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Agyeman WY, Seffah K, Seedarnee C, Addo B. Masquerading bundle branch block: an often missed electrophysiological event. BMJ Case Rep 2023; 16:e254953. [PMID: 38154871 PMCID: PMC10759045 DOI: 10.1136/bcr-2023-254953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 12/30/2023] Open
Abstract
Masquerading bundle branch block is an easily overlooked pattern on the ECG that indicates severe disease of the atrioventricular nodal conduction pathway. It is often caused by coronary artery disease, infiltrative diseases of the heart and idiopathic degeneration of the atrioventricular nodal conduction pathways. The diagnosis is easily missed as it needs a detailed interpretation of the ECG in addition to the clinical presentation of the patient. The presence of this specific bundle branch block pattern on the ECG indicates severe degeneration of the conduction system requiring intervention. Given its rarity, this clinical entity risks misdiagnosis and inappropriate management. This case highlights two diagnostic challenges for clinicians: the rarely described masquerading bundle branch block and the art of clinically differentiating between epilepsy and convulsive syncope.
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Affiliation(s)
- Walter Y Agyeman
- Piedmont Athens Regional Internal Medicine Residency Program, Athens, Georgia, USA
| | - Kofi Seffah
- Piedmont Athens Regional Internal Medicine Residency Program, Athens, Georgia, USA
| | - Christian Seedarnee
- Piedmont Athens Regional Internal Medicine Residency Program, Athens, Georgia, USA
| | - Basilio Addo
- Graduate Medical Education, Piedmont Athens Regional Internal Medicine Residency Program, Athens, Georgia, USA
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Lin L, Zhang Y, Zeng Q, Lin L, Geng X, Wang S. Atherosclerosis, inflammatory factor changes, cognitive disorder and vascular endothelial functions in patients with different grades of leukoaraiosis. Clin Hemorheol Microcirc 2020; 73:591-597. [PMID: 31306114 DOI: 10.3233/ch-190597] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To study the atherosclerosis (AS), inflammatory factor level, cognitive disorder and vascular endothelial functions in patients with different grades of leukoaraiosis (LA), and to explore the correlations of different grades of LA with cognitive disorder. METHODS A total of 180 patients with cerebral infarction admitted and treated in the Department of Neurology of our hospital were selected, and they were graded according to the Tarvonen-shcolder standard, with 45 patients in each group. The atherosclerotic plaques of the patients were detected via a color Doppler ultrasound system and magnetic resonance imaging (MRI). Their inflammatory factor levels were determined using enzyme-linked immunosorbent assay (ELISA). The cognitive function was scored based on the mini-mental state examination (MMSE), and the levels of malondialdehyde (MDA), superoxide dismutase (SOD), endothelin (ET) and nitric oxide (NO) were measured to evaluate vascular endothelial functions. RESULTS According to the comparisons among four groups of the patients, the incidence rate of AS was gradually increased among patients with different grades of LA (p < 0.05). With the aggravation of LA, the levels of inflammatory factors in patients were obviously increased (p < 0.05). LA patients had evidently lowered MMSE scores and levels of SOD and NO, but notably raised inflammatory factors C-reactive protein (CRP) and matrix metalloproteinase-9 (MMP-9) and vascular endothelial function indices MDA and ET (p < 0.05). CONCLUSION The occurrence of LA is implicated with the increasing levels of inflammatory factors in the patients, aggregation of cognitive dysfunction and impairment vascular endothelial functions.
