Pleocytosis After Status Epilepticus

-We describe a case of non-ketotic hyperglycemia (NKH), heralded by complex partial seizures and aphasia of epileptic origin, besides versive and partial motor seizures. This clinical picture was accompanied by left fronto-temporal spikes in the EEG. The seizures were controlled by carbamazepine only after the control of the diabetes. A month later, carbamazepine was discontinued. The patient remained without seizures, with normal language, using only glybenclamide. Complex partial seizures, opposed to simple partial seizures, are rarely described in association to NKH. Epileptic activity localized over language regions can manifest as aphasia.KEY WORDS: aphasia, seizures, diabetes mellitus. Crises parciais complexas e afasia como manifestações iniciais de hiperglicemia não cetótica: relato de casoRESUMO -Descrevemos um caso de hiperglicemia não-cetótica (HNC) cujas manifestações iniciais foram crises parciais complexas e afasia de origem epiléptica, além de crises versivas e parcias motoras. Este quadro clínico foi acompanhado por atividade epileptiforme na região fronto-temporal esquerda ao eletrencefalograma. As crises epilépticas foram controladas com carbamazepina (CBZ) apenas após o controle do diabetes mellitus. Após um mês, a CBZ foi suspensa, permanecendo a paciente com linguagem normal, sem novas crises epilépticas, em uso apenas de glibenclamida. Crises parciais complexas, ao contrário de crises parciais simples, são raramente descritas como manifestação de HNC. Atividade epileptiforme nas regiões relacionadas a linguagem podem manifestar-se como afasia. PALAVRAS-CHAVE: epilepsia, crises epilépticas, diabetes mellitus, afasia.Non-ketotic hyperglycemia (NKH) is classically associated to simple partial seizures and partial motor status epilepticus (SE) and rarely to complex partial seizures (CPS) 1,2 . We present a case that was heralded by CPS and aphasia of epileptic origin, before systemic signs and symptoms of diabetic decompensation. CASE REPORTA 60 year old black woman, right-handed, was brought by relatives to the neurological emergency room because of altered behaviour for a week. She presented irritation and moments of staring, that seemed to "turn off", stopping domestic work. At other times, she stopped speaking, or forgot the names of her relatives and objects, answering only monosyllables. Besides these episodes, she looked completely well. The patient and relatives denied other neurologic and systemic complaints, including fever, polyphagia, polydipsia, polyuria and Escola Paulista

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“…The moderate CSF cellularity we found in this case can be explained by the very frequent seizures, associated to the high seric osmolarity 20 .…”

Section: Discussionsupporting

confidence: 46%

Complex partial seizures and aphasia as initial manifestations of non-ketotic hyperglycemia: case report

Batista

Silva

Ferraz

et al. 1998

Arq. Neuro-Psiquiatr.

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“…CSF analysis is abnormal in most patients with lymphocytic pleocytosis (50%) and elevated protein content (70%). Mild pleocytosis and increased protein content can also be the result of seizures; therefore, other causes of encephalopathy must be excluded [12]. CSF lymphocytic pleocytosis and elevated protein levels may support an immune mechanism at least in those patients without seizures.…”

Section: Discussionmentioning

confidence: 99%

Plasmodium falciparum malaria, bilateral sixth cranial nerve palsy and delayed cerebellar ataxia

Duque

Seixas

Ventura

et al. 2011

J Infect Dev Ctries

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We describe the case of a 14-year-old Caucasian male, a resident in the Democratic Republic of the Congo, who was observed in Portugal with severe Plasmodium falciparum malaria with high-level parasitemia and severe thrombocytopenia. The course was complicated by bilateral sixth cranial nerve palsy during acute malaria, followed by the appearance of delayed cerebellar ataxia during the recovery phase. This occurred after successful treatment with quinine plus doxycycline over seven days. Different levels of thrombocytopenia and C-reactive protein were observed during both neurologic events in the presence of HRP-2 positive tests for Plasmodium falciparum antigen. The patient recovered completely after three months.

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“…The diagnostic value of other paraclinical examinations may depend on the very specific context. Thus, analysis of cerebrospinal fluid may help to diagnose an underlying CNS infection; unspecifically and as a bystander phenomenon, there may be pleocytosis of up to about 30 cells and slightly elevated protein levels in the CSF of noninfectious NCSE [147].An increase of neuron-specific enolase upon NCSE was suggested [148][149][150]. The various imaging modalities may be of lesser value in the emergency diagnosis of NCSE, but may reveal valuable localisatory, structural (CT, MRI, DTI), pathophysiological (DWI, SPECT) and…”

Section: S C H W E I Z E R a R C H I V F ü R N E U R O L O G I E U N mentioning

confidence: 99%

Non-convulsive status epilepticus in adults - an overview

Rüegg¹

2008

Swiss Arch Neurol Psychiatr

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Pleocytosis After Status Epilepticus

Cited by 59 publications

References 16 publications

Complex partial seizures and aphasia as initial manifestations of non-ketotic hyperglycemia: case report

Complex partial seizures and aphasia as initial manifestations of non-ketotic hyperglycemia: case report

Plasmodium falciparum malaria, bilateral sixth cranial nerve palsy and delayed cerebellar ataxia

Non-convulsive status epilepticus in adults - an overview

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