1
|
Acar A, Zampino A, Fotedar N. EEG based oculographic analysis of epileptic nystagmus. Epilepsy Res 2024; 200:107311. [PMID: 38286108 DOI: 10.1016/j.eplepsyres.2024.107311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
Epileptic nystagmus (EN) is a subtle seizure semiology, most commonly seen in seizures originating in the posterior cortical regions. EN is broadly categorized into type I and type II. Type I EN consists of contralateral repetitive saccadic eye movements alternating with post-saccadic slow drifts with an overall contralateral deviation. Type II EN is characterized by ipsilateral slow drift alternating with contralateral corrective saccades. In this article, we report a method to perform oculographic analysis of eye movements using EEG only. We used this method to classify the type of EN in three patients with parieto-occipital seizures. In all three patients, the ictal EEG demonstrated repetitive saccadic eye movements, directed contralateral to the seizure onset zone. With prolonged time constant, we were able to identify this eye movement pattern as EN with distinct slow and fast phases. We were able to further characterize the type of EN as type I and type II. In all three patients, the direction of EN (direction of fast phase or saccades) was contralateral to the seizure onset zone. EN can be easily missed on video-electroencephalography (vEEG) recordings because of various reasons. Our study demonstrates a systematic method of eye movement analysis on EEG, which can be used to not only identify EN as seizure semiology but also classify it, without requiring additional electrodes.
Collapse
Affiliation(s)
- Aybuke Acar
- Epilepsy Center, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Anthony Zampino
- Epilepsy Center, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Neel Fotedar
- Epilepsy Center, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA; Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
| |
Collapse
|
2
|
Ebel M, Jahodova A, Jerabek J. Early Manifestation of Benign Paroxysmal Positional Vertigo: A Case Report. Case Rep Neurol 2024; 16:1-5. [PMID: 38179212 PMCID: PMC10764089 DOI: 10.1159/000535550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/25/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder with a heterogeneous etiology, often linked to preceding infections, head injuries, or vestibular neuronitis. While it is commonly observed in the elderly, its occurrence in the pediatric population is rare. To our knowledge, there have been no reported cases of BPPV in patients younger than 5 years. Case Presentation A 4.5-month-old female infant was admitted with episodes of paroxysmal nystagmus. Parents reported fast horizontal eye movements lasting up to 30 s, with one episode accompanied by vomiting. Comprehensive differential diagnosis was considered from epileptic nystagmus to intoxications and both central and peripheral vestibular etiologies. During the observation on ward, connection between the baby's positioning and nystagmus was identified. The diagnostic roll test confirmed a transient positional geotropic nystagmus. The diagnosis aligned with BPPV characteristics, pointing to the right lateral semicircular canal canalolithiasis. A successful Lempert roll maneuver was performed with prompt effect. To further support the diagnosis and research, we introduced a semiautomatic video-oculography method. Conclusion This case highlights a rare instance of BPPV in an infant. The clinical findings combined with the effectiveness of the repositioning maneuvers support the diagnosis of right lateral semicircular canal lithiasis. Despite the rarity of this condition in such a young-age group, the need for thorough diagnostic evaluations is emphasized. In order to document the case, we also present a semiautomatic video analysis pipeline for analyzing abnormal eye movements in a home setting.
