Generalised myoclonus evolving into epilepsia partialis continua due to a cingulate gyrus lesion: case report and review of the literature.
A young Chinese male was admitted for a generalised tonic-clonic seizure preceded by a week-long history of fever. Subsequently, he developed continuous myoclonic jerks in all four limbs, with clear left sided predominance, and no accompanying clouding of consciousness. Contrast MRI of the brain demonstrated a venous angioma in the right cingulate gyrus. Over the next few days, the clinical picture evolved, with focal motor status involving primarily the left lower limb and the abdomen. These movements resolved with anticonvulsant therapy. This case illustrates generalised myoclonus arising from a focal brain abnormality. The epileptiform aetiology became obvious only after evolution into the typical features of a focal motor seizure and supportive neuroimaging. This demonstrates the protean manifestations of epileptic seizures which have been ascribed to the cingulate gyrus. The lack of clear declarative clinical and EEG features highlights the melding of the fields of epileptology and movement disorders.
Division of Neurology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
Erle C H
EC
Lim
June J H
JJ
Tan
Benjamin K C
BK
Ong
Einar P V
EP
Wilder-Smith
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology*; D004569:Electroencephalography; D017036:Epilepsia Partialis Continua / Q000188:drug therapy / Q000209:etiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D006179:Gyrus Cinguli / Q000473:pathology*; D006391:Hemangioma / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009207:Myoclonus / Q000150:complications* / Q000188:drug therapy
D000927:Anticonvulsants