Pittermann Patrick, Gabriel Susanne, Röschke Joachim
SCIVIAS St. Valentinus-Krankenhaus, Klinik für Psychiatrie, Psychotherapie und Psychosomatik Bad Soden. Sebastian-Kneipp-Straße 11, Bad Soden am Taunus.
Psychiatr Prax. 2012 May;39(4):189-92. doi: 10.1055/s-0031-1299005. Epub 2012 Apr 2.
We report about a patient (66 years) who was referred to our psychiatric hospital because of a progressive confusional state with acute onset. The colleagues of the referring psychiatric hospital considered a first manic episode as the cause of the symptoms and under therapy with haloperidol the confusional state had shown a progression.The clinical examination's findings were a mild central facial paresis on the right side and a mild hemiparesis on the right side with elevated reflex levels.The patient was disoriented, he had cognitive and mnestic deficits. His reasoning was slowed, incoherent and perseverating. The patient had a slight euphoria.An EEG recording showed a continuous regional EEG-seizure pattern. In combination with the clinical symptoms we diagnosed a nonconvulsive status epilepticus. Under anticonvulsive treatment with Lorazepam and Valproic acid the status epilepticus sustended but a control EEG recording showed signs of a Valproate-encephalopathy. Under treatment with Topiramate symptoms ameliorated but due to a vascular dementia the patient still showed fluctuating symptoms of cognitive and mnestic disturbances.
我们报告了一名66岁的患者，因其急性起病的进行性意识模糊状态被转诊至我们的精神病医院。转诊精神病医院的同事认为症状的原因是首次躁狂发作，在使用氟哌啶醇治疗期间，意识模糊状态有所进展。临床检查发现右侧轻度中枢性面瘫和右侧轻度偏瘫，反射水平升高。患者定向力障碍，有认知和记忆缺陷。他的推理缓慢、不连贯且持续存在。患者有轻微欣快感。脑电图记录显示持续的局部脑电图癫痫发作模式。结合临床症状，我们诊断为非惊厥性癫痫持续状态。在使用劳拉西泮和丙戊酸进行抗惊厥治疗期间，癫痫持续状态持续存在，但脑电图复查显示有丙戊酸脑病的迹象。在使用托吡酯治疗后症状有所改善，但由于血管性痴呆，患者仍表现出认知和记忆障碍的波动症状。