Collapse
Affiliation(s)
- Matyas Ebel
- Department of Paediatric Neurology, 2nd Faculty of Medicine, University Hospital in Motol, Charles University, Prague, Czech Republic
| | - Alena Jahodova
- Department of Paediatric Neurology, 2nd Faculty of Medicine, University Hospital in Motol, Charles University, Prague, Czech Republic
| | - Jaroslav Jerabek
- Department of Neurology, 2nd Faculty of Medicine, University Hospital in Motol, Charles University, Prague, Czech Republic
| |
Collapse
|
3
|
Manorenj S, Venniveli D, Reddy ME, Billa S. Ictal Nystagmus in a Patient with Nonketotic Hyperglycemia: A Rare Clinical Phenomenon of Occipital Epilepsy. Ann Indian Acad Neurol 2024; 27:77-79. [PMID: 38495234 PMCID: PMC10941902 DOI: 10.4103/aian.aian_800_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 03/19/2024] Open
Affiliation(s)
- Sandhya Manorenj
- Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | - Deepika Venniveli
- Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | - Mounika E. Reddy
- Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| | - Srujana Billa
- Department of Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, Telangana, India
| |
Collapse
|
4
|
Yang R, Wu H, Gao Z. Vestibular seizures and spontaneous downbeat nystagmus of ganglioglioma origin: a case report. BMC Neurol 2023; 23:278. [PMID: 37488495 PMCID: PMC10364402 DOI: 10.1186/s12883-023-03311-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/25/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Low-grade gangliogliomas (GGs) are typically epileptogenic intracranial neoplasms. Yet, the presentation of simplex vertiginous experience and spontaneous downbeat nystagmus (DBN) has not been reported to date. CASE PRESENTATION We present the case of a 26-year-old male with focal onset impaired awareness seizures, characterized by vertigo due to right temporal lobe epilepsy caused by ganglioglioma. As rare presentations, a spontaneous, consistent DBN in the absence of vertiginous experience was noticed. MRI suggested lesion in the right temporal pole. Twenty-four-hour continuous electroencephalogram (EEG) monitoring recorded periodic sharp and slow waves, originating from the right temporal lobe. The patient was completely relieved of the symptoms after surgical removal of the tumor, which was histologically confirmed as Grade I Ganglioglioma. CONCLUSIONS Asides from the cortical pathogenesis of epileptic vertigo, this case also provides insight into the DBN secondary to tumor of the temporal lobe. Moreover, the 24-h EEG is advantageous to recognize vestibular seizures and localize the ictal onset areas.
Collapse
Affiliation(s)
- Ruizhe Yang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, PR China
| | - Haiyan Wu
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, PR China.
| | - Zhiqiang Gao
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, PR China
| |
Collapse
|
5
|
Aykac SC, Ekinci AS, Tabakoglu AY, Gulluoglu H, Aydogdu I, Bademkıran F, Uludag B, Arac N, Guler A. What does epileptic nystagmus show us in cases presenting acute neurological symptoms? Seizure 2022; 101:184-189. [PMID: 36058101 DOI: 10.1016/j.seizure.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE This study aims to determine the clinical significance of epileptic nystagmus in patients with acute neurological symptoms. METHOD The clinical findings of patients with documented epileptic nystagmus, their original video and EEG data, and cranial imaging and laboratory tests were analyzed retrospectively. RESULTS 20 patients were included in the study and 21 epileptic nystagmus attacks were determined from patients' clinical and video-EEG recordings. All recorded seizures with epileptic nystagmus were focal onset in nature. The ictal discharge pattern was rhythmic fast activity with a mean frequency of 15 Hz. The ictal discharges originated from the parieto-occipital (n = 8), temporo-occipital (n = 7), parieto-occipito-temporal (n = 3), temporal (n = 2), occipital (n = 1), and centroparietal (n = 1) areas. In the fast phase, the nystagmus was beating away from the side of ictal discharges. The origin of the ictal discharges on EEG images was compatible with the lesion localization at cranial MRI in all patients. Etiologies were epilepsy in seven patients, non-ketotic hyperglycemia in four, ketotic hyperglycemia in one, PRES in three, acute stroke in three, HSV encephalitis in one, and MELAS in one. CONCLUSIONS Epileptic nystagmus represents a guide to the lateralization and localization of the lesion in cases presenting with acute neurological symptoms. In these patients, the lesion is frequently in the posterior regions of the hemispheres. Although various diseases affect these regions in terms of etiology, such cases should be evaluated in terms of the presence of hyperglycemia.
Collapse
Affiliation(s)
| | - Aysen Suzen Ekinci
- Neurology Department, Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Aycin Yıldız Tabakoglu
- Department of Neurology and Neurophysiology, University Of Health Sciences Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Halil Gulluoglu
- Neurology Department, Economy University, Medicalpark Hospital, Izmir, Turkey
| | - Ibrahim Aydogdu
- Neurology Department, Ege University Faculty Of Medicine, Izmir, Turkey
| | - Fikret Bademkıran
- Neurology Department, Ege University Faculty Of Medicine, Izmir, Turkey
| | | | - Nilgün Arac
- Neurology Department, Ege University Faculty Of Medicine, Izmir, Turkey
| | - Ayse Guler
- Neurology Department, Ege University Faculty Of Medicine, Izmir, Turkey.
