Sudden Onset Of Seizures Research Articles

Convexity dural arteriovenous fistula with Sylvian-Labbé collateral pattern: A case report.

Convexity dural arteriovenous fistula (dAVF) is associated with high-grade dAVF and is usually presented with aggressive clinical presentation. Precise diagnosis and understanding the pathogenesis are important to achieving successful treatment without complications. We report a case of dAVF with Sylvian-Labbé collateral pattern, concerning embryological development that was thought to be involved in the vascular architecture and pathogenesis of dural AVF. Thus, a 60-year-old man was presented with sudden onset of seizure with no history of trauma. Magnetic Resonance Imaging (MRI) showed cortical hemorrhage in the left precentral gyrus. Digital subtraction angiography (DSA) showed the convexity dural arteriovenous fistula (dAVF) involving a vein that appeared to be the vein of Labbé, the drainer was anastomosed with superior middle cerebral vein (SMCV) and formed the varix. With the successful treatment with trans-arterial embolization (TAE), obliteration of dAVF was achieved with no neurological deficits. This case highlights convexity dAVF with the complex relationship between embryological development and the arcade of venous drainage route, wherein the anomaly might be acquired and caused by elevated venous pressure in a vein that appeared to be the vein of Labbé. Gaining knowledge of the embryological basis may aid in a deeper understanding of acquired pathologies.

Conservative management of multiple pyogenic brain abscess from a rare hematogenous spread

This is a rare case of hematogenous spread of brain abscess in a young immunocompetent adult, who presented with an acute onset of symptoms of 1-week duration of headache and sudden onset of seizure. With the patient’s refusal for neurosurgical intervention, the choice for conservative management with aggressive antibiotics and close monitoring proved to be a viable alternative treatment.

Features of pregnancy management in epilepsy

Epilepsy is a chronic neurological disease that manifests itself in the body's predisposition to the sudden onset of seizures. The incidence of a combination of epilepsy and pregnancy in the general population does not exceed 1%. The features of the course of this disease against the background of pregnancy, the requirements for the choice of antiepileptic drugs during gestation and their possible effect on the fetus are presented in the article.

Case report: Oral antibiotics as conservative management of multiple pyogenic brain abscesses from a rare hematogenous spread

This is a rare case of hematogenous spread of brain abscess in a young immunocompetent adult, who presented with an acute onset of symptoms of one-week duration of headache and sudden onset of seizure. With the patient's refusal for neurosurgical intervention and staying in the hospital, the choice for conservative management with aggressive oral antibiotics and close monitoring proved to be a viable alternative treatment.

Dilemma of diagnosing sulphonylurea overdose in children: deliberations and considerations before reaching a diagnosis

A 15-year-old non-diabetic Caucasian girl presented with sudden onset of seizures, unrecordable blood glucose readings and acute renal failure. She denied any medication ingestion and no other precipitating factors were...

A case report: primary amoebic meningoencephalitis in a young Zambian adult

BackgroundPrimary amoebic meningoencephalitis (PAM) is a fulminant disease of the brain caused by Naegleria fowleri. Although the disease is rare, the case fatality rate is very high. In this report, we describe the first case of PAM in Zambia.Case presentationThe patient presented with sudden onset of seizures and fever on admission. On physical examination he was febrile, comatose and with a stiff neck. Cerebral spinal fluid (CSF) collected on admission did not reveal any organism on microscopy or culture but showed elevated white cell count. A working diagnosis of severe septicemia with acute meningoencephalitis was then made and the patient was started on IV Cephtriaxone (2 g) twice daily. Despite receiving treatment, his condition deteriorated. A second CSF sample collected on day 3 was also negative for bacteria and other organisms. However, a repeat CSF sample collected on day 8 revealed numerous motile organisms that were identified as Naegleria on microscopy and confirmed to be N. fowleri on polymerase chain reaction. The patient died on day 8 of hospital admission after having received one dose of Amphotericin B (50 mg). Features consistent with PAM were detected on autopsy.ConclusionThe isolation of N. fowleri in this patient calls for increased awareness among clinical and laboratory staff on suspected PAM cases to promptly diagnose and effectively manage the disease.

