Dados do Trabalho

Título

Epileptic Seizures as Stroke Mimics and Chameleons: A Challenge in the Emergency Room

RESUMO

Cases: J.C.R., a 58 year-old male, was admitted with sudden onset global aphasia, without no other neurological deficits. An unprecedented focal motor onset seizure, with secondary generalization, was witnessed at home. After admission to the emergency room, he underwent a cranial tomography, which didn’t show ischemic or hemorrhagic lesions. Intravenous thrombolysis was performed. After 24 hours, a new tomography still showed no signs of acute ischemic stroke. The patient remained with isolated aphasia and no new seizures were witnessed. An electroencephalogram showed a periodic pattern between 1-1,5 Hertz compatible with continuum interictal-ictal. He completely recovered from his language deficit with antiseizure medication.
T.M.B.S., a 39 year-old female, was admitted with a history of unprecedented tonic-clonic generalized seizure with subsequent transient left hemiparesis, which lasted about 1 hour, and completely remitted. Initial cranial tomography didn’t show any alterations and she was sent back to her original healthcare service for observation. She returned, 48 hours later, with left hemiparesis and dysarthria. A new tomography showed a subacute ischemic lesion in the territory of the right middle cerebral artery.
Discussion: This poster reports two cases of relevance for the study of acute ischemic stroke and epilepsy. The presence of unprecedented seizures with focal neurologic deficits may cause diagnostic doubt, as well as in the indication of thrombolytic therapy. In the first case, the symptom of aphasia in a patient who was actually in non-convulsive status epilepticus mimicked an actue ischemic stroke. The diagnosis of a “Stroke Mimic” was only made later, with the result of the electroencephalogram. In the second case, a young woman had a transient ischemic attack that was mistaken for Todd’s paralysis after a generalized seizure. 48 hours later, her case was found to be a “Stroke Chameleon”.
Final comments: Stroke mimics and chameleons represent a great challenge in every-day neurological practice. Approximately 5% of ischemic strokes present with seizures. Therefore, it is reasonable to proceed with thrombolytic therapy, in theses cases, if evidence suggests that residual impairment is secondary to stroke and not postictal phenomenon. Current evidence shows that, when in doubt about a stroke mimic, intravenous thrombolysis should not be delayed, because the risk of symptomatic intracranial hemorrhage, in these cases, is quite low.

Palavras Chave

Stroke; Seizure; Mimic; Chameleon; Epilepsy