Trapp Selina Denise, Noachtar Soheyl, Kaufmann Elisabeth
Neurology, Faculty of Medicine, Ludwig Maximilians University Munich, Munich, Germany
Epilepsy Center, Department of Neurology, University of Munich, Muenchen, Germany.
BMJ Case Rep. 2022 Mar 29;15(3):e247760. doi: 10.1136/bcr-2021-247760.
We describe a man in his 30s who presented with paroxysmal right-sided dyskinesias of the arm and neck, misdiagnosed with drug-resistant focal epilepsy. Two months earlier he had undergone surgery for chronic sinusitis. Immediately after this procedure, he developed hemiparesis, hemiataxia, paresthesias and disturbances in verbal fluency. Cranial MRI revealed a disruption of the left lamina cribrosa and an intracerebral injury resembling a branch canal spanning to the left dorsal third of the thalamus. Single-photon emission tomography imaging demonstrated malperfusion of the left ventral thalamus, left-sided cortex and right cerebellar hemisphere. During continuous video-EEG monitoring, three dyskinetic episodes with tremor of the right arm and dystonia of the finger and shoulder could be recorded. The paroxysmal dyskinesias did not improve with carbamazepine, valproate and tiapride. This case demonstrates an unusual symptomatic cause of a thalamic movement disorder misdiagnosed as focal epilepsy and highlights the postoperative complications, diagnostic and treatment efforts.
我们描述了一名30多岁的男性，他出现了手臂和颈部阵发性右侧运动障碍，曾被误诊为耐药性局灶性癫痫。两个月前，他接受了慢性鼻窦炎手术。就在该手术后，他出现了偏瘫、偏身共济失调、感觉异常和语言流畅性障碍。头颅磁共振成像显示左侧筛板破裂以及类似延伸至丘脑左侧背侧三分之一处分支管的脑内损伤。单光子发射断层扫描成像显示左侧腹侧丘脑、左侧皮质和右侧小脑半球灌注不良。在连续视频脑电图监测期间，记录到了三次伴有右臂震颤以及手指和肩部肌张力障碍的运动障碍发作。卡马西平、丙戊酸盐和硫必利均未能改善阵发性运动障碍。该病例展示了一种被误诊为局灶性癫痫的丘脑运动障碍的不寻常症状性病因，并突出了术后并发症、诊断及治疗方面的情况。