| |
Collapse
|
6
|
Turek G, Skjei K. Seizure semiology, localization, and the 2017 ILAE seizure classification. Epilepsy Behav 2022; 126:108455. [PMID: 34894624 DOI: 10.1016/j.yebeh.2021.108455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
In the study of epilepsy, the term semiology is used to comprise the clinical characteristics of a seizure, both subjective symptoms and objective phenomena. It is produced by activation of the symptomagenic zone, and an accurate and comprehensive understanding of the localizing value of seizure semiology is crucial for presurgical evaluation and planning. Myriad publications in epilepsy journals detail correlations between various semiological features and activation of specific cortical regions. Traditionally these studies involved scalp EEG recorded in epilepsy monitoring units. The increasing use of invasive monitoring, and specifically the use of depth electrodes and stereo-electroencephalography, has advanced our understanding of the characteristics of seizures arising from ictal foci deep to the scalp, including the cingulate, insula and operculum. However, the distinction between seizure onset and symptomogenic zones is not always clear. In 2017 the International League Against Epilepsy (ILAE) published an operational classification of seizure types based heavily on seizure semiology. The current paper provides an updated review of the current body of knowledge relating to seizure semiology, incorporating both scalp EEG studies and more recent stereo-electroencephalography discoveries in the framework of the 2017 ILAE classification.
Collapse
Affiliation(s)
- Grant Turek
- Department of Neurology, University of Louisville, 401 E. Chestnut St. Unit 510, Louisville, KY 40202-5710, United States.
| | - Karen Skjei
- Department of Neurology, University of Texas at Austin, Dell Medical School, 1601 Trinity St., Bldg B, Strop Z0700, Austin, TX 78712, United States
| |
Collapse
|
7
|
Selitsky GV, Pertsov SS, Sorokina ND, Titova NA, Zherdeva AS. [Neurophysiological and functional neuroimaging methods in the assessment of migraines and epilepsy with vertigo]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:106-111. [PMID: 34481445 DOI: 10.17116/jnevro2021121081106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A review of the current literature shows that the combined use of neurophysiological and structural-functional neuroimaging methods has significantly expanded the understanding of the mechanisms of migraine with vestibular dysfunction: functional and structural disorders were found in brain regions involved in multisensory vestibular control and Central vestibular processing. Analysis of numerous studies shows that epilepsy can also cause vestibular symptoms, they can occur both without epileptic markers, and in combination with epileptic paroxysms. In isolated epileptic vertigo, according to studies widely presented in the literature, epileptic activity was most often detected by EEG data in the temporal regions, to a lesser extent in the parietal regions. In these studies, neuroimaging findings of foci of reduced substance density were found, which could be a consequence of deafferentation, as well as violations of connections with the focus of neuronal activity. In the absence of structural abnormalities, numerous studies have shown using magnetic resonance spectroscopy, diffusion MRI, and PET that the physiological basis for impaired neuronal metabolism was a decrease in synaptic activity, a violation of maintaining the difference in membrane potentials on the surface of the hippocampus, or changes in neighboring tracts of the white matter of the brain.
Collapse
Affiliation(s)
- G V Selitsky
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - S S Pertsov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Anokhin Research Institute of Normal Physiology, Moscow, Russia
| | - N D Sorokina
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - N A Titova
- Clinical hospital No. 85 of the FMBA of Russia, Moscow, Russia
| | - A S Zherdeva
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| |
Collapse
|
8
|
Chowdhury FA, Silva R, Whatley B, Walker MC. Localisation in focal epilepsy: a practical guide. Pract Neurol 2021; 21:481-491. [PMID: 34404748 DOI: 10.1136/practneurol-2019-002341] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/03/2022]
Abstract
The semiology of epileptic seizures reflects activation, or dysfunction, of areas of brain (often termed the symptomatogenic zone) as a seizure begins and evolves. Specific semiologies in focal epilepsies provide an insight into the location of the seizure onset zone, which is particularly important for presurgical epilepsy assessment. The correct diagnosis of paroxysmal events also depends on the clinician being familiar with the spectrum of semiologies. Here, we summarise the current literature on localisation in focal epilepsies using illustrative cases and discussing possible pitfalls in localisation.
