Kim Ahwon, Hong Sang Bin, Lee Seonkyung, Mo Heejung, Koo Dae Lim
Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
J Epilepsy Res. 2018 Dec 31;8(2):90-92. doi: 10.14581/jer.18015. eCollection 2018 Dec.
Status epilepticus and stroke are occasionally characterized by indistinguishable symptoms. Diffusion-weighted imaging (DWI) could not only help differentiating seizure from stroke, but also assist in localizing a focus of seizure and reflect resolution of seizure. We report a case of non-convulsive status epilepticus that presented as acute ischemic stroke, mimicking the latter's clinical manifestations. A 77-year-old right-handed man visited the emergency room with complaints of impaired awareness and fluency with right hemiparesis. Moreover, he presented with first-onset focal to bilateral tonic-clonic seizure with eyeball deviation to the right for 1 minute. Magnetic resonance imaging showed hyperintensity on DWI with a reduced apparent diffusion coefficient (ADC) value in the left pulvinar and left temporo-occipital areas. However, eyeball deviation to the right was not matched with left hemispheric stroke. Electroencephalography (EEG) confirmed ictal discharges in the left temporal area, which were compatible with impaired awareness, ictal aphasia, and eyeball deviation to the right. In cases of conflicting results from neurological examination and DWI/ADC findings, clinicians should consider employing EEG for diagnosing and treating non-convulsive status epilepticus.
癫痫持续状态和中风有时表现出难以区分的症状。弥散加权成像（DWI）不仅有助于区分癫痫发作和中风，还能协助确定癫痫发作的病灶并反映癫痫发作的缓解情况。我们报告一例非惊厥性癫痫持续状态病例，该病例表现为急性缺血性中风，模仿了后者的临床表现。一名77岁右利手男性因意识障碍、言语流畅性受损及右侧偏瘫就诊于急诊室。此外，他首次出现局灶性至双侧强直阵挛发作，眼球向右偏斜1分钟。磁共振成像显示左侧丘脑枕和左侧颞枕区DWI呈高信号，表观扩散系数（ADC）值降低。然而，眼球向右偏斜与左侧半球中风不相符。脑电图（EEG）证实左侧颞区存在发作期放电，这与意识障碍、发作性失语及眼球向右偏斜相符。在神经检查结果与DWI/ADC表现相互矛盾的情况下，临床医生应考虑采用EEG来诊断和治疗非惊厥性癫痫持续状态。
