Reversible metronidazole-induced encephalopathy

We report the neuroimaging findings of a case of reversible metronidazole-induced encephalopathy. Magnetic resonance imaging (MRI) demonstrated lesions in highly suggestive locations. Follow-up imaging performed 1 month after cessation of metronidazole therapy demonstrated resolution of imaging findings.     

Electroencephalographic findings in post-anoxic myoclonic encephalopathy

The electroencephalographic (EEG) findings observed in nine patients with post-anoxic myoclonic encephalopathy are reported. The tracings showed typical myoclonus potential in some, and characteristic diffuse brain injury in others. In two of our cases the spike and wave complex was faster than in the others. Our EEG tracings are similar to those studied by Gastaut and Rémond in 1952.     

Severe dysautonomia revealing Wernicke's encephalopathy

Introduction

Wernicke's encephalopathy, a pathology caused by vitamin B1 (thiamin) deficiency, is often difficult to diagnose and can lead to severe cognitive sequels if left untreated.

Case report

We report the case of a 42-year-old HIV-positive women who, four days after recurrent episodes of vomiting, developed severe dysautonomia and symptoms suggestive of Wernicke's encephalopathy. Treatment with parenteral thiamine induced dramatic improvement within a few days.

Conclusion

This case report highlights an unusual presentation of symptomatic thiamin deficiency associating severe dysautonomia with the classical manifestations of Wernicke's encephalopathy. As dysautonomia is frequently the earliest sign of beriberi, this case illustrates the continuum between these two diseases whose cause, symptomatic thiamin deficiency, is the same. It also draws attention to the multiple risk factors that may be associated, leading to symptomatic thiamin deficiency. This deficiency, while often overlooked, is frequent in HIV-infected patients. Finally, this case contributes to the discussion on the possible genetic polymorphism that may make a limited deficiency symptomatic.     

可逆性后部脑病综合征

可逆性后部脑病综合征自1996年首先提出至今已有12年,早先国外报道较多,国内随着对该病的认识及影像学技术特别是MRI技术的进步,临床发现该病逐渐增多,近年来报道也越来越多。     

Hashimoto's thyroiditis and myoclonic encephalopathy. Pathogenic hypothesis

A 49 year old caucasian female with Hashimoto thyroiditis, developed during two years a neurological disorder with tonic-clonic and myoclonic seizures and confusional states. Some attacks were followed by a transient postictal aphasia. Some parallelism was noted between the clinical state and TSH levels. Neurological events disappeared with the normalisation of thyro?d functions. This association of Hashimoto thyroiditis and myoclonic encephalopathy has been rarely published. Pathogenesis could be double. Focal signs could be due to an auto-immune mechanism, perhaps through a vasculitis. A non-endocrine central action could explain diffuse signs: tonic-clonic seizures, myoclonus and confusional episodes.     

Clinical and electroencephalographical follow-up study of early myoclonic encephalopathy

We report a clinico-electroencephalographical follow-up study on a male patient with early myoclonic encephalopathy. Frequent massive and fragmentary myoclonic seizures, and myoclonic-clonic seizures were the initial symptoms at the age of 3 days. EEG revealed a suppression-burst pattern at the onset in which burst phases often coincided with myoclonic seizures. Subsequently, non-epileptic erratic myoclonus, various partial seizures and flexor spasms were observed. The partial seizures ceased at around 4 months of age, while the non-epileptic myoclonus and flexor spasms have persisted beyond the age of 6 months. The EEG pattern evolved into atypical hypsarhythmia at two months of age. No specific biochemical or neuroradiological findings were disclosed. His neuropsychiatric development was arrested from the onset. These observations suggest that early myoclonic encephalopathy is an independent epileptic syndrome and that it might be different from early-infantile epileptic encephalopathy described by Ohtahara.     

Posterior reversible encephalopathy syndrome revealing acute post-streptococcal glomerulonephritis

A case of acute encephalopathy with posterior corticosubcortical vasogenic edema on magnetic resonance imaging is reported. Angiography showed cerebral arterial vasospasm. A diagnosis of acute post-streptococcal glomerulonephritis was made 2 days after admission. This report highlights the fact that acute post-streptococcal glomerulonephritis can be revealed by a posterior reversible encephalopathy syndrome and that cerebral vasospasm can concur with vasogenic edema in this condition.     

Hypertensive encephalopathy as revealing symptom of Takayasu's arteritis

A 29-year-old patient presented with Takayasu's arteritis which was revealed by heart failure, epilepsy, right hemiparesis and fever. Transient abnormalities of MRI and CSF (raised protein and cell content) were initially observed. The hypothesis of a hypertensive encephalopathy is suggested.     