Collapse
Affiliation(s)
- Fahmida A Chowdhury
- Department of Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK .,Department of Clinical and Experimental Epilepsy, Institute of Neurology, London, UK
| | - Rui Silva
- Department of Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK
| | - Benjamin Whatley
- Department of Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Neurology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew C Walker
- Department of Epilepsy, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Clinical and Experimental Epilepsy, Institute of Neurology, London, UK
| |
Collapse
|
9
|
Lee ES, Kim KT, Lee TK, Moon HJ. Epileptic Vertigo and Nystagmus in Cerebral Hemiatrophy Syndrome. J Clin Neurol 2020; 16:341-343. [PMID: 32319257 PMCID: PMC7174109 DOI: 10.3988/jcn.2020.16.2.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Eek Sung Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Tae Kyeong Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hye Jin Moon
- Department of Neurology, Soonchunhyang University College of Medicine, Bucheon, Korea.
| |
Collapse
|
10
|
Nakayama C, Mikami T, Ukai R, Chiba R, Enatsu R, Suzuki H, Hirano T, Mikuni N. Moyamoya disease with epileptic nystagmus: A case report. J Clin Neurosci 2019; 70:251-254. [PMID: 31439486 DOI: 10.1016/j.jocn.2019.08.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/07/2019] [Indexed: 11/28/2022]
Abstract
Epileptic nystagmus is a quick, repetitive, jerky movement of the eyeball caused by seizure activity, which is unaccompanied by other ictal phenomena. We report a case of moyamoya disease with epileptic nystagmus. A 23-year-old woman presented with a headache and transient hemiparesis on her left side. Magnetic resonance imaging showed no ischemic or hemorrhagic stroke lesions. Digital subtraction angiography confirmed stenosis of the terminal portion of the right internal carotid artery and the formation of moyamoya vessels on the right side. 123I-N-isopropyl-iodoamphetamine (123I-IMP) single photon emission computed tomography (SPECT) showed decreased uptake in the right basal ganglia, frontal, and parietal regions. After electroencephalography (EEG) and a hyperventilation test were performed, nystagmus appeared and was accompanied with a declining level of consciousness. Ictal EEG during an attack showed no epileptiform discharge. Moreover, the patient sometimes experienced simultaneous upper limb-shaking and gelastic attacks. After superficial temporal artery to middle cerebral artery bypass surgery was performed on the right side, symptom frequency and duration gradually decreased. Decreased 123I-IMP SPECT blood flow in the right frontal region is considered a mechanism that causes the onset of epileptic nystagmus. It is presumed that the attack was caused by an ischemic abnormality in the saccade region of the frontal eye field. Moreover, revascularization can effectively treat the symptoms of moyamoya disease.
Collapse
Affiliation(s)
- Chie Nakayama
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
| | - Ryo Ukai
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Ryohei Chiba
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Hime Suzuki
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Toru Hirano
- Division of Radiology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| |
Collapse
|
11
|
Rossi KC, Brandstadter R, Fields MC, Shin S. Author response: Clinical Reasoning: A 54-year-old woman with confusion and visual disturbances. Neurology 2019; 92:1166. [DOI: 10.1212/wnl.0000000000007672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
12
|
Kim JM, Mun SK, Yoo IH, Lopez C, Kim JS. Vertigo and impaired pursuit eye movements in a small medial superior temporal infarction. J Neurol 2018; 265:2740-2742. [PMID: 30140968 DOI: 10.1007/s00415-018-9023-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/15/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Seog Kyun Mun
- Department of Otorhinolaryngology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Il-Han Yoo
- Department of Neurology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Christophe Lopez
- Centre National de la Recherhe Scientifique, Aix-Marseille Université, LNSC, Marseille, France
| | - Ji-Soo Kim
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, Bundang-gu, Seongnam, 13620, Republic of Korea.
