Context: Seizures are the most frequent clinical emergency neurological manifestation, corresponding to 1-5% of the visits, except for trauma. Several conditions have the potential to reduce the seizure threshold, and the use of antidepressant drugs as selective serotonin reuptake inhibitors is one of those reported. The seizure triggering risk related to SSRIs use is low, being 0.1%, perceptibly lower than that of tricyclic antidepressants, with a 1% rate. Case report: Male patient, previously healthy, 23-year-old, was seen at the Emergency Room in Rio Branco after a generalized seizure lasting 3 minutes. Complementary exams, including computed tomography, were all normal. Magnetic resonance imaging of the skull without atypical findings and electroencephalogram showed dysrhythmia by waves and discrete spicules. Patient reported using escitalopram (esc) 20mg for 3 months after 10mg progression dose, in use for 1 year, without clinical improvement. Due to the seizure event, medication management was switched for sertraline 50mg intake. After 2 months, the patient had a new generalized seizure, preceded by prolonged depersonalization. Complementary exams were normal, 10mg of esc was reestablished and the patient ceased with the seizures. Conclusions: The diagnostic hypothesis: patient’s seizure threshold is low, and seizures are triggered by SSRI higher doses adverse effect. Due to case rarity and SSRI efficacy and tolerance, it is suggested to encourage the discussion about administration safety of these drugs.
Introduction: Glioblastoma (GBM) is the most common and lethal Central Nervous System (CNS) malignant cancer, and the exclusion of differential diagnoses - eg primary central nervous system lymphoma (PCNSL) - often occurs via various Magnetic Resonance Imaging (MRI) methodologies. Objective: To describe which best image sequences are critical for greater accuracy in the diagnosis of GBM and for their distinction from other CNS tumors. Methods: This is a literature narrative review, initiated by research in Pubmed database, using associated Key words: “Glioblastoma” and “Magnetic Resonance”; and filters: systematic reviews + last 5 years publications. Productions that didn’t meet the objective were discarded. Results: MRI has accuracy for diagnosing GBM using the combination T2 + FLAIR + T1 with pre and post-gadolinic contrast. Diffusion and perfusion-weighted MRI association show an improvement in specificity. Computed tomography is used when MRI is unviable, identifying calcifications or hemorrhages and determining the lesion location and surgical potential. Also, spectroscopic MRI, diffusion tensor imaging and PET 18F-FDG, and 11C-MET were reported as important additional diagnostic criteria. Diffusion MRI (DWI) is a non-invasive, convenient, economical, and quick procedure when compared to GBM biopsy. Therefore, adding reliable evidence for moderate differentiation between GBM and PCNSL through DWI. Conclusion: Reliable methods are needed for GBM accurate diagnosis and its differential diagnoses, using at least T2 + FLAIR + T1, and physiological exams to enhance specificity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.