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Affiliation(s)
- Lirong Lin
- Department of Neurology, Inner Mongolia Baogang Hospital, Baotou, Inner Mongolia, China
| | - Yaxuan Zhang
- Department of Neurosurgery, Inner Mongolia Baogang Hospital, Baotou, Inner Mongolia, China
| | - Qingxin Zeng
- Department of Neurology, Inner Mongolia Baogang Hospital, Baotou, Inner Mongolia, China
| | - Ligong Lin
- Department of Hand and Ankle Surgery, Inner Mongolia Baogang Hospital, Baotou, Inner Mongolia, China
| | - Xiaoli Geng
- Department of Obstetrics and Gynecology, Inner Mongolia Baogang Hospital, Baotou, Inner Mongolia, China
| | - Shaobin Wang
- Department of Neurology, Inner Mongolia Baogang Hospital, Baotou, Inner Mongolia, China
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Arabi M, Dirani M, Hourani R, Nasreddine W, Wazne J, Atweh S, Samara H, Shatila AR, Beydoun A. Frequency and Stratification of Epileptogenic Lesions in Elderly With New Onset Seizures. Front Neurol 2018; 9:995. [PMID: 30559705 PMCID: PMC6284348 DOI: 10.3389/fneur.2018.00995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/05/2018] [Indexed: 12/04/2022] Open
Abstract
Objective: To evaluate prospectively the frequency of epileptogenic lesions in a consecutive cohort of elderly patients presenting with new onset unprovoked seizures, and who underwent a complete evaluation including dedicated epilepsy protocol MRI. Methods and materials: We included all consecutive patients 60 years or older who participated in a prospective study on new onset epilepsy. The work-up included the acquisition of a dedicated epilepsy protocol MRI and a 3 h video/EEG recording. We evaluated the frequency and types of epileptogenic lesions in the whole cohort and stratified those variables by age, gender, types and number of seizures at presentation. We also correlated the EEG findings with the clinical characteristics and neuroimaging results. Results: Of the 101 patients enrolled in the study and who underwent an epilepsy protocol MRI, an epileptogenic lesion was identified in 67% of cases. The most common etiologies were vascular events, followed by tumoral causes and traumatic brain injuries. Epileptogenic lesions were more likely to be identified in patients who presented with only focal aware and impaired awareness seizures. In addition, patients with tumoral epilepsy were significantly more likely to only experience those seizure types compared to patients with other pathological substrates. Interictal/ictal discharges were detected in the EEG of 21% of patients. Epileptiform discharges were significantly more frequent in patients with an epileptogenic lesion on brain MRI, especially in those with a brain tumor. Conclusions: Our results stress the importance of obtaining a dedicated epilepsy protocol MRI in elderly patients with new onset seizures. An epileptogenic lesion will be identified in approximately two thirds of patients with important implications regarding initiation of treatment. In addition, the data underscore the value of distinguishing the types of seizures experienced at presentation as this will apprise the treating physician on the likelihood of identifying an epileptogenic lesion and on the probable etiologies.
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Affiliation(s)
| | - Maya Dirani
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Roula Hourani
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Jaafar Wazne
- Rafik Hariri University Hospital, Beirut, Lebanon
| | - Samir Atweh
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Heba Samara
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Ahmad Beydoun
- American University of Beirut Medical Center, Beirut, Lebanon
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Izutsu N, Fujimoto Y, Yamada N, Kajikawa R, Yoshimura K, Nagashima M, Wakayama A, Yoshimine T. Small Hyperintensities in the Area of the Perforating Arteries in Patients with Seizure. Eur Neurol 2018; 79:221-227. [DOI: 10.1159/000488673] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/20/2018] [Indexed: 11/19/2022]
Abstract
Background/Aim: We previously observed spotty hyperintense lesions in the region of the perforating arteries on peri-ictal diffusion-weighted imaging (DWI); however, no report has formally described these findings. The aim of this study was to investigate focal intensities on peri-ictal DWI, and to evaluate the clinical significance of these lesions. Methods: We conducted a retrospective review of 677 consecutive patients with seizure who completed peri-ictal DWI within 24 h after seizure onset. Patients were grouped according to the presence or absence of diffusion hyperintense lesions (DHLs) in the region of the perforating arteries. We compared clinical and imaging characteristics between these 2 groups. Results: Among 677 patients, 23 patients (3.4%) had DHLs. Analyses of apparent diffusion coefficient values and fluid attenuated inversion recovery images suggested that DHLs were acute or subacute ischemic lesions that had appeared prior to seizure onset. Patients with DHLs were more likely to be older in age, have atrial fibrillation, and coronary artery disease, and have more severe deep white matter hyperintensity or leukoaraiosis compared to patients without DHLs. Conclusion: DHLs detected on peri-ictal DWI may represent incidental acute cerebral microinfarcts in the aging brain, especially in patients with small vessel disease.
