Lawson Jordan, Triner Wayne, Kluge Brady
Prisma Health Upstate, Department of Emergency Medicine, Greenville, South Carolina.
University of South Carolina, School of Medicine, Greenville, South Carolina.
Clin Pract Cases Emerg Med. 2022 Aug;6(3):212-215. doi: 10.5811/cpcem.2022.1.55482.
Stroke mimics are a major diagnostic challenge during the initial evaluation of patients presenting with an acute focal neurological deficit. This case reviews a patient who presented to the emergency department (ED) with homonymous hemianopsia, a rare manifestation of focal status epilepticus of the occipital lobe. Her initial brain computed axial tomographic perfusion scan and magnetic resonance imaging revealed novel findings associated with this diagnosis.
A 70-year-old female presented to our ED with left visual field hemianopsia, dyskinesia, dysmetria, and facial droop. Her initial diagnosis was left posterior fossa circulation cerebrovascular accident. However, her neuroimaging indicated hypervascularity of the left occipital lobe without evidence of infarct or structural lesion. A cerebral angiogram excluded arteriovenous malformation. Subsequently, an electroencephalogram showed left occipital lobe status epilepticus.
Hemianopsia is a rare presentation of focal status epilepticus mimicking stroke. Hypervascularity seen on advanced neuroimaging may have suggested this diagnosis on initial ED evaluation.
在对出现急性局灶性神经功能缺损的患者进行初始评估时，类卒中是一项重大的诊断挑战。本病例回顾了一名因同向性偏盲就诊于急诊科（ED）的患者，同向性偏盲是枕叶局灶性癫痫持续状态的一种罕见表现。她最初的脑部计算机断层血管造影灌注扫描和磁共振成像显示了与该诊断相关的新发现。
一名70岁女性因左侧视野偏盲、运动障碍、辨距不良和面部下垂就诊于我院急诊科。她最初的诊断是左后颅窝循环脑血管意外。然而，她的神经影像学检查显示左枕叶血管增多，无梗死或结构性病变的证据。脑血管造影排除了动静脉畸形。随后，脑电图显示左枕叶癫痫持续状态。
偏盲是类卒中的枕叶局灶性癫痫持续状态的一种罕见表现。在急诊科初始评估时，先进神经影像学检查中发现的血管增多可能提示了这一诊断。
