Deshmukh Narayan D, Singh Rakeshsingh K, Lalla Rakesh S, Karapurkar Anil P, Khadilkar Satish V
Department of Neurology, Bombay Hospital and Institute of Medical Sciences, Mumbai, Maharashtra, India.
Department of Neurology, Fortis Hospital, Mumbai, Maharashtra, India.
Ann Indian Acad Neurol. 2019 Apr-Jun;22(2):210-212. doi: 10.4103/aian.AIAN_445_18.
New-onset refractory status epilepticus (NORSE) is uncommon and almost 50% of cases are cryptogenic. We report the rare development of NORSE following carotid artery stenting (CAS), a procedure which is increasingly being used to treat the carotid stenosis.
Patients who developed NORSE following CAS for the prevention of stroke over a period of 5 years were analyzed retrospectively. The degree of internal carotid artery stenosis (ICA) was estimated as per the NASCET criteria.
We analyzed five patients (age: 56-83 years). NORSE was reported within 30 min to 14 days post-CAS. Status epilepticus was focal in two patients, generalized in two, and one had nonconvulsive status epilepticus. All patients were treated with multiple antiepileptic drugs. Four patients recovered and survived and one succumbed. Two patients had comorbid hypertension and two had diabetes and hypertension. Four patients had hemiparesis due to the contralateral middle cerebral artery territory infarction and one patient had syncope. Two patients had postinfarction gliosis.
We report a new cause of NORSE, following CAS. Stroke resulting in gliosis and cerebral hyperperfusion syndrome are the proposed mechanisms.
新发难治性癫痫持续状态（NORSE）并不常见，近50%的病例病因不明。我们报告了在颈动脉支架置入术（CAS）后罕见发生的NORSE，该手术越来越多地用于治疗颈动脉狭窄。
回顾性分析在5年期间因预防中风而行CAS术后发生NORSE的患者。根据北美症状性颈动脉内膜切除术（NASCET）标准评估颈内动脉（ICA）狭窄程度。
我们分析了5例患者（年龄56 - 83岁）。NORSE在CAS术后30分钟至14天内被报告。癫痫持续状态在2例患者中为局灶性，2例为全身性，1例为非惊厥性癫痫持续状态。所有患者均接受了多种抗癫痫药物治疗。4例患者康复存活，1例死亡。2例患者合并高血压，2例患者合并糖尿病和高血压。4例患者因对侧大脑中动脉供血区梗死出现偏瘫，1例患者出现晕厥。2例患者有梗死后胶质增生。
我们报告了CAS术后NORSE的一个新病因。中风导致胶质增生和脑血流灌注过多综合征是推测的机制。