A case of acute Sheehan\u2019s syndrome and literature review: a rare but life-threatening complication of postpartum hemorrhage

BackgroundSheehan’s syndrome occurs because of severe postpartum hemorrhage causing ischemic pituitary necrosis. Sheehan’s syndrome is a well-known condition that is generally diagnosed several years postpartum. However, acute Sheehan’s syndrome is rare, and clinicians have little exposure to it. It can be life-threatening. There have been no reviews of acute Sheehan’s syndrome and no reports of successful pregnancies after acute Sheehan’s syndrome. We present such a case, and to understand this rare condition, we have reviewed and discussed the literature pertaining to it. An electronic search for acute Sheehan’s syndrome in the literature from January 1990 and May 2014 was performed.Case presentationA 27-year-old woman had massive postpartum hemorrhage (approximately 5000 mL) at her first delivery due to atonic bleeding. She was transfused and treated with uterine embolization, which successfully stopped the bleeding. The postpartum period was uncomplicated through day 7 following the hemorrhage. However, on day 8, the patient had sudden onset of seizures and subsequently became comatose. Laboratory results revealed hypothyroidism, hypoglycemia, hypoprolactinemia, and adrenal insufficiency. Thus, the patient was diagnosed with acute Sheehan’s syndrome. Following treatment with thyroxine and hydrocortisone, her condition improved, and she was discharged on day 24.Her next pregnancy was established 2 years after her first delivery. She required induction of ovulation for the next conception. The pregnancy, delivery, and postpartum period were uneventful. An electronic search of the literature yielded 21 cases of acute Sheehan’s syndrome. Presenting signs varied, including adrenal insufficiency (12 cases), diabetes insipidus (4 cases), hypothyroidism (2 cases), and panhypopituitarism (3 cases), with a median time of presentation after delivery for each of those conditions being 7.9, 4, 18, and 9 days, respectively. Serial changes in magnetic resonance imaging were reported in some cases of acute Sheehan’s syndrome.ConclusionClinicians should be aware of the risk of acute Sheehan’s syndrome after a massive postpartum hemorrhage in order to diagnose it accurately and treat it promptly.

Meningioma - a Cause of Sudden Death

Background: Sudden unexpected death of an apparently healthy individual is an expected event in the life of a forensic expert. Neurological causes account for only 15% of all sudden deaths of which deaths from an undiagnosed primary intracranial neoplasm is exceptionally rare. Meningioma is a common intracranial tumor and it is rarely associated with sudden, unexpected deaths.Case Report: We report one such case of sudden death in a 32-year old male with an olfactory meningioma without any prior history of neurological symptoms raising queries regarding the cause of death.Conclusion: This case illustrates the possibility of meningioma remaining silent till middle age and can present with sudden onset of seizures which may lead to fatality.

Cerebral Echinococcosis

: Echinococcus granulosus can produce hydatid cysts (HCs) commonly in liver and lung. Central nervous system HCs are rare and comprise 2 - 3%. We found a 25-year-old woman with a medium cerebral HC. She had a rare manifestation, sudden onset of seizure with no other clinical findings 2 hours before admission. Brain CT-scan showed a medium round hypodense lesion at left hemisphere. She had several cystic lesions in right lobe of liver. The cyst was successfully removed without rupture. Although brain HCs is seen mostly in boys, it should be considered in endemic regions, even in young patients with sudden seizure.

Olfactory Groove Meningioma Extension to Paranasal Sinus and Nasal Cavity: Combined Approach by Unilateral Subfrontal and Endoscopic Endonasal

The local extension of olfactory groove meningioma into the paranasal sinuses and nasal cavity eroding underlying bone in young patients is considered as an unusual and extremely rare event. We report the case of a 25-year-old female of primary growth of olfactory groove meningioma extension to left ethmoidal sinus and nasal cavity, presented with sudden onset of seizure after delivering a baby. Although olfactory groove meningioma can grow to extreme size with unnoticed symptoms, frequent nasal obstruction, unilateral headache and gradual loss of smell are described. Head image revealed large mass into the anterior cranial fossa extending into the paranasal sinus and left nasal cavity containing cancellous bone. Considering the possibility of postoperative morbidity and mortality, complete removal of large tumor and the dura tail that extends beyond its attachment at skull base becomes challenging. The combined unilateral subfrontal and endoscopic endonasal approach is applied to achieve the Simpson grade-I removal.

Hemorrhagic Recurrence in Diffuse Astrocytoma without Malignant Transformation.

Although uncommon, hemorrhage can be a complication of low grade glioma with an unfavorable prognosis such as transformation to higher grade glioma. To our knowledge, hemorrhagic recurrence of World Health Organization Grade II, diffuse astrocytoma without malignant transformation has not been reported. Thus, we report a case of diffuse astrocytoma with hemorrhagic recurrence without malignant transformation. The patient had undergone craniotomy and tumor removal 7 years previously. Annual follow-up MRIs had shown evidence of slow tumor recurrence. With the sudden onset of seizure, the patient was diagnosed as hemorrhagic recurrence and underwent second tumor removal highly suspecting malignant change into higher grade glioma. Histopathology confirmed diffuse astrocytoma without malignant changes. As the patient's postoperative condition was excellent, we plan to withhold chemotherapy and radiation therapy for use as a later treatment option.

