Seizure during Graves' disease

Vergély, N.; Garnier, P.; Guy, Claire; Khalfallah, Y.; Estour, Bruno

doi:10.1684/epd.2009.0242

Cited by 8 publications

(1 citation statement)

References 11 publications

(11 reference statements)

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“…Although neurological hyperexcitability can theoretically be a cause of seizure development, the prevalence of thyrotoxicosis-related seizures appears to be very low with only 17 papers reported in the literature over the past 40 years 1 2. On the other hand, encephalopathy has been associated since several decades with thyroid dysfunction and was first described by Lord Brain in 1966 3.…”

Section: Discussionmentioning

confidence: 99%

Seizures and postictal stupor in a patient with uncontrolled Graves' hyperthyroidism

Leu

Unuane²,

Poppe³

et al. 2012

Case Reports

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A 16-year-old girl with a history of Graves' disease presented with two episodes of generalised tonic-clonic seizures, necessitating intensive care admission. Laboratory examination demonstrated a suppressed thyroid-stimulating hormone level with dramatically elevated free triiodothyronine, free thyroxine and thyroid-stimulating immunoglobulins. Cerebrospinal fluid analysis showed oligoclonal banding in the absence of pleocytosis, thyroid peroxidase antibodies or infection. Neuroimaging revealed the presence of a congenital arachnoid cyst in the right temporal lobe. Despite restoration of euthyroidism and administration of antiepileptic and antiviral drugs, neurological features persisted. Subsequently, intravenous corticoids were administered to exclude the contribution of an underlying autoimmune encephalopathy. The patient gradually recovered and, in retrospect, elevated serum N-methyl-D-aspartic acid-receptor (NMDA-R) antibodies were detected. Although this patient presented with an intracerebral arachnoid cyst that can act epileptogenic per se, the combination of prolonged postictal encephalopathy with unresponsiveness to antiepileptic measures, absence of focal epileptiform activity on EEG, response to corticoids and serum NMDA-R antibody positivity favours the diagnosis of autoimmune NMDA-R encephalitis in this case. BACKGROUND

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Section: Discussionmentioning

confidence: 99%