The role of EEG and neuroimaging in the diagnosis of non-convulsive status epilepticus in Subacute Encephalopathy with Seizures in Alcoholics (SESA syndrome): a case report and overview of the literature.

Autor: Biassoni E; Department of Neuroscience, Neurorehabilitation, Ophthalmology, Genetics, and Mother and Child Health (DINOGMI), University of Genoa, Genoa, Italy., Bellucci M; Department of Neuroscience, Neurorehabilitation, Ophthalmology, Genetics, and Mother and Child Health (DINOGMI), University of Genoa, Genoa, Italy., Micalizzi E; Neurophysiology Unit and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. elisa.micalizzi@hsanmartino.it.; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy. elisa.micalizzi@hsanmartino.it., Miggino M; HBP and Liver Transplant Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Andorno E; HBP and Liver Transplant Surgery Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Porcile E; Postoperative Intensive Care Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Resaz M; Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Roccatagliata L; Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy., Castellan L; Neuroradiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Villani F; Neurophysiology Unit and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy., Ferrari A; Neurophysiology Unit and Epilepsy Center, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Jazyk: angličtina
Zdroj: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology [Neurol Sci] 2024 Oct; Vol. 45 (10), pp. 5053-5062. Date of Electronic Publication: 2024 May 27.
DOI: 10.1007/s10072-024-07609-2
Abstrakt: Epileptic seizures are frequently associated with liver dysfunction and alcoholism. Subacute encephalopathy with seizures in chronic alcoholics (SESA) is an underrecognized condition with peculiar clinical, EEG and neuroradiological features.We report the case of a 58-year-old man with previous alcohol use disorder (AUD) and acute-on chronic liver failure on alcohol-related cirrhosis, referred for urgent Orthotopic Liver Transplantation evaluation. The patient presented with delirium, aphasia and progressive deterioration of consciousness leading to intensive care unit admission. EEG showed slow activity with superimposed lateralized periodic discharges (LPDs) over the left temporo-occipital regions and ictal discharges with focal motor phenomena, consistent with focal status epilepticus. Antiseizure treatment with lacosamide and levetiracetam was administered with progressive improvement of consciousness.Brain MRI disclosed T2/FLAIR areas of hyperintensity in the left pulvinar and T2/FLAIR hyperintensity with corresponding DWI hyperintensity in the left hippocampal cortex, suggestive of post/peri-ictal excitotoxic changes with anatomical correspondence to focal LPDs distribution. SWI demonstrated decreased prominence of cortical veins in the left temporo-occipital region consistent with increased venous blood oxygenation in compensatory hyperperfusion.In conclusion, SESA should be suspected in the differential diagnosis of patients with AUD presenting with focal neurological deficits, seizures and focal EEG abnormalities. In this context, EEG and brain MRI represent useful tools with both diagnostic and prognostic value.
(© 2024. Fondazione Società Italiana di Neurologia.)
Databáze: MEDLINE
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