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Verma A, Kumar A. Clinical and etiological profile of epilepsy in elderly: a hospital-based study from rural India. Acta Neurol Belg 2017; 117:139-144. [PMID: 27878560 DOI: 10.1007/s13760-016-0719-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 10/29/2016] [Indexed: 11/25/2022]
Abstract
To determine the clinical profile and etiology of epilepsy in elderly patients in rural population of India which is in a phase of demographic transition with steadily growing geriatric population. A cross-sectional, prospective, hospital-based clinicoepidemiological study was performed from October 2014 to November 2015. Patients having onset of epilepsy after 60 years were incorporated in the study. We excluded the acute symptomatic seizures. One hundred and ten patients were enrolled and were divided into three standard subgroups: subgroup A (aged 60-70), subgroup B (aged 71-80), and subgroup C (aged 81-90). Out of 110 patients, 72 (65.45%) were male and 38 (34.54%) were female. The most common etiology was cerebrovascular disease (46.36%), followed by focal cerebral calcifications single or multiple (11.81%), tumors (9.09%), trauma (6.36%) dementias (6.36%) and unknown (16.63%). In our study, the frequency of epilepsy decreases with advancing age which was 77.27% in group A (less than 70 years), 16.36% in group B and 6.36% in group C (70-90 years).The most common type of seizure in the group studied was focal 59.09% followed by generalized seizures 37.27%. Hypertension was the most common co-morbidity found in 40 (36.36%) patients. The present study proposes that epilepsy in the elderly patients have etiological relationship with stroke, focal cerebral calcifications, tumors and dementias. CNS infections account for a significant number of cases of remote symptomatic epilepsy in elderly in our region where neurocysticercosis is endemic.
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Affiliation(s)
- Archana Verma
- Department of Neurology, UP Rural Institute of Medical Sciences and Research, Saifai, Etawah, Uttar Pradesh, 206301, India.
| | - Alok Kumar
- Forensic Medicine and Toxicology, UP RIMS & R, Saifai, Etawah, Uttar Pradesh, 206130, India
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Hanby MF, Al-Bachari S, Makin F, Vidyasagar R, Parkes LM, Emsley HCA. Structural and physiological MRI correlates of occult cerebrovascular disease in late-onset epilepsy. NEUROIMAGE-CLINICAL 2015; 9:128-33. [PMID: 26413475 PMCID: PMC4556750 DOI: 10.1016/j.nicl.2015.07.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Late-onset epilepsy (LOE), with onset after 50 years of age, is often attributed to underlying occult cerebrovascular disease. LOE is associated with a three-fold increase in subsequent stroke risk, therefore it is important to improve our understanding of pathophysiology. In this exploratory study, we aimed to determine whether established structural magnetic resonance imaging markers and novel physiological imaging markers of occult cerebrovascular disease were more common in patients with LOE than age-matched controls. Sixteen patients with LOE (mean age ± SD: 67.6 ± 6.5 years) and 15 age-matched control subjects (mean age: 65.1 ± 3.9 years) underwent a 3 T MRI scan protocol. T1-weighted images and T2-weighted fluid attenuated inversion recovery (FLAIR) images were used to determine cortical grey matter volume and white matter hyperintensity (WMH) volume respectively, whilst multiple delay time arterial spin labelling (ASL) images were collected at rest and during a hypercapnic challenge. Cerebral blood flow (CBF) and arterial arrival time (AAT) were calculated from ASL data under both normocapnic and hypercapnic conditions. Cerebrovascular reactivity was also calculated for both CBF and AAT relative to the change in end-tidal CO2. Patients with LOE were found to have significantly lower cortical volume than control subjects (33.8 ± 3.8% of intracranial volume vs. 38.0 ± 5.5%, p = 0.02) and significantly higher WMH volume (1339 ± 1408 mm3 vs. 514 ± 481 mm3, p = 0.047). Baseline whole brain AAT was found to be significantly prolonged in patients with