Partial motor status epilepticus as a clinical manifestation of carotid stenosis.

Renée Ribacoba,Vanessa De La Vega,Javier Salas-Puig,Manuel Menéndez-González,Sergio Calleja

doi:10.1186/1755-7682-3-18

Abstract

Limb shaking (LS) is often confused with focal motor seizures. Distinguishing between both is crucial, because LS may represent an indicator of severe carotid occlusive disease and patients are at high risk of stroke. We report the case of a patient with occlusive carotid stenosis without definite stroke who develops partial motor status epilepticus (SE). Clinical, neuroimaging and electroencephalographic findings are provided. We conclude that focal motor seizures should be distinguished from LS based on clinical and electroencephalographic findings.

Highlights

Since Miller Fischer described limb shaking (LS) in 1962 as a rare clinical manifestation of severe stenosis carotid in humans with transitory ischemic attack (TIA) [1] this diagnosis has been reported regularly [2]
In the following report we present a case of partial motor status epilepticus with preocclusive carotid stenosis without stroke that responded to treatment with antiepileptic drugs
Authors explain this finding suggests that the hyperkinetic movements may be associated with a hyperfunction of cortical neurons rather than a direct cortical suppression because cerebral blood flow is coupled to neuronal activity in most physiologic and pathologic conditions

Summary

Introduction

Since Miller Fischer described limb shaking (LS) in 1962 as a rare clinical manifestation of severe stenosis carotid in humans with transitory ischemic attack (TIA) [1] this diagnosis has been reported regularly [2]. In rat models of middle cerebral artery occlusion with cerebral infarction periodic lateralized epileptiform discharges (PLEDs) occurred ipsilateral to the lesion within the first 72-hour period (ischemic and reperfusion) in most of the animals tested [3]. LS is often confused with focal motor seizures. Distinguishing between both is crucial, because LS may represent an indicator of severe carotid occlusive disease and patients are at high risk of stroke [4]. The clinical features of LS are rhythmic or arrhythmic involuntary hyperkinesias affecting the hand, arm, leg, hand-arm, or hand-arm-leg unilaterally. The frequency is variable from isolated episodes to several episodes a day, lasting for seconds or minutes

Results

Discussion

Conclusion