Neurologist
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Review
Neuroendocrine hormonal conditions in epilepsy: relationship to reproductive and sexual functions.
Hormones may influence susceptibility to develop seizures. The concept of the interrelation between epilepsy, hormones, and hormonotherapy is currently emerging. On the other hand, epilepsy and its medications are associated with hormonal disturbances resulting in altered endocrine reproduction and sexual functions. ⋯ Epileptic patients will benefit from regular monitoring of ovarian and testicular functions. Early characterization of reproductive abnormalities encountered in patients with epilepsy will allow neurologists to properly choose and change antiepileptic medications. This will also improve patients' sexual function.
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An isolated prolonged episode of transient amnesia can be a major manifestation of transient global amnesia (TGA) and transient epileptic amnesia (TEA). We report a case of transient amnesia associated with a left temporal tumor and try to elucidate the possible mechanism of the amnesia. ⋯ This case serves to emphasize that transient dense anterograde amnesia resembling TGA might possibly occur as a manifestation of TEA and that there is a risk of subsequent epileptic features. The amnesia in this case also supports the hypothesis of spreading depression in patients with TGA and migraine and could support the epileptic hypothesis for the pathogenesis of TGA.
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Review Case Reports
Adjunctive haloperidol prophylaxis reduces postoperative delirium severity and duration in at-risk elderly patients.
Delirium is a potentially life-threatening syndrome that is particularly common in elderly hospitalized patients, especially those with preexisting neurologic disorders. Nonpharmacological tactics can reduce the incidence and severity of delirium in acute care settings and antipsychotic drugs are widely used to treat established delirium. More effective preventive strategies could notably impact morbidity, mortality, and health care costs. ⋯ Adjunctive low-dose haloperidol prophylaxis reduces delirium severity, duration, and subsequent hospitalization length in elderly at-risk patients. Further study is needed to determine the optimal pharmacological approach, combination with nonpharmacological strategies, and generalizability to other settings.
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Papillary fibroelastoma is the most common primary cardiac valvular tumor. Historically, papillary fibroelastoma was an incidental autopsy finding, deemed to have no clinical significance. More recently, reports of symptomatic cases of papillary fibroelastoma with complications such as myocardial infarction and stroke suggest it should be considered a potentially dangerous lesion. In this report, we describe the clinical and echocardiographic findings of 3 patients with cardiac papillary fibroelastoma who presented with cerebral vascular events. ⋯ Cardiogenic embolism is recognized increasingly as an important cause of stroke, accounting of 20% of ischemic strokes. Cardioembolic stroke is largely preventable. The likelihood of recurrence is relatively high for most cardioembolic sources and therefore secondary stroke prevention is fundamental. TEE allowed to characterize well-established sources of embolism, and it was the best diagnostic approach in our patients. Magnetic resonance imaging was used in 1 of these patients, while it confirmed the presumptive diagnosis of cardiac tumor. The first-choice treatment of symptomatic CPF is surgical excision which must be performed as early as possible to reduce the risk of early recurrences of embolic events. The use of TEE in the evaluation of cerebral vascular events is not routinely performed, this method must be considered in patients for whom the cause of cerebrovascular ischemia is unclear, after noninvasive neurovascular studies.
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Case Reports
Focal cortical resection for complex partial status epilepticus due to a paraneoplastic encephalitis.
We report a 57-year-old female who presented with epilepsia partialis continua and rapidly progressed to refractory complex partial status epilepticus (CPSE) with brain magnetic resonance imaging revealing a focal cortical lesion on T2 sequences corresponding to the seizure focus on ictal electroencephalographic recordings. The patient underwent focal cortical resection of the seizure focus. Though clinical and electrographic seizure activity ceased, the patient remained unresponsive with repeat neuroimaging showing diffuse limbic and brainstem involvement. ⋯ Chest computed tomography showed a 5-mm pulmonary nodule and resection of the pulmonary nodule confirmed the diagnosis of small cell lung cancer. Plasmapheresis was performed without clinical improvement. Focal resection can be effective in terminating refractory CPSE but evaluation for a paraneoplastic syndrome must be considered early in the diagnosis of epilepsia partialis continua and CPSE as these patients have a poor prognosis.