients the seizure was heralded by a headache, and in five cases was accompanied by vomiting. The seizure began with visual symptoms in only one patient. The seizure occurred while awake in seven and during sleep in two. The age at onset was from 3 1/4 to 10 years. Interictal EEGs showed occipital discharges typical of BOE, and the clinical course was benign. In four cases a few partial or complex partial seizures recurred during subsequent anticonvulsant therapy, but in five cases seizures never recurred. anticonvulsants were discontinued in five patients who remained free from seizures for one to 11 1/2 years after withdrawal of treatment. Sudden coma in a child associated with focal features such as tonic deviation of the head or eyes or both may represent a benign seizure disorder.- - - - - - - - - - ranking = 1.1267530198991keywords = headache (Clic here for more details about this article) |
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