Jain Varun, Remley William, Mohan Arvind, Leone Emma L, Taneja Srishti, Busl Katharina, Almeida Leonardo
Neurology, University of Florida, Gainesville, USA.
Neurology, Lake Erie College of Osteopathic Medicine, Jacksonville, USA.
Cureus. 2021 Sep 28;13(9):e18361. doi: 10.7759/cureus.18361. eCollection 2021 Sep.
Transient neurological deficits can occur in the setting of subdural hemorrhages with subsequent unremarkable electrodiagnostic and radiological evaluation. This scenario is rare and can be difficult for physicians to interpret. These transient neurological deficits are thought to result from relative ischemia, secondary to a lesser-known concept known as cortical spreading depolarization. These transient neurological deficits are thought to result from relative ischemia, secondary to a lesser-known concept known as cortical spreading depolarization, which may present clinically as nonepileptic, stereotypical, and intermittent symptoms (NESIS). In these instances, patients are often misdiagnosed as epileptics and committed to long-term antiseizure drugs. We present a 51-year-old patient developing acute global aphasia following the evacuation of a subdural hematoma, with no significant findings on laboratory, microbiological, electrodiagnostic, or radiological evaluation. The patient experienced spontaneous improvement and returned to baseline in the subsequent weeks. Increased awareness of NESIS as a cortical spreading depolarization phenomenon can improve patient care and prevent both unnecessary, extended medical evaluations and therapeutic trials.
短暂性神经功能缺损可发生在硬膜下出血的情况下，随后的电诊断和影像学评估无明显异常。这种情况很罕见，医生可能难以解释。这些短暂性神经功能缺损被认为是由相对缺血引起的，其继发于一个鲜为人知的概念，即皮质扩散性去极化。这些短暂性神经功能缺损被认为是由相对缺血引起的，其继发于一个鲜为人知的概念，即皮质扩散性去极化，临床上可能表现为非癫痫性、刻板性和间歇性症状（NESIS）。在这些情况下，患者常被误诊为癫痫患者并长期服用抗癫痫药物。我们报告一名51岁患者，在硬膜下血肿清除术后出现急性完全性失语，实验室、微生物学、电诊断或影像学评估均无显著发现。患者在随后几周内自发好转并恢复至基线水平。提高对NESIS作为一种皮质扩散性去极化现象的认识可以改善患者护理，并防止不必要的长期医学评估和治疗试验。