Neuronavigation-guided endoscopic and hodotopic approach to an arachnoid cyst

Background:Arachnoid cysts are intraarachnoid benign cystic lesions filled with cerebrospinal fluid and should be treated without incurring further morbidity to the patients.Case Description:The authors present a case of a 68-year-old elderly female with a large right fronto-parieto-temporal arachnoid cyst who has been suffering from mild left hemiparesis for the past 4 years and presented with sudden onset of seizures. The 3 Tesla MR system with diffusion tensor imaging (DTI) and MR tractography of the brain showed a large right fronto-parieto-temporal cystic lesion measuring 7 × 5 × 5 cm with a midline shift of 1 cm, suggestive of an arachnoid cyst with surrounding ipsilateral white matter projection pathways and inferior occipito-frontal fasciculus or inferior longitudinal white matter tracts. The cyst was successfully treated with neuronavigation-guided endoscopic and hodotopical approach to fenestrate the arachnoid cyst into the sylvian cistern, avoiding inadvertent injury to major white matter tracts portrayed by DTI. Postoperatively, a repeated computed tomography (CT) scan of the brain revealed a smaller arachnoid cyst with correction of the midline shift. The patient was weaned off from the ventilator and her hemiplegia improved gradually.Conclusion:This case report emphasizes the value of neuronavigation-guided endoscopic and hodotopic approach to fenestrate the intra-axial arachnoid cyst.

Blood-fluid level in cortical venous thrombosis—a rare diagnostic entity

Background With improvement in imaging, CVT is being diagnosed more frequently. Early diagnosis and rapid institution of remedial measures such as anticoagulation, anticonvulsants, hydration, and treatment of underlying abnormality will aid in salvaging life. Case Description We report an autopsy case of a 34-year-old man who presented with sudden onset of seizures, followed by right hemiplegia and altered sensorium. Magnetic resonance imaging of the brain revealed intraparenchymal hemorrhage in the left posterior frontal region with a blood-fluid level. The SSS was devoid of the routine hypointense signal intensity. Routine evaluations for hypercoagulable states were negative. All the coagulation parameters were within normal limits. He was managed conservatively with anticonvulsants, anticoagulants, and hydration. A CT scan of the brain done 24 hours later revealed left posterior frontal hemorrhage with perilesional edema. A CT venogram confirmed the presence of CVT involving the SSS and the right transverse sinus. However he died within next 24 hours. An autopsy confirmed thrombosis in the SSS, right transverse sinus, lungs, and kidneys. Conclusions Blood-fluid level in CVT may be an early radiologic sign in the absence of any other imaging abnormality. The presence of this sign in the early stages warrants an aggressive treatment because this probably suggests a large bleed with raised capillary and venous pressures. The case is discussed in view of the unusual radiologic sign in CVT in the absence of anticoagulant therapy.

Hypertensive encephalopathy and reversible magnetic resonance imaging changes in a renal transplant patient

An 18-year-old renal transplant patient presented with sudden onset of seizures almost 2 years after she received the graft. Diagnostic work-up was unrevealing except for magnetic resonance imaging abnormalities of the brain that resolved spontaneously 4 weeks later. In this brief report, we discuss the etiology of the seizures and neurological abnormalities in renal transplant patients in light of the findings of our patient.

Clinical and neuropsychological results after operative and conservative treatment of arachnoidal cysts of the perisylvian region.

Most supratentorial arachnoid cysts are found in the perisylvian region. They are thin extracerebral fluid filled pouches and occasionally symptoms are caused by space occupation. We have studied 28 cases with these cysts, with follow-up time varying from one to ten years. 8 of the cases presented with a sudden onset of seizures, while 5 cases had a history of seizures dating from childhood. 14 cases underwent surgery, of whom most had histological evidence of previous haemorrhage and some had evidence of subdural haematoma. Surgery was uneventful in all cases regardless of the method used and all had satisfactory outcome. All 28 cases were followed up systematically including intelligence testing and specific testing of memory and other temporal lobe functions. The group scored normal in standardized tests with a distribution similar to the normal population. Results did not show any deficit of function related to the localization of the cyst. Despite of the severity of their initial symptoms, postoperative cases performed just as well at psychological testing. Those cases who continued to experience seizures showed a memory disturbance and seemed to lack initiative. Most cases studied had normal error scores in the dichotic listening examinations. There was no connection between the side of the cyst and a unilateral deficit. The results are discussed.