Atsuji Kiyohiro, Neshige Shuichiro, Ohno Narumi, Maruyama Hirofumi
Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, JPN.
Cureus. 2024 Mar 22;16(3):e56696. doi: 10.7759/cureus.56696. eCollection 2024 Mar.
A 79-year-old woman visited our department for chronic visual field abnormalities with a floating sensation for two months. Neurological and ophthalmologic examinations yielded normal results, except for brain MRI indicating left hippocampal atrophy. Cognitive function tests were normal. EEG revealed frequent spikes and slow waves in the left frontotemporal region, corroborated by reduced accumulation in I-iomazenil single photon emission computed tomography. A diagnosis of temporal lobe epilepsy was established, and treatment with lacosamide resulted in a remarkable improvement in symptoms and EEG findings. Mild focal seizures from the temporal region might cause mild impaired awareness, resulting in the patient's report as a sensation of uncertainty between the self and the outside world, mimicking ophthalmologic abnormalities. The repeated nature of the seizures contributed to the absence of the term "transient" in symptom description. Diagnosing epilepsy in the elderly proves challenging due to nonspecific complaints.
一名79岁女性因慢性视野异常伴漂浮感两个月前来我科就诊。神经科和眼科检查结果均正常,不过脑部磁共振成像显示左侧海马萎缩。认知功能测试正常。脑电图显示左额颞叶区域频繁出现尖波和慢波,碘-异喹胍单光子发射计算机断层扫描显示该区域放射性摄取减少,进一步证实了上述结果。确诊为颞叶癫痫,使用拉科酰胺治疗后症状及脑电图表现显著改善。颞叶区域的轻度局灶性发作可能导致轻度意识障碍,致使患者自述有一种自我与外界之间的不确定感,类似眼科异常表现。发作的反复性导致症状描述中未出现“短暂性”一词。由于主诉不具特异性,老年癫痫的诊断颇具挑战性。