Nonkonvulsiver Status epilepticus als Ursache eines Delirs

Abstract

We report about a patient (66 years) who was referred to our psychiatric hospital because of a progressive confusional state with acute onset. The colleagues of the referring psychiatric hospital considered a first manic episode as the cause of the symptoms and under therapy with haloperidol the confusional state had shown a progression.The clinical examination's findings were a mild central facial paresis on the right side and a mild hemiparesis on the right side with elevated reflex levels.The patient was disoriented, he had cognitive and mnestic deficits. His reasoning was slowed, incoherent and perseverating. The patient had a slight euphoria.An EEG recording showed a continuous regional EEG-seizure pattern. In combination with the clinical symptoms we diagnosed a nonconvulsive status epilepticus. Under anticonvulsive treatment with Lorazepam and Valproic acid the status epilepticus sustended but a control EEG recording showed signs of a Valproate-encephalopathy. Under treatment with Topiramate symptoms ameliorated but due to a vascular dementia the patient still showed fluctuating symptoms of cognitive and mnestic disturbances.

Novel clinical features of nonconvulsive status epilepticus

“…Cases have also been reported of Wernicke's aphasia secondary to limbic encephalitis or cerebral infarction (these remitted or disappeared in response to antiepileptic medication 16 , 17 ). Other symptoms include confabulation, hallucinatory delusion, and delirium 13 , 18 . We also treated a patient with total aphasia due to NCSE secondary to hyperammonemic encephalopathy resulting from Osler–Weber–Rendu disease and a second patient with Broca's aphasia associated with NCSE secondary to right extracranial internal carotid artery stenosis ( Table 1 ).…”