LOE in comparison to control subjects (1539 ± 129 ms vs. 1363 ± 167 ms, p = 0.005). Voxel-based analysis showed the significant prolongation of AAT to be predominantly distributed in the frontal and temporal lobes. Voxel-based morphometry showed the lower cortical volume to be localised primarily to temporal lobes. No significant differences in CBF or cerebrovascular reactivity were found between the two groups. Baseline whole brain AAT and cortical volume differences persisted upon further analysis to take account of differences in smoking history between patients and control subjects. These findings suggest that occult cerebrovascular disease is relevant to the pathophysiology of LOE. LOE patients were found to have increased WMHs and reduced GM volume on MRI imaging in comparison to HC. Baseline arterial arrival time was significantly longer in LOE patients than HC. Baseline cerebral blood flow did not differ between LOE patients and HC. Cerebrovascular reactivity did not differ between LOE patients and HC.
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Key Words
- AAT, arterial arrival time
- ASL, arterial spin labelling
- Arterial spin labelling
- CBF, cerebral blood flow
- CT, computerised tomography
- CVD, cerebrovascular disease
- CVR, cerebrovascular reactivity
- Cerebral blood flow
- Cerebrovascular disease
- EEG, electroencephalogram
- ETCO2, end-tidal CO2
- FLAIR, fluid attenuated inversion recovery image
- FWHM, full width half maximum
- GM, grey matter
- ICV, intracranial volume
- LOE, late-onset epilepsy
- Late-onset epilepsy
- MRI, magnetic resonance imaging
- MoCA, Montreal cognitive assessment
- SVD, small vessel disease
- Seizures
- VBA, voxel-based analysis
- VBM, voxel-based morphometry.
- Voxel-based morphometry
- WMH, white matter hyperintensity
- oCVD, occult cerebrovascular disease
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Affiliation(s)
- Martha F Hanby
- Centre for Imaging Science, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK ; Department of Neurology, Royal Preston Hospital, Preston, UK
| | - Sarah Al-Bachari
- Centre for Imaging Science, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Fadiyah Makin
- Centre for Imaging Science, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Rishma Vidyasagar
- Centre for Imaging Science, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Laura M Parkes
- Centre for Imaging Science, Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Hedley C A Emsley
- Department of Neurology, Royal Preston Hospital, Preston, UK ; Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
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Lanza G, Papotto M, Pennisi G, Bella R, Ferri R. Epileptic seizure as a precipitating factor of vascular progressive supranuclear palsy: a case report. J Stroke Cerebrovasc Dis 2014; 23:e379-81. [PMID: 24656241 DOI: 10.1016/j.jstrokecerebrovasdis.2013.12.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/22/2013] [Accepted: 12/29/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vascular progressive supranuclear palsy (vPSP) is an uncommon akinetic-rigid syndrome characterized by asymmetric lower body involvement, predominant corticospinal and pseudobulbar signs, urinary incontinence, cognitive impairment, and increased frequency of stroke risk factors, together with neuroimaging evidence of vascular disease. CASE REPORT We report a case of a patient with a PSP-like phenotype and marked cognitive impairment who significantly worsened after a generalized epileptic seizure that occurred a few months after its clinical onset. RESULTS Signs of widespread ischemic subcortical vascular disease, together with atrophy of the midbrain tectum, corpus callosum, and cerebral cortex, were evident on brain magnetic resonance imaging. CONCLUSIONS vPSP is a condition that should be considered when a patient presents with a gradually progressive clinical picture suggestive of idiopathic PSP associated with neuroimaging evidence of cerebrovascular disease. The occurrence of epileptic seizures has not been reported before in vPSP but they might trigger the onset or precipitate the course of the PSP-like disorders.
