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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sixty patients with intractable complex partial seizures underwent surgery between 1969 and 1990, and 58 of these underwent a temporal resection. Of 39 patients who had chronic subdural electrocorticography (ECoG) 37 subsequently underwent an anterior temporal lobectomy (ATL) and two had the electrodes removed without resection. Two patients had bilateral depth electrodes placed and then had an ATL. Fourteen patients with evidence of temporal structural lesions had temporal resections with intraoperative ECoG and five had resection without ECoG. Mean length of follow-up for all patients was 6 years. Fifty-five per cent of cases were seizure-free postoperatively, 7% almost seizure-free, 21% had worthwhile improvement and 17% no improvement. The outcome for patients with structural lesions was particularly good. Nine patients complained of mild memory impairment postoperatively and one had a severe amnestic problem. One patient with an unsuspected tumour developed a hemiparesis and dysphasia. One other patient had persistent dysphasia. No mortality was attributable to the surgery. It is concluded that ATL is an excellent operation for the treatment of intractable epilepsy arising from the temporal lobe and chronic subdural ECoG is a safe and reliable method for localizing the seizure origin.
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PMID:Temporal lobectomy for intractable epilepsy: experience with 58 cases over 21 years. 843 41

Cocaine use is associated with a variety of serious neurological complications, including cerebral infarction, intracerebral and subarachnoid hemorrhage, transient ischemic attacks, migraines, and seizures. We report two cases of intracerebral hemorrhage with biopsy-proven cerebral vasculitis associated with the use of cocaine. The first case involved a 32-year-old man who presented with headache, left-sided hemiparesis, and severe hypertension and who was found to have a large right putaminal hemorrhage on cranial tomographic (CT) scan. Cerebral angiography did not show vasculitic changes, but brain tissue obtained during hematoma evacuation revealed a nonnecrotizing leukocytoclastic angiitis of the small vessels. The second case involved a 20-year-old man who presented with headache, agitation, and speech difficulty that progressed to disorientation and dysphasia. He had a large left temporoparietal hematoma seen on CT scan. Cerebral angiography was consistent with vasculitis, and brain tissue obtained during hematoma evacuation revealed a small vessel vasculitis. In both cases, thorough clinical and laboratory investigations found no evidence of systemic vasculitis or an etiologic agent other than cocaine. We also critically reviewed the previously reported cases of cocaine-associated cerebral vasculitis and the relevant medical literature to discuss the "cocaine-associated vasculitis syndrome" in the context of more established vasculitidies, including hypersensitivity vasculitis. In addition, we outline a diagnostic and therapeutic approach to patients with possible cocaine-associated vasculitis.
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PMID:Cocaine-associated cerebral vasculitis. 865 May 87

Neurological symptoms of transient unsteadiness, dysarthria, dysphasia, dysbasia, transient monoor hemiparesis, hemiparesis, scintillating scotomas, amaurosis fugax, vertigo, dizziness, migraine accompaniments, syncope and seizures were the presenting manifestations of thrombocythemia in various myeloproliferative disorders. Erythromelalgia preceded or followed the neurologic ischemic attacks. The neurologic and ocular attacks usually had a sudden onset, lasted for a few seconds to several minutes and occurred independently or sequentially rather than simultaneously. This clinical syndrome is caused by platelet-mediated ischemic and thrombotic processes in the end-arterial microvasculature and reflects the existence of a platelet dependent and aspirin responsive arterial thrombophilia in thrombocythemia as novel disease entity, which confirms and elucidates Mitchell's hypothesis.
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PMID:Atypical transient ischemic attacks in thrombocythemia of various myeloproliferative disorders. 895 74

A 12-year-old girl had minor head trauma, with resultant mild headache, one day prior to onset of an apparently generalized tonic clonic seizure, right hemiparesis and dysphasia. A cranial CT scan showed evidence of a left middle cerebral artery infarct. Despite ventilation, fluid restriction, mannitol, thiopental infusion and intracranial pressure monitoring she deteriorated and died. Autopsy demonstrated dissection of the left middle cerebral artery with an intact internal carotid artery and no evidence of vasculitis. Middle cerebral artery dissection in children is very rare. Most reported cases are diagnosed at autopsy. The pathogenesis of cerebral artery dissection may include preceding minor head trauma or exertion and this should be sought for in the history.
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PMID:Middle cerebral artery dissection. 905 53

We encountered a 67-year-old man who presented with repetitious dysphasia accompanied by periodic lateralized epileptiform discharges (PLEDs) on the electroencephalogram. A good correlation was established between the dysphasia and the PLEDs. A persistent partial seizure accompanied by PLEDs originating in the left hemisphere presented with dysphasia clinically. None of the previously reported patients with epileptic dysphasia had accompanying PLEDs. The administration of carbamazepine was successful to terminate the seizure, however valproate was not. This case indicates that PLEDs may produce significant, however reversible, functional damage, and may advance our understanding of the pathophysiology of epileptic dysphasia.
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PMID:Dysphasia accompanied by periodic lateralized epileptiform discharges. 905 4