| |
Collapse
|
13
|
Zhang W, Liu X, Zuo L, Guo Q, Chen Q, Wang Y. Ipsiversive ictal eye deviation in inferioposterior temporal lobe epilepsy-Two SEEG cases report. BMC Neurol 2017; 17:38. [PMID: 28222686 PMCID: PMC5320722 DOI: 10.1186/s12883-017-0811-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/26/2017] [Indexed: 11/25/2022] Open
Abstract
Background Versive seizure characterized by conjugate eye movement during epileptic seizure has been considered commonly as one of the most valuable semiological signs for epilepsy localization, especially for frontal lobe epilepsy. However, thelateralizing and localizing significance of ictaleye deviation has been questioned by clinical observation of a series of focal epilepsy studies, including frontal, central, temporal, parietal and occipital epilepsy. Case presentation Two epileptic cases characterized by ipsiversive eye deviation as initial clinical sign during the habitual epileptic seizures are presented in this paper. The localization of the epileptogenic zone of both of the cases has been confirmed as inferioposterior temporal region by the findings of ictalstereoelectroencephalography (SEEG) and a good result after epileptic surgery. Detailed analysis of the exact position of the key contacts of the SEEG electrodes identified the overlap between the location of the epileptogenic zone and human MT/MST complex, which play a crucial role in the control of smooth pursuit eye movement. Conclusion Ipsiversive eye deviation could be the initial clinical sign of inferioposterior temporal lobe epilepsy and attribute to the involvement of human MT/MST complex, especially human MST whichwas located on the anterior/dorsal bank of the anterior occipital sulcus (AOS).
Collapse
Affiliation(s)
- Wei Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Epilepsy Center, Guangdong Sanjiu Brain Hospital, Jinan University, No. 578, Sha Tai Nan Lu, Guangzhou, 510510, China
| | - Xingzhou Liu
- Epilepsy Center, Guangdong Sanjiu Brain Hospital, Jinan University, No. 578, Sha Tai Nan Lu, Guangzhou, 510510, China
| | - Lijun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiang Guo
- Epilepsy Center, Guangdong Sanjiu Brain Hospital, Jinan University, No. 578, Sha Tai Nan Lu, Guangzhou, 510510, China
| | - Qi Chen
- School of Psychology, South China Normal University, Guangzhou, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Department of Neurology, Tiantan Clinical Trial and Research Center for Stroke, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
14
|
Shah NH, Bhatt N, Tipirneni A, Condes D, Khandelwal P, Romano JG. Conjugate Eye Deviation on CT Associated With Worse Outcomes Despite IV Thrombolysis. Neurohospitalist 2016; 7:74-77. [PMID: 28400900 DOI: 10.1177/1941874416674603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Rapid stroke management has significant implications in patient outcomes. Ipsilateral computed tomography conjugate eye deviation (CT-CED) has been associated with worse outcomes but has never been evaluated as predictive of vascular occlusion. To test the hypothesis that CT-CED is a marker for vascular occlusion, we evaluated patients treated with intravenous tissue plasminogen activator (IV tPA). METHODS We performed a retrospective analysis of patients with acute ischemic stroke treated with IV tPA at a large tertiary care hospital over an 18-month period. A waiver of informed consent was granted. Two examiners evaluated baseline brain CTs blinded to the location of infarct to assess the presence of CT-CED and follow-up imaging for the location of infarct and the presence of intracranial large vessel occlusion. Demographics, initial National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scales (mRSs), and hospital length of stay (LOS) were collected. RESULTS Among 104 patients treated with IV tPA, 36 had CT-CED. Inter-rater reliability for CT-CED was excellent (κ = 0.97; 95% confidence interval: 0.98-1.0). The CT-CED group was older (69.8 vs 64 years; P = .038), had higher initial NIHSS (14.6 vs 11; P = .01), worse mRS (3.2 vs 2.4; P = .03), and longer LOS (8.4 vs 6.4; P = .05) compared with those without CT-CED. A vascular occlusion in the territory of the infarct was seen in 58% of patients with CT-CED versus 32% without CT-CED (P < .01). Atrial fibrillation (AF) was diagnosed in 61% patients with CT-CED versus 22% without (P < .01). CONCLUSION The CT-CED is associated with higher initial NIHSS, large vessel occlusion, and AF. Prospective studies are needed to ascertain whether CT-CED may be utilized part of a screen for endovascular therapy.
Collapse
Affiliation(s)
- Nirav H Shah
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Nirav Bhatt
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Anita Tipirneni
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Diego Condes
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Priyank Khandelwal
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jose G Romano
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| |
Collapse
|
15
|
Lee SU, Yun CH, Kim JS. Delayed diagnosis of vestibular epilepsy due to temporal cavernous malformation. J Neurol Sci 2015; 352:112-4. [PMID: 25819120 DOI: 10.1016/j.jns.2015.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sun-Uk Lee
- Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, South Korea
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
| |
Collapse
|