Status epilepticus amauroticus revisited: ictal and peri-ictal homonymous hemianopsia.
OBJECTIVE
To describe the clinical, electrographic, and radiographic features of status epilepticus amauroticus, or homonymous hemianopsia associated with partial status epilepticus, in 3 patients w:h subsequent resolution of radiographic abnormalities and visual deficits.


METHODS
Case series.


METHODS
Rancho Los Amigos National Rehabilitation Center in Downey, California, and the Los Angeles County + University of Southern California Medical Center.


METHODS
One patient with a single remote seizure and 2 patients with symptomatic partial epilepsy all presented with homonymous hemianopsia.


METHODS
Continuous electroencephalographic monitoring, magnetic resonance imaging, and antiepileptic medical therapy for status epilepticus.


METHODS
Neurologic examination, electroencephalography, and magnetic resonance imaging.


RESULTS
The association of homonymous hemianopsia and restricted diffusion on magnetic resonance imaging led to an initial diagnosis of ischemic infarction in 2 cases despite atypical diffusion-weighted imaging patterns. However, continuous electroencephalogram demonstrated focal epileptiform discharges in 2 cases and repetitive focal seizures in another, suggesting a diagnosis of status epilepticus amauroticus. Homonymous hemianopsia resolved in all 3 patients after escalation of the dosage of anticonvulsant therapy. Follow-up magnetic resonance imaging and electroencephalogram demonstrated complete or near-complete resolution of associated abnormalities.


CONCLUSIONS
Status epilepticus amauroticus is an uncommon but important cause of homonymous hemianopsia, and it should be considered in any patient with a history of seizures, fluctuating visual symptoms, or atypical patterns of restricted diffusion involving the occipital cortex. Continuous electroencephalographic monitoring is an important diagnostic tool for the diagnosis of status epilepticus amauroticus, which may have a favorable prognosis when treated with aggressive anticonvulsant therapy.
Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242, USA. millett@usc.edu
Susan
S
Shaw
Paul
P
Kim
David
D
Millett
D000328:Adult; D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging; D004569:Electroencephalography; D005500:Follow-Up Studies; D006423:Hemianopsia / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D013226:Status Epilepticus / Q000150:complications* / Q000473:pathology