Posterior Reversible Encephalopathy Syndrome

Background: The presentation of posterior reversible encephalopathy syndrome (PRES) features neuropsychiatric symptoms in the context of predominantly white matter cerebral edema in the setting of a diverse variety of underlying clinical entities. Objective: To illustrate the presentation and diagnostic strategy for this under-recognized condition. Method: We present two cases of PRES and review the available literature. Results: PRES may be due to a number of underlying conditions, but typically presents with symptoms consistent with delirium. Conclusions: Psychiatrist practicing in the general hospital should be aware of the presentation and appropriate work-up of PRES to forestall serious potential sequelae

Transient Coma Due to Epidural Anesthesia: the Role of Loss of Sensory Input

Objective: Unknown ethiology Background: Epidural anesthesia is the most commonly used method of pain relief during labor in the USA. It is not classically associated with alterations in level of alertness. Coma during the procedure is rare, with a reported incidence of 0.1€“0.3%. Case Report: An otherwise healthy patient experienced almost complete loss of brainstem function following routine epidural anesthesia during delivery. The episode lasted for less than 3 hours and the patient made a full recovery. To our knowledge, this is the most detailed clinical observation to date of this condition. Conclusions: Clinicians should be aware of this rare and potentially serious complication of epidural anesthesia. The case highlights the need for sensory input to maintain alertness through the activity of the ascending reticular activating system

Outcomes After Hemispherectomy in Adult Patients With Intractable Epilepsy: Institutional Experience and Systematic Review of the Literature

OBJECTIVE: Hemispherectomy is a surgical technique that is established as a standard treatment in appropriately selected patients with drug-resistant epilepsy. It has proven to be successful in pediatric patients with unilateral hemispheric lesions but is underutilized in adults. This study retrospectively evaluated the clinical outcomes after hemispherectomy in adult patients with refractory epilepsy. METHODS: This study examined 6 cases of hemispherectomy in adult patients at Barrow Neurological Institute. In addition, all case series of hemispherectomy in adult patients were identified through a literature review using MEDLINE and PubMed. Case series of patients older than 18 years were included; reports of patients without clear follow-up duration or method of validated seizure outcome quantification were excluded. Seizure outcome was based on the Engel classification. RESULTS: A total of 90 cases of adult hemispherectomy were identified, including 6 newly added by Barrow Neurological Institute. Sixty-five patients underwent functional hemispherectomy; 25 patients had anatomical hemispherectomy. Length of follow-up ranged from 9 to 456 months. Seizure freedom was achieved in 80% of patients. The overall morbidity rate was low, with 9 patients (10%) having new or additional postoperative speech or language dysfunction, and 19 patients (21%) reporting some worsening of hemiparesis. No patients lost ambulatory or significant functional ability, and 2 patients had objective ambulatory improvement. Among the 41 patients who underwent additional formal neuropsychological testing postoperatively, overall stability or improvement was seen. CONCLUSIONS: Hemispherectomy is a valuable surgical tool for properly selected adult patients with pre-existing hemiparesis and intractable epilepsy. In published cases, as well as in this series, the procedure has overall been well tolerated without significant morbidity, and the majority of patients have been rendered free of seizures

Acute Transient Cortical Blindness Due to Seizure Following Cerebral Angiography

Objective Transient cortical blindness (TCB) is reported as a rare complication of coronary and cerebral angiography. Angiography of the vertebral arteries carries the highest incidence of causing TCB. The etiology of this phenomenon is unknown. Clinical presentation A 42-year-old woman underwent treatment for an enlarging pseudoaneurysm of her vertebral artery. The patient had a brief complex seizure during angiography. Following the procedure, she experienced TCB. During this time, an electroencephalogram (EEG) showed seizure activity. This case represents the first recorded instance of abnormal EEG during angiography-associated TCB. Intervention The patient was immediately given intravenous lorazepam and phenytoin sodium. Her EEG returned to normal in the ensuing hours and subsequently her vision returned to normal. Conclusion We present the first reported case of abnormal EEG activity during angiography-associated TCB. We hypothesize that seizure activity is a possible underlying cause of angiography-induced TCB