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Affiliation(s)
- Giuseppe Lanza
- Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina (EN), Italy.
| | - Maurizio Papotto
- Department of Neurorehabilitation, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina (EN), Italy
| | - Giovanni Pennisi
- Department of Neurosciences, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Neurosciences, University of Catania, Catania, Italy
| | - Raffaele Ferri
- Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina (EN), Italy
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Gibson LM, Hanby MF, Al-Bachari SM, Parkes LM, Allan SM, Emsley HCA. Late-onset epilepsy and occult cerebrovascular disease. J Cereb Blood Flow Metab 2014; 34:564-70. [PMID: 24517978 PMCID: PMC3982095 DOI: 10.1038/jcbfm.2014.25] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 01/13/2014] [Indexed: 11/09/2022]
Abstract
The interface between cerebrovascular disease (CVD) and epilepsy is complex and multifaceted. Late-onset epilepsy (LOE) is increasingly common and is often attributed to CVD, and is indeed associated with an increased risk of stroke. This relationship is easily recognizable where there is a history of stroke, particularly involving the cerebral cortex. However, the relationship with otherwise occult, subcortical CVD is currently less well established yet causality is often invoked. In this review, we consider the diagnosis of LOE in clinical practice--including its behaviour as a potential mimic of acute ischemic stroke and transient ischemic attack; evidence for an association between occult CVD and LOE; and potential mechanisms of epileptogenesis in occult CVD, including potential interrelationships between disordered cerebral metabolism and perfusion, disrupted neurovascular unit integrity, blood-brain barrier dysfunction, and inflammation. We also discuss recently recognized issues concerning antiepileptic drug treatment and vascular risk and consider a variety of less common CVD entities associated with seizures.
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Affiliation(s)
- Lorna M Gibson
- Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | | | - Sarah M Al-Bachari
- 1] Department of Neurology, Royal Preston Hospital, Preston, UK [2] University of Manchester, Manchester, UK
| | - Laura M Parkes
- Biomedical Imaging Institute, University of Manchester, Manchester, UK
| | - Stuart M Allan
- Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - Hedley C A Emsley
- 1] Department of Neurology, Royal Preston Hospital, Preston, UK [2] School of Medicine, University of Manchester, Manchester, UK
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Brigo F, Tezzon F, Nardone R. Late-onset seizures and risk of subsequent stroke: a systematic review. Epilepsy Behav 2014; 31:9-12. [PMID: 24291522 DOI: 10.1016/j.yebeh.2013.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 10/29/2013] [Accepted: 11/03/2013] [Indexed: 11/25/2022]
Abstract
Otherwise unexplained late-onset seizures, conventionally defined as epileptic seizures occurring in subjects older than 60years and in the absence of disorders known to increase the risk of developing epilepsy, have been assumed to be, in most cases, of cerebrovascular origin. We systematically searched the literature to identify the evidence supporting the association between otherwise unexplained late-onset seizures/epilepsy and the risk of subsequent stroke. Most data from the literature indicate that cerebrovascular disease often underlies otherwise unexplained late-onset seizures/epilepsy. Patients presenting with seizures occurring for the very first time in late life and without clinically overt cerebrovascular disease should be considered as at increased risk of stroke. Consequently, these patients should be screened for the presence of vascular risk factors and treated accordingly. Such measures may greatly contribute to prevent strokes in these patients.
