Focal nonconvulsive status epilepticus associated to PLEDs and intense focal hyperemia in an AIDS patient.
OBJECTIVE
Periodic lateralised epileptiform discharges (PLEDs) can be seen associated to nonconvulsive status epilepticus (NCSE), although their pathophysiological meaning remains questionable. Functional neuroimaging has suggested that, in this setting, PLEDs may indeed be an ictal pattern. In this report we describe perfusional changes in a patient with AIDS, PLEDs and NCSE.


METHODS
A 37-year-old man with AIDS, cryptococcosis and recurrent epileptic seizures was admitted. After initial treatment, he remained comatose, and had MRI and serial EEG recordings performed. Technetium-99m-ethyl cysteinate dimer (99mTc-ECD) SPECT scans were also obtained, before and after continuous benzodiazepine infusion.


RESULTS
EEG disclosed PLEDs over the right fronto-polar region while MRI revealed meningeal thickening and scattered unspecific findings. SPECT revealed marked focal hyperperfusion overlapping the areas with PLEDs, both resolved after continuous midazolam infusion and clinical improvement.


CONCLUSIONS
This report demonstrates association of PLEDs, NCSE, and focal hyperperfusion on SPECT, additionally supporting the concept of PLEDs as an ictal pattern. Considering that status epilepticus may eventually not be detected by conventional approaches alone, we advocate the use of functional neuroimaging to assess suspected patients with impaired consciousness.
Cury
Rodrigo F
RF
Section of Clinical Neurophysiology, Department of Neurology, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900, CEP:14.048-900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil.
Wichert-Ana
Lauro
L
Sakamoto
Américo C
AC
Fernandes
Regina M F
RM
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D004569:Electroencephalography; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D006940:Hyperemia / Q000209:etiology*; D008297:Male; D010507:Periodicity; D019275:Radiopharmaceuticals; D013226:Status Epilepticus / Q000503:physiopathology*; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime