INTRODUCTIONThe advances in the current medical science and technology have strived forward in increasing longevity of the population. Major economies in the worlddeveloping and developed alike are facing an ever increasing graying population with the inherent risk of morbidity and mortality. The combined endpoint of a mechanized and sedentary lifestyle added up with an increase in life span invites our acuity towards a fragile unbalanced segment of the society to whom we are obliged for what we are.Epilepsy is the third most common neurological disorder in old age after dementia and stroke. The elderly are now the group with the highest incidence of epilepsy in the general population. 1 Incidence rates of over 100 per 100000 for epilepsy in people over 60 years old have been reported in contemporary literature. 2The incidence of acute symptomatic or provoked seizures also rises significantly in older persons 3 and the prevalence of epilepsy increases with advancing age, although to a lesser degree.Different studies show considerable variability in the etiology and risk factors for epilepsy. [4][5][6] The most frequently reported risk factor is cerebrovascular disease. Tumors, metabolic and toxic causes and cerebral hypoxia secondary to the many causes of syncope in old age account for around 10% of all seizures. 5,7 Other causes of seizures include head injury, infection, subdural haematoma and neurodegenerative disorders. ABSTRACTBackground: Seizure disorder and epilepsy are one of the common presenting symptoms to an emergency department for geriatric population. Cerebrovascular accident, metabolic derangement, trauma, neurodegenerative diseases, tumor, infections and psychiatric illnesses add up to the frequent etiological spectrum of seizure in elderly. Objective of current study was to describe clinical and etiological spectrum of seizures in later life. Methods: This retrospective study was conducted from medical records of 227 cases of elderly subjects presenting with seizure to emergency department, during a period of 3 years (2010)(2011)(2012)(2013). Results: Most common age group involved was 65-75 years. Mean age of subjects included in the study was 68.13 ± 23.38 years. The most common etiology was cerebrovascular disorders 132 (58.14%), followed by CNS tumor in 16 (07.04%), hypoglycemia in 14 (06.16%), infections 14 (06.16%), substance abuse 12 (05.28%) and trauma 10 (04.40%). The most common presentation was with focal seizures, with 119 (52.42%) subjects whereas 82 (36.12%) presented with generalized tonic clonic seizure, 20 (08.81%) with generalized tonic seizure and 05 (02.20%) with absence seizures. Conclusion: The present study aims at pointing out the different clinical features and etiologies of geriatric seizures, thereby lets the reader have a head start with the management of an elderly patient presenting with seizure.
Introduction: Wernekink commissure syndrome is a rare midbrain syndrome selectively affecting the Wernekink commissure, characterized by bilateral cerebellar ataxia and eye movement disorders, especially internuclear ophthalmoplegia. This article aims at proposing clinico-radiological criteria for Wernekink commissure syndrome with review of the neural circuitary responsible, to aid in recognition and reporting. Methods: This was a prospective study conducted at Department of Neurology, at Pushpagiri institute of medical sciences and research centre, Thiruvalla, Kerala, India, over a period of 5 years among patient with pure midbrain syndromes. All patients with pure midbrain infarction were studied. Subjects presenting with clinical features of Wernekink commissure syndrome were shortlisted and were assessed by investigators independently. Neuroradiology was assessed by investigators 1 and 2, independently. The demographic profile, risk factors, clinical features, neuroimaging findings and outcomes were analysed using SPSSv21. Results: Details of 43 subjects with pure midbrain stroke were included in the study. 8 had clinical features of Wernekink commissure syndrome. The most common findings were bilateral ataxia and unilateral or bilateral internuclear ophthalmoplegia. None of our patients had palatal tremor. Unilateral caudal paramedical infarction was seen on MRI in 5 patients, whereas it was bilateral in 3 patients. Conclusions: The proposed clinico-radiological criteria consisting of all of the essential criteria (Ipsilateral internuclear ophthalmoplegia, Unilateral or bilateral ataxia and Neuroradiological evidence of Caudal midbrain involvement) with or without one among the supportive criteria (Rubral Tremor, Palatal myoclonus) can safely point at a diagnosis of Wernekink commissure syndrome.
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