Spike-wave stupor in a patient with metabolic disorder.
We report a 79-year-old woman with a decreased level of consciousness. Investigation revealed an elevated serum ammonia and a portal-systemic shunt on angiography. Thus, her symptoms were thought to be due to metabolic encephalopathy. Her electroencephalogram (EEG) showed bilaterally synchronous runs of three-phase waves consistent with the triphasic waves typically seen in metabolic encephalopathy. However, after intravenous administration of diazepam, the EEG abnormalities improved; indicating that her decreased consciousness was of epileptic etiology, consistent with spike-wave stupor. Therefore, even in the presence of a clearly defined metabolic disorder, triphasic waves on the EEG may not be due to metabolic encephalopathy; they may reflect an epileptic state precipitated by the metabolic disorder.
Momoo
Takayuki
T
Department of Neurology, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka 254-8502, Kanagawa, Japan.
Johkura
Ken
K
Kuroiwa
Yoshiyuki
Y
D000368:Aged; D001928:Brain Diseases, Metabolic / Q000150:complications* / Q000188:drug therapy; D003128:Coma / Q000188:drug therapy / Q000209:etiology*; D003975:Diazepam / Q000627:therapeutic use; D004569:Electroencephalography; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008642:Mesenteric Veins / Q000002:abnormalities; D000644:Quaternary Ammonium Compounds / Q000097:blood; D012082:Renal Veins / Q000002:abnormalities
D006993:Hypnotics and Sedatives; D000644:Quaternary Ammonium Compounds; D003975:Diazepam