Oono Miki, Uno Hisakazu, Umesaki Arisa, Nagatsuka Kazuyuki, Kinoshita Masako, Naritomi Hiroaki
Department of Neurology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan ; Department of Neurology, Utano National Hospital, National Hospital Organization, 8 Ondoyama-Cho, Narutaki, Ukyoku, Kyoto 616-8255, Japan.
Department of Neurology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
Epilepsy Behav Case Rep. 2014 May 4;2:105-7. doi: 10.1016/j.ebcr.2014.03.009. eCollection 2014.
We report an 84-year-old female who showed a rare manifestation of epilepsy, ictal paresis, a type of simple partial seizure presenting with focal motor dysfunction. While the patient exhibited severe left hemiplegia which lasted for a week, cranial diffusion-weighted MRI demonstrated slightly high intensity in the right posterior quadrant, and electroencephalography (EEG) showed continuous epileptiform discharges located mainly in the right parieto-occipital area, strongly suggesting that the patient was in an ictal state. (99m)Tc-hexamethylpropylene amine oxime-single photon emission computed tomography (HMPAO-SPECT) showed markedly high blood perfusion in the right parieto-temporo-occipital areas. Considering the distribution of EEG epileptiform activities and HMPAO-SPECT hyperperfusion, it is most likely that the ictal paresis of our patient was associated with epileptic activities at the sensorimotor area which caused either direct or indirect activation of an inhibitory system. Careful clinical consideration of the possibility of ictal paresis is needed in elderly patients, especially in those with preexisting dementia, because paresis can be as severe as complete flaccid hemiplegia and can last as long as for a week.
我们报告了一位84岁女性，她表现出癫痫的罕见表现——发作性轻瘫，这是一种简单部分性发作，伴有局灶性运动功能障碍。患者出现严重的左侧偏瘫，持续了一周，头颅扩散加权磁共振成像（MRI）显示右侧后象限有轻度高强度信号，脑电图（EEG）显示持续性癫痫样放电主要位于右侧顶枕区，强烈提示患者处于发作状态。锝（99m）-六甲基丙烯胺肟单光子发射计算机断层扫描（HMPAO-SPECT）显示右侧顶颞枕区有明显的高血流灌注。考虑到EEG癫痫样活动的分布和HMPAO-SPECT高灌注情况，很可能我们患者的发作性轻瘫与感觉运动区的癫痫活动有关，这种活动导致了抑制系统的直接或间接激活。老年患者，尤其是那些已有痴呆症的患者，需要仔细临床考虑发作性轻瘫的可能性，因为轻瘫可能严重至完全性弛缓性偏瘫，且可持续长达一周。