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Affiliation(s)
- Francesco Brigo
- Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy; Division of Neurology, Franz Tappeiner Hospital, Merano, Italy.
| | - Frediano Tezzon
- Division of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Raffaele Nardone
- Division of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
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De Reuck J, Sieben A, Van Maele G. Characteristics and outcomes of patients with seizures according to the time of onset in relation to stroke. Eur Neurol 2008; 59:225-8. [PMID: 18264010 DOI: 10.1159/000115635] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2006] [Accepted: 07/12/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM Although most late-onset seizures (LS) appear within 2 years after stroke, some of them occur later and their characteristics are unknown. The aim of this study was to compare the characteristics of patients with very-late-onset seizures (VLS) to those with early-onset seizures (ES) and those with LS. PATIENTS The study group consisted of 204 patients with stroke-related seizures (29 ES, 128 LS and 47 VLS). RESULTS Intracranial haemorrhage was a more frequent cause of ES than of LS and no cause at all of VLS. On the other hand, 25% of the VLS were related to lacunar strokes. Status epilepticus occurred in 20.7% of the ES, in 11.7% of the LS and in 2.1% of the VLS patients. Seizure recurrences were 13.8% in the ES, 54.7% in the LS and 34.0% in the VLS group. Neurological impairment, at stroke onset, and the degree of disability were more severe in patients with ES compared to those with LS and were very mild in the VLS group. The EEG findings as a whole did not show significant differences between the three groups, although a normal EEG was more frequent in the VLS group. CONCLUSION VLS occur in patients with minor ischaemic strokes with good recovery and benign disease course.
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Affiliation(s)
- J De Reuck
- Department of Neurology, University Hospital, Ghent, Belgium.
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De Reuck J, Nagy E, Van Maele G. Seizures and epilepsy in patients with lacunar strokes. J Neurol Sci 2007; 263:75-8. [PMID: 17610904 DOI: 10.1016/j.jns.2007.06.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 05/29/2007] [Accepted: 06/08/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND The relation between seizures and small subcortical infarcts is uncertain. The present retrospective study investigates whether differences are observed between patients with and without seizures following a lacunar stroke. PATIENTS AND METHODS Thirty-seven patients with seizures and a prior history of a lacunar stroke were admitted to the Ghent University Hospital during 2000 and 2005. They were compared to 205 patients, admitted between 2002 and 2004, with an acute lacunar stroke and without epileptic spells on follow-up. Nine out of the 37 patients with seizures and 48 out of the 205 without seizures had a history of recurrent strokes. RESULTS No differences in vascular risk factors, distribution and frequency of the lacunes, degree of severity of the white matter changes and outcome were observed. On the Mini-Mental State Examination moderate to severe cognitive disturbances were observed in the seizure group and in some patients of the non-seizure group. CONCLUSIONS In the present study we found no evidence that seizures are directly induced by lacunar infarcts. The seizures appear to be part of a more global ongoing cerebral disorder probably leading to cognitive impairment.
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Affiliation(s)
- J De Reuck
- Stroke Unit, Department of Neurology, University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
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De Reuck J, De Clerck M, Van Maele G. Vascular cognitive impairment in patients with late-onset seizures after an ischemic stroke. Clin Neurol Neurosurg 2005; 108:632-7. [PMID: 16316720 DOI: 10.1016/j.clineuro.2005.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Revised: 10/10/2005] [Accepted: 10/15/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive impairment and seizures are both common conditions in patients with cerebrovascular disease. PURPOSE The present study investigates whether the occurrence of late-onset seizures, following an ischemic stroke, contributes to vascular cognitive impairment. PATIENTS AND METHODS The mean Mini-Mental State Examination (MMSE) and the median modified Rankin (mR) scores were compared between 125 patients who developed late-onset seizures (66 with a single seizure and 59 with repeated seizures or epilepsy) following an ischemic stroke and 125 patients who did not during, at least, a 2-year follow-up. RESULTS There were no differences in age, gender, etiology and degree of neurological impairment on admission for their stroke between the groups with and without seizures. Although the mean MMSE score was similar between both groups the median mR score was significantly higher in the seizure patients. Comparing the patients with a single seizure to the non-seizure ones showed the same results. On the other hand, comparison of the patients with epilepsy to the non-seizure group revealed, in addition to the higher median mR score, a significantly lower mean MMSE score in the former group. CONCLUSION Repeated seizures following an ischemic stroke promote vascular cognitive impairment.