Early myoclonic encephalopathy, early infantile epileptic encephalopathy, and benign and severe infantile myoclonic epilepsies: a critical review and personal contributions

Nosological confusion within the epilepsies with myoclonic manifestations occurring in early life has led several epileptologists to separate more rigorously true myoclonic seizures from pseudomyoclonic ones and to identify clusters of homogeneous parameters that may lead to the formulation of syndromatic groupings. In recent years, four neonatal, infantile, and early myoclonic syndromes have been proposed: early myoclonic encephalopathy (EME), early infantile epileptic encephalopathy (EIEE), benign infantile myoclonic epilepsy (BIME), and severe infantile myoclonic epilepsy (SIME). These are reviewed critically, historically, and in the context of personal observations. The author's conclusions are that there is some justification to support, provisionally, a nosological place for the EME syndrome, that a nosologically separate position for the EIEE syndrome appears less firm, and that it seems safer to consider it at this time as an early variant of the West syndrome. From personal observations it appears that BIME and SIME, while justifiably constituting recognizable entities, may best be combined into a single syndrome of "infantile myoclonic epilepsy following febrile convulsions," with variable clinical outcomes.     

Reversible multifocal encephalopathy following tuberculous infection

Tuberculous encephalic infection is commonly reported as confined to Asians or Africans or people living in poor hygienic conditions; very often it follows meningitis in patients with lung TB infection. We describe three western patients coming from good social environment and suffering from multifocal tuberculous encephalopathy. Two of them showed neither meningitis or lung TB when CNS involvement appeared. Complete recovery after therapy is described, together with the evolution of brain CT and, in 1 case, MRI features. The instrumental findings accompanying the complete recovery suggest that the lesions described in these cases are a localized form of encephalitis responsive to medical treatment, unlike tuberculomas, which often need surgical treatment. The occurrence of tuberculous encephalic infection in western, middle-class patients with or without meningitis emphasizes that tuberculous encephalopathy must be considered in the differential diagnosis of multifocal brain lesions.

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Sommario L'infezione encefalica tubercolare è comunemente descritta come esclusiva di individui asiatici o africani, o di soggetti che vivono in scadenti condizioni igieniche; molto spesso essa segue la meningite nei pazienti con evidente tubercolosi polmonare. Vengono qui descritti tre casi di encefalopatia tubercolare multifocale in pazienti italiani di buona condizione socio-economica. Due di essi non mostravano né meningite né tubercolosi polmonare quando comparvero i segni di compromissione del S.N.C. In particolare viene descritto il completo recupero dopo terapia medica e vengono riportate le caratteristiche TAC e, in un caso, di Risonanza Magnetica Nucleare. I dati strumentali suggeriscono che questi casi rappresentano una forma localizzata di encefalite, sensibile al trattamento medico, a differenza dei tubercolomi che richiedono spesso il trattamento chirurgico. Il verificarsi di infezione encefalica tubercolare in pazienti occidentali di buon livello socio-economico suggerisce che la encefalopatia tubercolare deve rientrare nella diagnosi differenziale delle lesioni cerebrali multifocali.

     

Acute encephalopathy and myoclonic status induced by vigabatrin monotherapy]

Vigabatrin (VGB) is a new antiepileptic drug useful in refractOry partial seizures. Psychosis as a secondary effect of VGB is well known. This drug may even induce new epileptic seizures. We report a 69-year-old hypertensive patient with multiple cerebral infarcts. She was diagnosed as having late onset symptomatic partial epilepsy (complex partial seizures and generalized secondary motor partial seizures). She had been receiving VGB 3 g/day in monotherapy. She came to the emergency room in a psychotic state with new epileptic seizures. We performed an EEG and video during the ictal phase. The patient was awake, conscious and partially oriented. The video showed generalized myoclonic jerks involving facial and limb muscles, separated by non-convulsive intervals lasting three minutes. The EEG showed spike and wave discharges over a diffuse slow-wave background activity. The patient was conscious throughout the recording. The electroclinical picture was considered as an encephalopathy-associated generalized myoclonic status. VGB was replaced by phenytoin. Two weeks later, and after a clinical improvement, a new recording showed the disappearance of signs of encephalopathy and the myoclonic status. Epileptic seizures induced by VGB are well reported. Several pathogenic mechanisms have been suggested. In our case the myoclonic status was related to a non-dose dependent encephalopathy induced by VGB. The electroclinical improvement after withdrawal of the drug supports this possibility.     

Repetitive EEG recordings are necessary for the diagnosis of early myoclonic encephalopathy

Early myoclonic encephalopathy (EME) is a rare malignant epileptic syndrome. The erratic myoclonus with or without focal motor seizures, time of onset before 3 months of age, and suppression-burst (SB) pattern in EEG are accepted as the diagnostic criteria for EME. We report a 40-day-old infant with the diagnosis of non-ketotic hyperglycinemia (NKHG). The infant developed myoclonic and focal tonic seizures on the first day of life. His first sleep EEG recorded after onset of seizure was normal. Because of the diagnosis of NKHG and early developed myoclonic seizure, we thought the infant might be EME, and repeated sleep EEG on admission in which asymmetrical SB pattern was seen. We concluded that the absence of SB pattern in the first EEG recording does not exclude the diagnosis of EME, but repetition of EEG is necessary to demonstrate the presence of SB pattern to meet the diagnostic criteria for EME.