The Landau-Kleffner and the continuous spike and wave discharges during slow sleep (CSWS) syndromes are described and possible links between the two are discussed. They certainly overlap, with clinical and electroencephalographic features in common. Potential causes are discussed. There is seldom a definite reason for the seizures but it way well be that the spike and wave discharges seen in the EEG, whatever their origin, may disrupt the development of language and cognitive function at a critical stage. If neurons and axons are involved in this disorganized activity they surely cannot perform normally. The evidence that these discharges in the Landau-Kleffner syndrome can have a focal origin in areas important for language supports this hypothesis. Certain variations among studies quoted may be due to factors such as age of onset, the duration of the paroxysmal activity, its intensity and especially its localization. Also, if development has been distorted subsequent progress is likely to be disturbed after the primary condition has ceased to exist. The diagnosis can sometimes present difficulties, for example from deafness, psychiatric condition, post-ical dysphasia and from progressive degenerative neurological disorders. If the possible role of the epileptic activity is accepted, there are strong reasons for advocating anti-epileptic treatment, even if overt seizures are rare. The response to drugs is varied. Fits will usually stop, but not so often the spike and wave discharges, and it is justifiable to try various regimes. Subpial resection has been reported to be successful, possibly by preventing the cortex generating seizures, and their spread.
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PMID:The Landau-Kleffner syndrome: increased understanding. 925 82

Sarcoidosis presents only infrequently with stroke or focal neurological deficit and recurrent focal neurological deficit is rarer still. This case report describes a patients presenting with episodic non-fluent dysphasia of abrupt onset occurring during a period of 18 months without evidence of seizure activity or macroscopic granulomatous collection. The case illustrates that the presentation of neurosarcoidosis may mimic classic reversible ischaemic neurological deficit.
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PMID:Transient focal neurological deficit in sarcoidosis. 930 10

In order to assess the lateralizing value of several ictal and postictal clinical symptoms in temporal lobe epilepsy (TLE), we analyzed 89 seizures of 20 left dominant patients with intractable left (n = 9) versus right (n = 11) TLE who had undergone successful anterior temporal lobectomy. In left TLE, movement arrest at seizure onset, postictal dysphasia > 120 s and postictal dyslexia > 180 s were the most typical findings and associated with a sensitivity of 94, 94, and 100%, respectively. The highest specificity of 100% each was evident for contralateral versions of eyes and head and dystonic posturing. In right TLE, the highest sensitivity was seen for whole-body movements at seizure onset, postictal dysphasia < 120 s and postictal dyslexia < 180 s with figures of 82, 87, and 93%, respectively. As compared to left TLE, contralateral version and dystonic posturing, ictal speech, and postictal dyslexia < 180 s each had a specificity of 100%. The careful combined analysis of certain ictal clinical signs combined with consistent findings of interictal EEG and neuroimaging studies may be often sufficient to proceed with epilepsy surgery without invasive recordings even if ictal scalp EEG is not unambiguous.
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PMID:The lateralizing value of ictal clinical symptoms in uniregional temporal lobe epilepsy. 952 67

A 36-year-old female presented with seizures and transient dysphasia in her 31 week of pregnancy. Neuroradiological investigations revealed a large falx meningioma. A decision was taken to deliver the infant and excise the tumor before term because of the risk of an increase in the size of the tumour and the risk of sinus thrombosis. Therefore, she underwent in her 32 week of pregnancy an elective Caesarean section followed by a craniotomy to remove the meningioma. There were no neonatal complications and she made an uneventful recovery. The final pathology report confirmed the diagnosis of meningioma with progesterone positive receptors.
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PMID:Intracranial meningioma with progesterone positive receptors presenting in late pregnancy. 952 50

The authors analyzed 22 patients younger than 18 years of age with temporal lobe epilepsy (TLE) treated surgically. Patients underwent a comprehensive presurgical evaluation, including video-electroencephalogram. Fifty-five percent had a history of febrile seizures. Eighty-two percent had auraes and most exhibited oroalimentary and gestural automatisms. Contralateral dystonic posturing was present in 36% and postictal dysphasia in 54% of patients with left-sided resections. Cranial magnetic resonance imaging (MRI) was abnormal in 59% of patients. MRI revealed changes consistent with mesial temporal sclerosis in 8 (47%) of 17 patients without lesions. Fluorodeoxyglucose-positron emission tomography (PET) scans revealed ipsilateral temporal hypometabolism (PET-TH) in 12 (85.7%) of 14 patients. The intracarotid amobarbital procedure revealed impaired memory of the epileptogenic side in 59% of patients. Seventeen patients underwent en-bloc resections and five lesionectomies and resection of the epileptogenic area. There was no surgical morbidity or mortality. Forty-three percent had hippocampal sclerosis, 28.5% gliosis, 14% low-grade tumors, 9.5% cavernous angiomas, and 5% had no pathologic findings. Follow-up (6 months to 12 years) was available for 21 patients; 76% became seizure free, 19% had rare seizures, and 5% had a worthwhile improvement. TLE can be safely treated surgically in younger patients with excellent results. The clinical manifestations were similar to adult patients. PET-TH was present even at a younger age, suggesting that the focal functional deficits appear early in patients with medically refractory TLE, which may help in the early identification of these patients.
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PMID:Presurgical evaluation and surgical outcome of temporal lobe epilepsy. 1020 24


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