Gaete Germán, Velásquez Álvaro
Unidad de Neurofisiología, Hospital de Carabineros de Chile, Santiago, Chile.
Rev Med Chil. 2017 Jan;145(1):126-130. doi: 10.4067/S0034-98872017000100017.
The differential diagnosis of non-convulsive status epilepticus (NCSE) is often complex due to a wide clinical variability of its presentation, including psychiatric manifestations. We report a 68 years old male with a history of depression treated with venlafaxine, mirtazapine, quetiapine and risperidone, presenting in the emergency room with confusion and generalized rigidity. A brain CT scan did not show lesions. A neuroleptic syndrome was initially suspected. At the third day the obtundation worsened and an electroencephalogram (EEG) was performed, which showed epileptiform abnormalities. Treatment with valproic acid resulted in disappearance of such abnormalities. After three weeks of mechanical ventilation, the patient was extubated and remained lucid and partially orientated in time and space.
非惊厥性癫痫持续状态(NCSE)的鉴别诊断往往很复杂,因为其临床表现具有广泛的临床变异性,包括精神症状。我们报告一例68岁男性,有抑郁症病史,曾用文拉法辛、米氮平、喹硫平和利培酮治疗,因意识模糊和全身僵硬在急诊室就诊。脑部CT扫描未显示病变。最初怀疑为抗精神病药物所致综合征。第三天意识障碍加重,进行了脑电图(EEG)检查,结果显示有癫痫样异常。丙戊酸治疗后此类异常消失。机械通气三周后,患者拔管,仍保持清醒,对时间和空间有部分定向能力。