title: Severe and prolonged ictal paresis in an elderly patient.
abstract: We report an 84-year-old female who showed a rare manifestation of epilepsy, ictal paresis, a type of simple partial seizure presenting with focal motor dysfunction. While the patient exhibited severe left hemiplegia which lasted for a week, cranial diffusion-weighted MRI demonstrated slightly high intensity in the right posterior quadrant, and electroencephalography (EEG) showed continuous epileptiform discharges located mainly in the right parieto-occipital area, strongly suggesting that the patient was in an ictal state. (99m)Tc-hexamethylpropylene amine oxime-single photon emission computed tomography (HMPAO-SPECT) showed markedly high blood perfusion in the right parieto-temporo-occipital areas. Considering the distribution of EEG epileptiform activities and HMPAO-SPECT hyperperfusion, it is most likely that the ictal paresis of our patient was associated with epileptic activities at the sensorimotor area which caused either direct or indirect activation of an inhibitory system. Careful clinical consideration of the possibility of ictal paresis is needed in elderly patients, especially in those with preexisting dementia, because paresis can be as severe as complete flaccid hemiplegia and can last as long as for a week.
authors: Department of Neurology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan ; Department of Neurology, Utano National Hospital, National Hospital Organization, 8 Ondoyama-Cho, Narutaki, Ukyoku, Kyoto 616-8255, Japan.
authors: Miki
authors: M
authors: Oono
authors: Department of Neurology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors: Hisakazu
authors: H
authors: Uno
authors: Department of Neurology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors: Arisa
authors: A
authors: Umesaki
authors: Department of Neurology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors: Kazuyuki
authors: K
authors: Nagatsuka
authors: Department of Neurology, Utano National Hospital, National Hospital Organization, 8 Ondoyama-Cho, Narutaki, Ukyoku, Kyoto 616-8255, Japan.
authors: Masako
authors: M
authors: Kinoshita
authors: Department of Neurology, Senri Chuo Hospital, 1-4-3 Shinsenri-higashi-machi, Toyonaka, Osaka 560-0082, Japan.
authors: Hiroaki
authors: H
authors: Naritomi
keywords: Dementia; Electrographic seizure pattern; Hyperperfusion; Ictal paresis; Inhibitory motor seizures