Chander Subhash, Jazayeri Shahab, Moulton Julia, Alston Shawnette
Internal Medicine, Saint Mary's Hospital, Waterbury, USA.
Internal Medicine, Frank H. Netter MD School of Medicine, North Haven, USA.
Cureus. 2022 Jun 27;14(6):e26368. doi: 10.7759/cureus.26368. eCollection 2022 Jun.
A 22-year-old Hispanic immigrant presented to the emergency department after having a witnessed seizure. The patient was born and raised in Columbia and had a history of ventricular septal defect repair at the age of five years. Computer tomography (CT) of brain showed an unusual demonstration -"heterotopia of gray matter"- and the follow-up magnetic resonance imaging (MRI) revealed absence of splenium part of corpus callosum. The patient received a loading dose of IV antiepileptic medications and was then transitioned to oral dose. He was then discharged with seizure prophylaxis and referred for a follow-up at another tertiary care hospital for further workup. This case led to a management dilemma as the role of seizure prophylaxis in genetic brain malformations is not well established.
一名22岁的西班牙裔移民在被目睹癫痫发作后前往急诊科就诊。该患者在哥伦比亚出生并长大,5岁时曾接受室间隔缺损修复手术。脑部计算机断层扫描(CT)显示出一种不寻常的表现——“灰质异位”,后续的磁共振成像(MRI)显示胼胝体压部缺失。患者接受了静脉注射抗癫痫药物的负荷剂量,然后转为口服剂量。随后,他在接受癫痫预防治疗后出院,并被转诊至另一家三级护理医院进行进一步检查。由于癫痫预防在遗传性脑畸形中的作用尚未明确,该病例导致了治疗困境。