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Affiliation(s)
- Jacques De Reuck
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
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De Reuck J, Vonck K, Santens P, Boon P, De Bleecker J, Strijckmans K, Lemahieu I. Cobalt-55 positron emission tomography in late-onset epileptic seizures after thrombo-embolic middle cerebral artery infarction. J Neurol Sci 2000; 181:13-8. [PMID: 11099706 DOI: 10.1016/s0022-510x(00)00382-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The pathogenesis of late-onset epileptic seizures after thrombo-embolic cerebral infarction is poorly understood. Our previous positron emission tomographic (PET) studies with 15O have demonstrated that post-apoplectic epilepsy is associated with more severe brain ischemia, but we were unable to determine if this was the cause or the consequence of the seizures. Using cobalt-55 (55Co) as PET tracer we can now distinguish recurrent, recent infarction in patients with a previous old infarct in the same vascular territory. In seven out of twelve patients with post-apoplectic seizures an increased uptake of 55Co was observed in the border area and in two of them also within the old infarct core. In the control group, composed of eight seizure-free patients with also an old infarct involving the cortical territory of the middle cerebral artery, no increase in 55Co uptake was observed on PET examination. The present study indicates that in a significant number of patients late-onset epilepsy is the clinical expression of recurrent strokes, occurring in the same vascular territory.
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Affiliation(s)
- J De Reuck
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
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Abstract
OBJECTIVES To determine the profile of late epileptic seizures following cerebral infarcts and the predictive clinical and radiological factors associated with their development. METHODS We compared 86 patients who developed late seizures after cerebral infarction with 285 similar patients who did not develop seizures for at least 1 year after their stroke. Patients who had seizures only at the onset of the stroke were excluded. Odds' ratios were used for statistical analysis. RESULTS Simple partial, and mainly motor seizures, with or without secondary generalization, accounted for 80% of the classifiable seizures but it was not possible to determine the seizure type in half of the cases. Factors that appeared to be predictive of seizure development were the presence of large cortical infarcts and the presence of apparently preserved cerebral tissue within the infarcted area. Seizures were rare in patients with lacunar infarction but the presence of associated leukoaraiosis increased the risk. The risk was also increased in patients with other medical problems known to lower seizure threshold, such as renal failure.
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Affiliation(s)
- A Awada
- Neurology Section, King Fahd National Guard Hospital, Riyadh, Saudi Arabia
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Hesdorffer DC, Hauser WA, Annegers JF, Rocca WA. Severe, uncontrolled hypertension and adult-onset seizures: a case-control study in Rochester, Minnesota. Epilepsia 1996; 37:736-41. [PMID: 8764811 DOI: 10.1111/j.1528-1157.1996.tb00644.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Hypertension is an established risk factor for clinically detected stroke, which is in turn a risk factor for epilepsy. This relation suggested that hypertension, particularly severe and uncontrolled, might increase the risk of epilepsy in the absence of prior clinically detected stroke. METHODS Subjects in this population-based case-control study were the 145 incident cases of first unprovoked seizure aged 55 years or older and 290 controls matched to cases on age, gender, and duration of medical follow-up. Using the records-linkage system of the Rochester Epidemiology Project, we obtained, for both cases and matched controls, all blood pressure readings before each case's first seizure came to medical attention. Subjects were classified as hypertensive if they had at least two readings of > or = 160/95 mm Hg or if there was electrocardiographic evidence for left ventricular hypertrophy. RESULTS Severe uncontrolled hypertension increased the risk of unprovoked seizure. Left ventricular hypertrophy without diuretic treatment was associated with an 11-fold increased risk of unprovoked seizure: left ventricular hypertrophy treated with diuretics did not increase the risk. CONCLUSIONS In the absence of clinically detected stroke, left ventricular hypertrophy without diuretic use may increase the risk of unprovoked seizures, and diuretic treatment may protect against this increased risk.
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Affiliation(s)
- D C Hesdorffer
- G. H. Sergievsky Center, Columbia University, New York, NY 10032, USA
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